Last week’s topic, Abortions for Earth?, sparked some great commentary, thanks to everyone who joined in! Andrea Zak of Schizofrenetic started a lively debate on her site, and my post was carried on BrazenCareerist. The conversation will continue until we all run out of steam I suppose, so feel free to join in.
This week I turn to Universal Health Care, an oft-battled issue at BrazenCareerist. In fact, just yesterday Vanessa Mason of Subject to Change offered a well-written piece on the topic. I've offered plenty of my ideas there so I wanted to delve into a different aspect of the arguement here.
Like a bunch of pedigreed doctors on a House episode, the ideas about how to cure this ailing system fly in the comments section, getting pretty heated at times. "Sarcoidosis!" "No, you're wrong, it's simple dyspepsia!" "No, you're all wrong - it's a tumor."
So, what exactly is wrong with America's health care system? It is indeed broken, but why, and how did it get that way? I think that when we can look at how things went wrong, we are able to correctly administer the medicine that will heal it. There are myriad problems, so I thought I'd highlight one of the most glaring.
It all starts in World War II with changes to the tax code. The federal government allowed tax breaks to businesses providing health care to their employees, which appears magnanimous, right? Always looking to profit, employers figured out they could effectively pay their employees less by offering the same value in dollars by adding health care. For example, if a company got a 35% tax break for offering the benefit, then $0.35 of every dollar of pay corresponding to a health care benefit could be tax-deductible. Yippee! "Big business" wins big time, so more and more businesses took advantage of the tax advantage.
If we fast-forward to today, we realize that roughly 60%* of Americans are now provided employer-based health care. As a result there is a sort of blindness that occurs in the payment and pricing of health care costs and reimbursement. Think about it. If you have the luxury of being covered by your employer's health plan, do you even look at your total bill? If you do, do you flinch when you see it? No, because you probably have a much smaller percentage or co-pay than the total figure meaning you aren't discriminating about costs of services or how necessary they are.
While I'm the sort of person who avoids the doctor as long as possible and only go when needed, I know many people who skip off to the emergency room at the first sign of heartburn. Because a third party foots the bill, they don't care about the cost, using more care than they actually need. (Not to be confused with my thinking they shouldn't have the choice to go to the doctor every other monday if they want, that is not my point.) However, this system is driving up costs for everyone else and leaving those who cannot afford private health care eating their dust.
This "third-party" system is a foolproof way to jack up prices and keep the poor from getting care they need. Similarly, Medicare and Medicaid which covers roughly 27%* of Americans creates the same (normal) human reaction.
In response to increased demand for services, the third parties (the government and employers) respond in kind, by managing supply the way they see fit. That could include reducing the available options to choose from, coding certain procedures as unecessary, or outright refusal of coverage. This means people won't get the care they need.
Why would anyone think universal health care would be any different? Will increasing the role of the third party's decision-making provide additional choice, freedom, and lower costs? Will universal health care really be "free"?
The answer is that universal health care will only result in a deepening of the current problems and a degradation of care. If we think choices and costs are dismal today, they will be worse in the future and anything but free.
Stay tuned for The Antidote: How to Solve the Health Care Dilemma.
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*All figures from The Cato Institute Handbook for Congress.
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