Sunday, October 5, 2008

Laodicean health care

Having as much time as I do, I listen to podcasts constantly. Quickly depleting my old wave of standbys, I recently found a podcast of the Intelligence Squared debates and have been working my way through their archives. In much the same what that you will hear a newly-learned word a half dozen times in the week after you learned it, the subject of health care policy kept popping up this week after I listened to the debate on this subject.

I promise that I am not going to turn my blog into a forum for me to continue my days of college debate. As much as I miss debating, an activity where I could be unnecessarily mean to nice kids from Colorado and could argue passionately about meaningless platitudes or policy decisions that would never possibly be considered, it too often devolved into a pedantic exercise in defining terms or nit-picking the rules of debate. Instead of trying to have a debate with all of you, I wanted to point out a few things about health care in America that are somehow missing from the national debate. I'm not trying to indoctrinate anyone to my particular view--you'll see that I am still very torn on the issue myself--but rather to raise the level of dialogue beyond what can easily be found in the popular media.

Do you realize that we already have socialized medicine in America? In most debates about what America can do about their health care system, the socialists line up against the capitalists to debate whether America should switch to a one-payer system or whether we should keep the market-based system that we have now. Individual anecdotes are then traded ad nauseam about the beauties or horrors of either system.

In actual fact, U.S. law prevents hospitals from refusing basic care to anyone who shows up at at an emergency room. This prohibition means that emergency rooms nationwide have turned into the primary care facilities of everyone who can't afford normal health care. This continues until the emergency room goes out of business (someday the national government will learn the same lesson: you can't keep on spending without taking anything in before you eventually become insolvent). After a hospital goes bust, the government steps in to shore up the hospital's finances if it decides that that hospital is necessary for the public health of that area.

My point is simply that we should stop pretending that nationalized health care would be such a departure from where we are right now. Either we should have the resolve to be capitalists, shooing the poor out of our hospitals to die of their gunshot wounds, diabetes, and emphysema (I mean really, they should have moved out of the ghetto if they didn't want to get shot), or we should simply embrace the fact that we're going to pay for them anyway and try and find the cheapest way possible to do it.

While I'm talking about uncomfortable issues, I should probably mention rationing. No one is so naive as to believe that we can give away MRIs, chemotherapy, and AZT for free and still have enough for everybody. The classic argument against nationalized health care is that the rest of the developed world--all of whom have a one-payer system--has long lines (I guess they would be queues, since they're in Britain) for specialized care. The rich, as well as the poor, have to wait for months to get treatment for diseases such as lung cancer; many of them die as a result because the most important factor in surviving such diseases is how soon you start treatment. Clearly, rich Americans, the ones who directly or indirectly end up paying for most of the medical costs in this country, are not going to stand idly by while a poor person gets life-saving treatment instead of them. Most of you would probably chaff at the thought too; how many of us are really so charitable that we would give our lives so that a poor person can get top-rate care (on our dime)?

In closing, I just want to point out that health care in America could probably be better. We spend more than any country in the world yet we have, by many measures, a system which is wildly inefficient and ineffective. We have neither a free-market system nor a universal one. If the government is unable to reform health care in any meaningful way, might I recommend that you do what I do--lie to BYU about having health insurance, put away the money saved by not having insurance, and then blow your entire bank account by traveling to Europe if you don't get sick.

P.S.-if any of you are religious, please pray for me that I don't get a horrible disease that isn't covered by my cut-rate insurance; you'd end up paying for it anyway after I declare bankruptcy, so I suppose it's already in your best interest.

1 comment:

Carl said...

Uh, I feel indoctrinated now. Can I go home. Great post. Totally agree. Don't like the current system, but have been to enough European doctors to jump on board the socialized health care bandwagon. It's been a while since I read about it, but I do remember thinking while I read it, that Romney had made a good move on health care in Mmaassaacchhuusseettss (couldn't remember how to spell so all letters got doubled). It seemed like a move towards social healthcare in a capital system. I believe he was taking the money the government was spending on the healthcare (like you talked about), and putting towards giving everybody coverage. Of course, now I'm going to have to go back and read it and see what he really did. I do think a middle of the line solution is best here though. What do you think is the solution, since you obviously think it's broken (wasn't it angela that always said don't criticize without offering a solution)?