Wednesday, September 30, 2009

The Case for Single-Payer Health Care

The Case for Single-Payer Health Insurance


One of the problems with the United States health care system is that it’s a cobbled together mess of government and private plans. Some members of the population get access to health care via Medicare (if over 65) and some adults and children living in poverty conditions can have access to Medicaid. Explaining Medicaid is extremely complicated because it functions as a joint state/federal program. Suffice to say for now, some people can get “government-paid” health care, but many cannot. This is problematic because there are cases of parents turning down promotions and better jobs to stay within the income perimeters. They did the calculations, and they came out ahead having Medicaid but earning less income. Thus, they are playing the system, but I can’t say I blame them.

The rest of us need to hope our employer covers us, or we have to go on the open market to purchase insurance. Good luck with that! Individual insurance is extremely costly unless you go with a major-medical, extremely high deductible plan.
Rates vary significantly, and what most employees don’t realize is that insurance is part of salary! Insurance plans cost employers anywhere from $7,000 to $10,000 on average per employee. Family plans are more. Why does it cost so much? At many places, the employer is insuring a relatively small “pool” of people. Where I work, we insure about 250 employees, and our average age of employee is on the high side. Thus, on the whole, we are higher risk. In many cases, health insurance consumes a significant portion of salary. If you earn around 40K annually, about one-fifth of your salary package is likely going to health insurance.

I wanted to explain some basics before going into what I would advocate. Essentially, I would argue that the United States should have a single-payer system. Many nations do this differently, but I would propose that our money is essentially pooled as if we were paying into one big insurance company. This would spread the risk, and spreading risk is what insurance is all about. With over 300 million people on one plan, we should be able to keep the costs lower than what we’re currently doing. This would not be “free” healthcare. Everyone would pay with payroll deductions.

One other part of my rationale is that I strongly believe health insurance should not be a “for-profit” enterprise. It should be a basic right just like fire and police protection. How would we like the police department or fire department to be “for profit”? “We’re sorry sir, but you forgot to pay your premium, so we can’t put your house fire out today.” Or, “Your house had old wiring, which is a pre-existing condition; we’re sorry, but we deny your fire coverage based on a failure to disclose a pre-existing condition.”

Health insurance companies serve absolutely no positive function in our nation. They make profit off sickness and disease. Period. We don’t need them. They raise premiums at a pace that far exceeds inflation and cost of living expenses, in many cases 10-15% annually. At any rate, regardless of the actual profit via statistics, any profit means more money out of individuals’ pockets. And, there’s no denying that insurance company executives get big payouts and bonuses, and private insurance company employees are rewarded (with bonuses and promotions) for DENYING coverage to policy holders.

Now, I know there are objections to single-payer, so I’ll try to respond to the more common concerns.

First objection: “This is government-run health care, and it means that government bureaucrats would make decisions.” Many people, apparently, do not trust the government. I have two responses to this legitimate concern.

Responses:

First, it’s not government “run” health care. Hospitals and doctors are still private; hospitals are not suddenly federal buildings, and doctors are not made into government employees. That would be a truly socialistic system, and that is not what single payer means.
Second, and this is debatable, but I’ll throw it out there: I trust my government more than I trust insurance company executives. Why? It goes back to the profit idea. When health care is not-for-profit, decisions of life and death are not made based on profit margins.
Finally, insurance companies already “get in between” patient and doctor. Single-payer would actually eliminate this, not cause it! Any doctor, by definition, would be “in-network.” That means, you could go to any doctor at any time in any U.S. location. (At least, in my version of single-payer, but I don’t see how this could be false under any single-payer plan.)

Second objection: “But then we’re paying for the unemployed, “lazy” people.”

Response: We already are, except now we get no benefit from the taxes and deductions taken. With a single-payer system, at least everyone gets something back for what they pay in.

Third objection: We can’t afford government paid health care.

Response: We can’t afford private health care either! Soon, fewer and fewer will be able to afford private health care. More families will go bankrupt. Guess who pays for bankruptcies? All of us in the form of higher medical costs. Why do you think you get charged 20 dollar for aspirin, or 100 dollars for a box of Kleenex? Because many people default on their medical bills and then declare bankruptcy.

A challenge to Congress:

I want just one Republican or so-called Blue Dog Democrat to stand up and make the case AGAINST Medicare, Medicaid, and the Veterans’ Administration. If they go on record against any form of government insurance, I want them on the record as saying that, on principle, they will work to abolish Medicare! Not one single conservative politician has done this. So, either they are pandering to the elderly for votes, or they really believe it. If they really believe, then I want them to put forth a piece of legislation that calls for abolishing Medicare!
Then, I want them to decline their taxpayer paid health insurance and pick up their own policy since they claim the government is so terrible at running programs.

Here’s the bottom line response to any and all objections to a single payer system:

We ALL are ALREADY paying for EVERYONE’S health care.

Monday, September 28, 2009

Quality of Public Deliberation Suffering

Since Obama has taken office, a very small, very vocal, and apparently very hateful minority has attempted to hijack public deliberation. And it has worked. And the media have made it happen.

It began with claims that Obama was not born in the United States. The claim was so outrageous that the mainstream media covered it precisely because it was ludicrous. This ended up, of course, actually legitimizing the claims. Had the media ignored it—and they should have because it was completely false—then few of us would even have been talking about it. Simply put: it was a distraction we didn’t need when we should have been debating other issues that actually matter.

