Monday, November 28, 2005
An Argument about Universal Health Care
In this blog I identify myself as an opinionated old Democrat. I use the word “old” both in a literal meaning, as I am now part way through my ninth decade of life, and to distinguish myself from “new” Democrats, such as the Democratic Leadership Council (or is it “conference?) or DLC. The DLC members argue that the Democratic Party must adopt “new” positions relating to welfare, labor, social security, taxes, budget deficits, and all the rest in order to attract independent voters away from the Republican Party. They argue that the Democratic Party doesn’t have any “new” ideas. They seem to concede that “new” ideas these days are the exclusive property of the Republican Party.
Well, that may be true. However, the Democratic Party has a lot of good “old” ideas that haven’t yet been tried. One of them is the idea that universal health care is a public good, something that would be of great benefit to everyone, whether sick or healthy. I present here a summary of a running debate several of my e-friends and I have had over this issue. When I quote an argument from a friend, I will identify that person only by an initial: H, S, C, etc.
H has some objections to universal health care (UHC). Here is a summary of some of them:
1. If UHC is “free” or paid for by government out of taxes, there are some who will take advantage of it. Hypochondriacs will overuse the system and make it very expensive.
2. Since there aren’t enough doctors and other health care providers, care will have to be rationed. Medical procedures will have to be denied or postponed. Canada has a system of UHC, but there are (said to be) waiting periods of several months for many kinds of surgery.
3. In addition to rationing, there will be certain procedures that the system can’t provide at all because of the expense. Some Canadians have to come to the United States for such procedures as heart transplants.
4. I ask you, Al and S and C and others, whether you want your tax dollars spent to take care of some individual who has ruined his liver or lungs by excessive drinking or smoking and provide that person an expensive organ transplant? You yourselves have been careful not to smoke or drink to excess. You would therefore be taxed for your abstinence.
At one time I wrote H a rather tart and unkind message:
Dear H:
Your continual argument against any form of UHC provided by society (e.g., government) seems to be of the following form: "I've got very good health care. Let those who can afford it have the best. Too bad about everyone else."
H responded as follows:
(1) You think because I think something would be thus or thus that I am for or against something. This is a Dem faulty thinking. I would be happy for everyone to have UHC. I just try and study what the effects of this would be.
(2) I say if we give all medical care the care will be substandard. I am not sure I can prove it right now. Those on Kaiser HMO are not getting the best care, they just don't have others to compare it with.
(3) Providing health insurance is a big problem. It may not be their major problem though, I think the unfunded retirement liability is looming large now and will be worse.
My comment:
Your comment (1) is that you would be happy if everyone had UHC. However, in (2) you say that the care provided under UHC would be substandard. In (3) you say that we can't afford it.
H: You don't understand my logic and I am not sure I can make you understand. But, before I attempt to answer please tell me what you mean by UHC? Does this mean everyone in the US has the same full coverage paid by taxes? Or, some graduation (i.e., some GOV help…) of coverage based on ability to pay say a sliding scale of 0 to 100% ability to pay (this still would be UHC).
This would be the money side of it, then there is the availability and compensation for the medical industry and doctors. All these things and more have to be considered.
Here is an interesting exchange between H and S:
H: Most experts say Medicare is going to be much more of a expense problem than SS. Why would you want taxes to pay for those who can afford their own plans?
S: I volunteer at (the local) High School. Those students miss a lot of classes due to sickness. I am already paying taxes for school. Most likely, very few have health. Answer Yes
H: You can afford Cigna Traditional. Since Medicare pays 80 % you, like me are already on the dole somewhat. But you can afford your part. This means you can go anywhere and get the care which is the most advanced.
H: True.
H: HMOs do not have the most modern care. Those on HMOs just do not know it. If there is a better way and it is not available in the HMO net you are out of luck. The HMO people will not even let you know there is something better elsewhere.
S: True but they have a profit motive.
H: HMO allows the more people to get care for less. In someway this is probably what will be available if they ever get Universal Health Care. We someday may have UHC but don't kid yourself that you will be getting the best care.
S: True but it will be available to more people especially children.
H: Have you done research on UHC in other countries? Those I have talked to who have lived in England and here say our our health care is much better.
S: I was in Canada this summer and two friends of mine are from England. One went back to England because he could not get the care he needed and could not afford it. The other friend is one that I often socialize with. He as a sever lung problem. (pulmonary hypertension) The only real cure is a lung transplant. His cousin is a doctor in England and informed him that he most likely would get one quicker in England. So far he lives on a soup of medications and oxygen. He has some money and for now is willing to stay and hope for relief through our medical system. He sees doctors at UCLA.
H: Al said if he got less than the best care but everyone had UHC that that would be OK with him. Let me add for Al that means you won't live as long.
S: Longevity depends mostly on your genetic makeup and lifestyle. Mental outlook also plays a big part too. Don't you think Al is thinking compassionately?
H: I will ask you the same question, would you accept a sub (compared to the best) health care so everyone had some health care?
