Demanding Health Care as a Right is Wrong
Even the debate over health care is not immune from commentators whose caustic, even violent rhetoric would be more at home at a third-world pit fight than in a democratic society. Witness one Dr. Kirk James Murphy, whose idea of the Hippocratic Oath is apparently limited to those he personally approves of:
The megacorps executives don’t deserve mere corporate bankruptcy: they’ve killed and maimed so many of us to deserve a fate worse than Gitmo. In a world free of human rights concerns, I’d cheerfully nominate them all – and their in house / outside legal counsel and lobbyists – for mandatory total organ donation. Though these heartless bastards don’t have anything to offer those awaiting cardiac transplant, the rest of the transplant lists could use the relief.
Doctor, please, your hatred of free enterprise is showing and it’s not pretty.
Read the rest of Murphy’s article if you feel you must. It can be summarized as follows: “Every one of my patients is entitled to free health care on demand, without regard to price, because I say so.”
It would be great if we could provide unlimited medical care to every man, woman, and child in America. It really would. But that’s unrealistic and a doctor like Murphy should know better than to get on his soap box and pretend that universal health care can be delivered without a massive transfer of wealth from the middle and upper classes to the poor and a corresponding reduction in the standard of care delivered to those who would be paying for the system.
If health care were part of the so-called “commons”, as air and water are, Murphy’s demand for universal health care would make sense. But the truth is that medical care does not exist in elemental form. Health care comes into being only through the study and labor of the best minds in America and these doctors and nurses deserve to be compensated according to the value they deliver to their patients.
This is the mechanism through which our most gifted people are attracted to the medical industry. Remove it and the result will be a reduction in the quality and supply of health care to people who need it. This has already happened in regard to Medicare patients, many of whom have to settle for substandard care because of the program’s cost restrictions and overhead.
Hoping to drum up an emotional response, Murphy hysterically cries that his patients are dying and that he could save them if we would only give him carte blanche with our health care dollars.
Unfortunately we’re all dying and it can’t be helped – it’s in our make-up. No one’s like is truly saved by medicine, only prolonged. In itself this is a noble goal and not to be diminished. But it should be recognized for what it is, a short-term, earthly solution to the real problem, which is fear of eternity.
I find it interesting that he starts the article by pointing out that his patients that are dying don’t qualify for Medicaid or Medicare, but afterward repeatedly refers to them as indigent. This follows a pattern I’ve noticed from the left: pretend we don’t live in a nation that already goes to great lengths to help the poor.
However, I disagree with you that health care, at least basic health care, is not a right. I came to that conclusion in a simple way. I imagine someone who is sick and will not get better without simple treatment, but can’t afford the treatment. Should we let him die? I’ve come to the conclusion that we should provide the treatment to save his life (and yes, I meant “save”–I think your argument that there’s no such thing as saving a life and therefore we should get used to the idea of dying is a bit rediculous–no offense). Therefore, health care is a right to some degree. But there are still plenty of gray areas to argue about–how much health care are the indigent entitled to? How do we reduce costs but maintain innovation? What about end-of-life care?
So I guess you could say I fall somewhere in the middle of you two.
I don’t believe Dr. Murphy will have a “seat at the table” when they discuss healthcare reform. As someone who works for one of those “evil megacorporation health insurance companies” I can point out an odd irony: the health insurance companies are as interested in an effective,efficient system as he is.
As I’ve said before the key issue is COST (even before coverage; higher premiums lead to fewer covered lives). We have limited resources (hey, what do you know, basic economics) and we will need to figure out how to best use those resources. Improving coverage is the “easy” part: just pass a law. Paying for it is where the heavy lifting is (see Massachusetts). And Dr. Murphy may feel that if those evil corporations went away costs wouldn’t be an issue. Unfortunately only about 7% of total health care expenditures goes to administrative costs. Eliminating ALL administrative costs would still leave us far from where we need to be. Doctors (and I’m one) and hospitals consume over 50% of our health care dollars. If we need BIG TARGETS, there they are.
The product of health insurance is to provide you with medical coverage when you need it.
Unlike other businesses that need to provide you with their product in order to make any money, health insurance companies actually make more money for themselves when they restrict and do not pay claims.
In other words, they make more money when they do NOT provide the product that you have paid them for.
Read the 50 to 70 pages of your health insurance contract.
Pay particular attention to the section entitled “limitations and exclusions”.
People’s health is not a product that needs to be left to the whims of money motivated CEO’s and stockholders.
If that is your thinking, you might as well have your police and fire department protection based on insurance premiums you pay.
