Saturday, September 12, 2009


A Simpleton’s View of the Healthcare Debate

Social Security and Medicare are two very popular federal programs. I don’t recall the vote on Social Security, but I believe Medicare was enacted with only Democratic votes in Congress. Probably Social Security was too. Republicans have railed against both programs, especially Social Security, ever since they went into effect.

I’ve been trying to make some sense of the partisan divide about reforming our healthcare system. Thinking Republicans and Democrats agree that the system needs fixing. They agree that more Americans should be covered, that the cost of medical care is increasing too rapidly, and that some insurance companies do some things that ought to be forbidden. I think that they agree that everyone (except illegal aliens) should be covered in some way.

Republicans also believe that one of the main problems in the present system is that it is too easy to sue a doctor or medical provider on the basis of unfulfilled expectations. They want “tort reform.” Tort reform would make it very difficult to sue a doctor for malpractice. Republicans believe, with some justification, that most malpractice suits have no basis in fact but go to court anyway because everyone knows doctors are rich and can afford to pay for their “mistakes.” Republicans assert, again with justification, that doctors are forced to protect themselves by purchasing malpractice insurance and by practicing defensive medicine, thereby greatly increasing the total cost of health care. Some Republicans believe that simply getting rid of frivolous malpractice lawsuits would to a great deal to rein in the rapid increase in the cost of medical care.

Democrats believe, in addition to those beliefs that they share with Republicans, that the biggest problem in American healthcare is the strong influence of insurance companies that provide health insurance. These firms, in order to stay in business and make a profit, have to be careful not to insure persons that are going to have very expensive health problems, just as firms selling auto insurance try not to sell policies to reckless drivers. Some of the practices of health insurance companies include dropping policy holders who develop expensive illnesses or other medical problems after having been insured for a number of years. Insurance firms are not motivated to reduce the actual costs of medical care; they simply pass along the increasing cost of care to policy holders in the form of increased premiums.

Hence, Democrats want to set up an insurance system that will cover the individuals who lose or can’t get health insurance. They’re rather vague as to who will be able to participate in this non-profit “public option” insurance plan. It will have to be subsidized with public money to enable persons who can’t afford any other insurance to buy “public option” insurance policies. Of course, these same individuals would be offered subsidies to buy private insurance if they wished.

Republicans hate the “public option” plan. They have both a philosophical and an economic objection. The philosophic objection is that it goes against the Republican principle of small government. The economic objection is that the plan would grow into a national single-payer plan and put the insurance companies out of business.

Democrats are cool to the idea that tort reform would have a big impact on the cost of health care. They know that tort reform would not provide health insurance coverage to a single additional person. They also believe that the present methods of penalizing and eliminating bad or incompetent doctors are inadequate. Bad doctors continue to practice for years and nothing is done to stop them.

So, from what I’ve read and heard, there seems to be a set of concepts on which there is agreement and some concepts on which there is disagreement. Reasonable people among our representatives and Senators ought to be able to find compromises that everyone can live with. Why is there such great opposition to trying to find compromises? Is it that Republicans are simply trying to make a Democratic president look incompetent, to improve their chances at coming elections? Are Democrats simply trying to get even with Republicans for the years of Republican domination under Speakers Gingrich and Hastert and Representative Tom Delay?

Will someone please set me straight? Post your comments below this article, please.

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