S: Fortunately, I do not have to make that sacrifice. I recently got my flu shot. I feel I must have it to tutor sick students. I do it because of my lung problems and to be able to continue working with the kids. If it met that all my students and others were to do better in school, be better prepared for the future and have more income, Yes. You might read my "A Democrat raising Hell" e-mail and better appreciate my opinion. Reference: Scientific American.
H: I suspect places that have UHC piggy back on our research.
S: Questionable? I now take a new inhaler. It is called Spiriva. It just became available in this country six months ago. The doctor estimated that it would increase my lung capacity by 15%. After Thanksgiving, I am scheduled for a capacity test. My estimate is that this estimate will easily be accomplished. It has been available in Europe for some time. Furthermore, my wife's hip replacement was available earlier in Europe then this country. Others having UHC might piggy back on our research but make use long before we start. This gives their medical companies a jump on us. This also includes stem cell research. I guess they might do the testing but their doctors see the results or failures first.
Finally, my own latest word in this debate:
Dear H (and others):
To me UHC means that everyone receives as a public benefit the same level of health care. Of course, if an individual has the money, he can pay for more expensive treatments. I recognize that there isn't enough money in our economy to provide everyone with his own kidney dialysis machine, with his own mechanical heart, heart transplants, liver transplants, etc. UHC would be something constructed by us humans and would not be perfect. Only God (assuming He exists) can create something that is perfect. My argument in favor of UHC is that there are many people in our society who do not get any health care at all except what they can get free at an emergency room. There are so many of these indigent people that they are straining our existing health care system to shreds. Our existing system, based on buying services from doctors and other medical people and paying for the services, is breaking down. Only a small portion of the population is affluent enough today to forego all forms of health insurance and simply pay the doctor and the hospital out of their income and savings when they have a medical problem. It is to our advantage to provide a reasonable level of health care to everyone, because the poor now can spread dangerous diseases (SARS, bird flu, small pox, clap, TB, syphilis, AIDS, etc.) because they are not treated. It is better to provide the treatment than to take a chance on epidemics. Therefore, UHC should be paid for out of taxes on everyone. That is, a portion of my income tax money should be devoted to providing health care for some poor illegal immigrant who might otherwise spread his disease.
I grant all the objections you raise. UHC can not be perfect. There will always be better and more thorough health care for the very rich than for the rest of us. However, providing everyone with a suitable standard of health care would be beneficial to everyone, not merely in preventing the spread of epidemics but in reducing lost work time due to illnesses.
In order for the public to understand and accept it, UHC has to be simple in concept. The Canadians have a system that is easy to understand. Everyone pays what he is able through taxes and co-payments. Everyone is taken care of. Expensive or rare treatments may be postponed or even denied. These expensive and rare treatments are not generally available to most of us under our present system either, so what's the objection?
Well, that may be true. However, the Democratic Party has a lot of good “old” ideas that haven’t yet been tried. One of them is the idea that universal health care is a public good, something that would be of great benefit to everyone, whether sick or healthy. I present here a summary of a running debate several of my e-friends and I have had over this issue. When I quote an argument from a friend, I will identify that person only by an initial: H, S, C, etc.
H has some objections to universal health care (UHC). Here is a summary of some of them:
1. If UHC is “free” or paid for by government out of taxes, there are some who will take advantage of it. Hypochondriacs will overuse the system and make it very expensive.
2. Since there aren’t enough doctors and other health care providers, care will have to be rationed. Medical procedures will have to be denied or postponed. Canada has a system of UHC, but there are (said to be) waiting periods of several months for many kinds of surgery.
3. In addition to rationing, there will be certain procedures that the system can’t provide at all because of the expense. Some Canadians have to come to the United States for such procedures as heart transplants.
4. I ask you, Al and S and C and others, whether you want your tax dollars spent to take care of some individual who has ruined his liver or lungs by excessive drinking or smoking and provide that person an expensive organ transplant? You yourselves have been careful not to smoke or drink to excess. You would therefore be taxed for your abstinence.
At one time I wrote H a rather tart and unkind message:
Dear H:
Your continual argument against any form of UHC provided by society (e.g., government) seems to be of the following form: "I've got very good health care. Let those who can afford it have the best. Too bad about everyone else."
H responded as follows:
(1) You think because I think something would be thus or thus that I am for or against something. This is a Dem faulty thinking. I would be happy for everyone to have UHC. I just try and study what the effects of this would be.
(2) I say if we give all medical care the care will be substandard. I am not sure I can prove it right now. Those on Kaiser HMO are not getting the best care, they just don't have others to compare it with.
(3) Providing health insurance is a big problem. It may not be their major problem though, I think the unfunded retirement liability is looming large now and will be worse.
My comment:
Your comment (1) is that you would be happy if everyone had UHC. However, in (2) you say that the care provided under UHC would be substandard. In (3) you say that we can't afford it.