What we call a “debate” about health care is no debate at all. When one side fabricates outright lies and the other side actually spends time responding to the ignorance, we’ve hit a new low in what passes for public “debate.”

Here’s a case in point: Can anyone articulate the actual concept of what has now become known as “death panels?” The media, on both conservative and liberal progressive outlets, keep repeating the phrase “death panel,” allegedly first used by Sarah Palin on her Facebook page for crying out loud, either to embrace it or to discredit it. No matter the reason, repeating the idiotic phrase has embedded that concept into the “debate,” and we’ve almost entirely ignored any real deliberation about how end-of-life counseling might better allow the elderly to make their wishes known to their family, loved ones, and caregivers before they are mentally and/or physically unable to do so. (By the way, as governor of Alaska, Sarah Palin devoted a day to promote exactly this idea. It was called “Health Care Decisions Day.”)

Most recently, critics have attempted to claim that Obama planned to “indoctrinate” our children in schools with his socialistic views. (As a side note, most people I encounter who call Obama a socialist cannot define the term; they merely believe it’s “un-American.”) Obama’s speech simply encouraged kids to study and to stay in school. Again, this marks a new low in our public discourse because such accusations were being circulated days before Obama spoke to discredit him before anyone even knew the content of the speech. Obama’s opponents are so desperate to see him fail that they don’t even wait to respond to what he actually says.

For the most part, this outrage has been fabricated and orchestrated by special interest groups or extremists on the left and the right. Most of these “debates” were not legitimate, and most reasonable people would simply have ignored it. Unfortunately, the media apparently are starving for controversy. Republicans, too, have played some role in this for frequently perpetuating the lies and myths either explicitly or because they will not, when asked, correct them.

The United States can do better than this. I hope.

Pay No Attention to Public Opinion Polls

Public opinion polls are misleading, they become the focus of the news—rather than the issues--, and, polls suggest that what’s popular is what ought to be.

Polls mislead. Take this most common example. “Do you approve of the job the President is doing?” What does this actually measure? If the number is low, does that mean a progressive President is being “too progressive”? Absolutely not. But, on the face of it, that’s what it suggests. One could easily disapprove of the President because he’s not, in their estimation, being progressive enough. Yet, we tend to assume that disapproval ratings mean that a Democrat is being “too far left” and a Republican is being “too far right.” I suspect dips in Obama’s current ratings are for both reasons, although the media (you know, the “liberal” media) treat the poll as if Obama is being too liberal.

Likewise, I’ve seen polls that ask, “Do you agree with Obama’s/Baucus’/Democrats, etc. health care reform?” If I answer “No,” then what am I really saying? The poll does not measure what we might think. I could disagree for any number of reasons, most of which give a false impression. I know dozens of people who would answer “no” to that question because they are in favor of a single payer system that abolishes private health insurance altogether. I know other people who want no reform at all, and many of them have different reasons for that position. So, oddly, all of these groups would be shown to agree (about something)—even though they are on opposite sides of the political spectrum—if they answered this poll. Yet, the headline in a newspaper or blog would read something like, “58% say they disagree with Obama’s health care reform.” See the problem with that? What does that sound like? Most would interpret it as opposition to health care reform, but it’s not.

Second, the media treat polls as if they are newsworthy. In fact, they report more on polls than on virtually anything else. This is called “horserace journalism.” It means the media focus on who, or which side, is allegedly “winning” a given debate, rather than on any actual substance. Rather than debating the merits of any particular idea, working with the same example from above, polls ask, “Are you in favor of health care reform”? Then, if the numbers are high, we conclude that Obama is “winning.” If they’re low, we assume people want no reform and the media conclude that Obama is “failing.” Every day, we have a different winner. It’s silly, of course, but the media need something to talk about on slow days, right? This is all very superficial, and does not help us solve problems. Indeed, it may even give a completely opposite picture.

Moreso, news anchors and commentators treat polling data as if it is fact. They are opinion, and, as I’ve already shown, they are not even accurate gauges of public opinion. The way the media treat polls as fact is by constantly citing them as “evidence” of what to do or what not to do, or as some kind of proof that something will or will not happen. Republican spin doctors, for example, appear on cable news and proclaim that health care reform will not pass because a slight majority apparently “oppose” reform. It’s all quite humorous if we realize that reform is a slow process and the polls change every single day along with the weather.

Finally, popular support does not mean it’s the right—or the best—thing to do. Using public opinion as a reason to do or not to do something is a weak form of reasoning known as “argumentum ad populum.” It’s the classic scenario where your mother asks you if you’d jump off the bridge if Johnny did it. You know the rest. Our founding fathers knew that might does not make right, which is why there are so many checks and balances to negate potential majority rulings. Merely because—allegedly—a narrow majority of United States citizens “oppose” health care reform does not mean we should do nothing.

If we operated this way as a nation—according to polls—then we would not have fought the Revolutionary War, abolished slavery, allowed women to vote, or eliminated segregation. Those were not “popular” causes. (Yes, many women were against giving women the right to vote; on simple numbers, if polled, it’s doubtful a majority of the nation would have agreed to the statement, “Women should be granted the right to vote.”)

Ignore polls. The future of our country, and important policy matters, should not be influenced so heavily, if at all, by “public opinion.” That may sound undemocratic, but polls are not the way to attempt to solve problems. Especially with so much misinformation and misunderstanding out there, do we really want the fate of health care reform (or any matter of policy) to be determined by a few polls that asked a few thousand people a question they may or may not have really understood?