Then you can go to the police and fire protection insurance page for ‘limitations and exclusions’ on whether or not the police or fire department would come out to your house in the event of an emergency.
The point is, you would never think of discriminating against another citizen if he was the victim of a fire or crime.
So why would you be ok with health insurance companies discriminating against fellow citizens who have pre-existing medical conditions?
You don’t think that single-payer health care systems have limitations and exclusions?
“In other words, they make more money when they do NOT provide the product that you have paid them for.”
True, which is why we need to make it easier to switch insurers (which means putting the ones that don’t produce a good product out of business) by getting rid of the employer based system, and also intoduce regulations on how premiums CSM br calculated and coverage provide such that insurers can’t just dump patients that aren’t profitable, which by the way would be much easier if there was a public option.
adelinesdad, according to what c3 has said in the comments to an article I wrote a couple weeks ago, insurers are just not that interested in marketing to individuals. They prefer to go for the plans that will pay big. Namely, businesses.
Also notice that among the current solutions to the healthcare problem there is nothing about plans catered to the individual. The plan most talked about these days that isn’t single-payer or the public plan is cooperatives. Even those are based on groups, not individuals.
@Michael Merritt
Yes, I’m not advocating any particular plan that is being discussed right now–just pointing out that the employer based model makes it difficult to switch insurers, which means insurers can get away with a certain amount of abuse of customers which would not be tolerated in other industries. Also, the customers that are most likely to be denied coverage are the ones that aren’t profitable for the insurance company anyway, so the insurance company doesn’t mind losing them to a public plan if their not satisfied.
You’re right, I don’t see anything in the current proposals that address those problems.
And I agree that insurers would rather market to businesses, because they’re the ones that get the tax break and have the deep pockets. If you took away the tax incentive from businesses (and gave it to individuals instead) the market would change.
Free enterprise is not a good description of the system in the US right now, what with the effective monopoly some insurance companies have in some states. The entire insurance market is detached from the reality of the customers, so the fact that there are so many shouting about “statism” and “destroying a free market” shows that this issue has become less of a matter and more of an obsession for many voices on the right. The ideological fixations on the left are duly noted as well if anyone thought otherwise, but considering how the issue of not letting the state competing unfairly with insurers is actually addressed by the democrats in congress and elsewhere, I don’t think the major obstacle to a well-made reform comes from the public proponents/democrats in general.
Kastanj, while I completely agree about the lack of market forces in our current healthcare system, I think you grossly underestimate the degree to which most conservatives also note that. When we argue against a government run healthcare system, what we are saying is that much of the current problems are due to lack of market forces, and that itself should be fixed as much as possible before resorting to a centralized beaurocratic healthcare system.
Scarcely anyone is saying that the system as it exists now is fine, and certainly no one of any note or any intelligence thinks that market forces currently operate in the way consumers purchase healthcare. What we advocate is restoring those forces as much as possible by reintroducing competition, and making the consumer more aware of the true costs of their healthcare, and allowing them to purchase private plans at the same tax advantage as their employer does, and allowing them to purchase plans across state lines- plus adding other fixes such as reduction of malpractice and defensive medicine costs through tort reform, and addressing supply issues by promoting larger number of graduates and encouraging more to practice primary care, as well as increasing supply by delegating more routine tasks to physicians assistants and nurses (whose number would also need to be increased.)
“When we argue against a government run healthcare system, what we are saying is that much of the current problems are due to lack of market forces, and that itself should be fixed as much as possible before resorting to a centralized beaurocratic healthcare system.”
but what needs to be centralized just because it’s public? It would create some sort of middleman between patient and doctor in a way, but not for all sort of procedures. Unfortunately, the result would be rationing (which is something akin to the holocaust if I’ve understood it correctly) and some state bureaucracy (which is incredibly horrible, unlike the very sensible bureaucracy the insurance companies impose on everyone). I mean, why can’t the competition be provided by the state provided the state isn’t allowed to pull strings or operate without any of the budgetary/shareholder concerns regular actors have to?
I agree with all the other matters and objectives you raised, but I must wonder if this can be accomplished without making provision for those without HC come from a public payment system. I also wonder if a more public reform would make your (our) objectives less likely to be accomplished. The one goal that seems to be in trouble is removing tax reductions for providing employers. Democrats don’t want to touch this because there are unions that have too much self-interest and the idea is not popular among voters either.
Still, it seems that there is work being done not only in trying to keep the reform below the cost of Bush’s tax cuts but also in getting the industries on board to a degree.
I mean, why can’t the competition be provided by the state provided the state isn’t allowed to pull strings or operate without any of the budgetary/shareholder concerns regular actors have to?