H: You don't understand my logic and I am not sure I can make you understand. But, before I attempt to answer please tell me what you mean by UHC? Does this mean everyone in the US has the same full coverage paid by taxes? Or, some graduation (i.e., some GOV help…) of coverage based on ability to pay say a sliding scale of 0 to 100% ability to pay (this still would be UHC).
This would be the money side of it, then there is the availability and compensation for the medical industry and doctors. All these things and more have to be considered.
Here is an interesting exchange between H and S:
H: Most experts say Medicare is going to be much more of a expense problem than SS. Why would you want taxes to pay for those who can afford their own plans?
S: I volunteer at (the local) High School. Those students miss a lot of classes due to sickness. I am already paying taxes for school. Most likely, very few have health. Answer Yes
H: You can afford Cigna Traditional. Since Medicare pays 80 % you, like me are already on the dole somewhat. But you can afford your part. This means you can go anywhere and get the care which is the most advanced.
H: True.
H: HMOs do not have the most modern care. Those on HMOs just do not know it. If there is a better way and it is not available in the HMO net you are out of luck. The HMO people will not even let you know there is something better elsewhere.
S: True but they have a profit motive.
H: HMO allows the more people to get care for less. In someway this is probably what will be available if they ever get Universal Health Care. We someday may have UHC but don't kid yourself that you will be getting the best care.
S: True but it will be available to more people especially children.
H: Have you done research on UHC in other countries? Those I have talked to who have lived in England and here say our our health care is much better.
S: I was in Canada this summer and two friends of mine are from England. One went back to England because he could not get the care he needed and could not afford it. The other friend is one that I often socialize with. He as a sever lung problem. (pulmonary hypertension) The only real cure is a lung transplant. His cousin is a doctor in England and informed him that he most likely would get one quicker in England. So far he lives on a soup of medications and oxygen. He has some money and for now is willing to stay and hope for relief through our medical system. He sees doctors at UCLA.
H: Al said if he got less than the best care but everyone had UHC that that would be OK with him. Let me add for Al that means you won't live as long.
S: Longevity depends mostly on your genetic makeup and lifestyle. Mental outlook also plays a big part too. Don't you think Al is thinking compassionately?
H: I will ask you the same question, would you accept a sub (compared to the best) health care so everyone had some health care?
S: Fortunately, I do not have to make that sacrifice. I recently got my flu shot. I feel I must have it to tutor sick students. I do it because of my lung problems and to be able to continue working with the kids. If it met that all my students and others were to do better in school, be better prepared for the future and have more income, Yes. You might read my "A Democrat raising Hell" e-mail and better appreciate my opinion. Reference: Scientific American.
H: I suspect places that have UHC piggy back on our research.
S: Questionable? I now take a new inhaler. It is called Spiriva. It just became available in this country six months ago. The doctor estimated that it would increase my lung capacity by 15%. After Thanksgiving, I am scheduled for a capacity test. My estimate is that this estimate will easily be accomplished. It has been available in Europe for some time. Furthermore, my wife's hip replacement was available earlier in Europe then this country. Others having UHC might piggy back on our research but make use long before we start. This gives their medical companies a jump on us. This also includes stem cell research. I guess they might do the testing but their doctors see the results or failures first.
Finally, my own latest word in this debate:
Dear H (and others):
To me UHC means that everyone receives as a public benefit the same level of health care. Of course, if an individual has the money, he can pay for more expensive treatments. I recognize that there isn't enough money in our economy to provide everyone with his own kidney dialysis machine, with his own mechanical heart, heart transplants, liver transplants, etc. UHC would be something constructed by us humans and would not be perfect. Only God (assuming He exists) can create something that is perfect. My argument in favor of UHC is that there are many people in our society who do not get any health care at all except what they can get free at an emergency room. There are so many of these indigent people that they are straining our existing health care system to shreds. Our existing system, based on buying services from doctors and other medical people and paying for the services, is breaking down. Only a small portion of the population is affluent enough today to forego all forms of health insurance and simply pay the doctor and the hospital out of their income and savings when they have a medical problem. It is to our advantage to provide a reasonable level of health care to everyone, because the poor now can spread dangerous diseases (SARS, bird flu, small pox, clap, TB, syphilis, AIDS, etc.) because they are not treated. It is better to provide the treatment than to take a chance on epidemics. Therefore, UHC should be paid for out of taxes on everyone. That is, a portion of my income tax money should be devoted to providing health care for some poor illegal immigrant who might otherwise spread his disease.
I grant all the objections you raise. UHC can not be perfect. There will always be better and more thorough health care for the very rich than for the rest of us. However, providing everyone with a suitable standard of health care would be beneficial to everyone, not merely in preventing the spread of epidemics but in reducing lost work time due to illnesses.
In order for the public to understand and accept it, UHC has to be simple in concept. The Canadians have a system that is easy to understand. Everyone pays what he is able through taxes and co-payments. Everyone is taken care of. Expensive or rare treatments may be postponed or even denied. These expensive and rare treatments are not generally available to most of us under our present system either, so what's the objection?