Because already, the moment a state provider is created, it enjoys competitive advantages that private insurers will never have. Start up capital is provided by the government, and negotiating power is greater, and if costs aren’t met through premiums it is implicit that taxes will be levied (or money shifted from other parts of the budget) to cover the deficit. Level playing field, my a$$.
Yes, the tax deductions influences decisions by both employer and employee. However, I believe the major reason for insurance companies to work with employers is man employers, especially large ones, feel they should offer health care to their employees and that they have no particular skill/expertise in administering these benefits. Insurance companies are generally paid a certain amount per employee and so they will go after companies that have many employees. It seems a pretty straightforward business proposition.
I won’t argue that to make a profit, or in the case of a non-profit insurer such as Kaiser, the insurance company must work hard to keep expenses (the majority being the insured’s health care expenditures) below revenue (the premiums the employer pays). That’s basic business budgeting. I would likewise suggest that a governmentally run program will do similar budgeting although they also have the power of legislation (i.e. you will see all patients in the ER regardless of ability to pay) and the power of taxation. But even Massachusetts has discovered those extra resources don’t guarantee universal coverage and balanced budgets.
I would suggest that your comment should have stated “Unlike other INSURANCES (i.e. life, auto) the customer is actually betting he/she WILL get sick and in fact intends to use the insurance to pay for “planned healthcare” That’s not insurance, that pre-payment, and often inadequate pre-payment. And as the insurance model is supposed to do, insurers make up for the lack of “pre-payment” by getting folks who don’t anticipate big healthcare expenditures to “pay for the sick guy”.
Among the things I find frustrating in this whole healthcare debate are: 1) the search for the “sucker” who doesn’t mind underwriting the costs of the sick 2) the reluctance to ask “how much is your health really worth to you? and what are you willing to invest in terms of money and lifestyle to make it better?” 3) the search for the “bad guy” who’s at fault for this mess. Face it, we Americans want healthcare when we want it, we want as much as we can get and we want to decide what we get without “outside influence”
c3,
I agree, and it seems you share my concern about the concept of pools, which seems to be the popular magic bullet these days. But as you point out, pools only serve as a mechanism to get healthy people to subsidize the cost of the sick. I actually think that is a good goal, but pools are the wrong way to do it because it removes any personal accountabiliy and therefore any financial incentive.
Instead, I think we should remove the incentive for employer pools (which, as you point out, would not eliminate them entirely but would balance rhe market between pools and individual plans) and then regulate insurance companies such that they charge based on behavior and not health status. It would he a challenge to implement but as far as I can see would be the best way to incentivize healthy choices while not punishing those who get sick through no fault of their own.
And in addition the government ( taxpayer) would pay for the premiums of the poor on a sliding scale, since as I said before I do believe that basic healthcare is a right and it is in the interest of us all that we all get care. But of course we’re already doing that.
I agree that incentivization (is that a word) of health behavior is hard, but not impossible (many employers do it) From an insurance perspective you have much better understanding of risk is you charge based on health status vs behavior. (i.e. I have a much better idea how much I’ll spend on someone who has chronic lung disease from smoking than from a smoker alone.) Remember, its an insurance model.
c3,
Yes, that’s the point. A smoker with lung cancer would pay the same as a smoker without lung cancer. The problem you mentioned is that health insurance does not follow the typical insurance model of risk-mitigation. Some people, such as lung cancer patients and anyone else with chronic conditions (preventable or not), are essentially uninsurable in a typical insurance model, because there is no reasonable amount of pre-payment that could make up for the expected cost. So a typical insurance model that bases premiums only on risk will not work. It punishes people (harshly) for having the nerve to get sick (even if it wasn’t preventable).
If premiums were based on behavior, the insurance company would look at two potential customers, both smokers, and they would have to consider the probability that they have or will get lung cancer. If 25% of smokers (a number I made up) have or will get lung cancer, that will be factored into the premiums for smokers such that the insurance company can still be profitable (I know, how evil of me to suggest they should still be able to make a profitJ). That way, smokers who don’t have lung cancer subsidize the cost of smokers would do have lung cancer. That seems fair to me. If you engage in risky behavior, you pay the cost of the consequences of that behavior, even if you are lucky enough to avoid them.
And you’re right that insurance companies are already doing this to some extent. I get some of my CSA reimbursed, for example. I think we should take this model further. It will take some ingenuity on the part of the private market (smoking is an easy example, it gets more difficult with less measurable/enforceable behaviors), but if we take away the easier alternative (charging based on health status) I think insurance companies would have a great motivation to make it work.
I just realized that I have a different profile depending on where I post from.
adelinesdad = Mike.
Sorry for the confusion.