Trade-offs necessary for health care

I think that the infantile turn that the health care debate has taken has been such a surprise to many of us, because of the urgency of our health care problem. As we all know, there is a growing uninsured population and a decline in the ability of employers to pay for health insurance because of increasing costs. At the same time, individual insurance is incredibly expensive, which gives people the incentive to go uninsured.

And yet, knowing that we need change, we have a debate that has been marred by crazies at town halls. The problem with it, which is a larger problem with discourse in this country, is the unwillingness of those involved to address reality or even worse, to totally ignore it. When Republicans say that the government will start making health care decisions for us if we have a public option, they have no clue what they are talking about.  The government plans, Medicare and Medicaid, dispute fewer health claims than private insurance companies do, which means that private insurers, not government insurers, assert more power over health care decisions. The Republicans who rail against government insurance, like the UK’s NHS, as if we have unlimited health care choices under our current system, are just off-base.

At the same time, supporters of a public option have not assuaged reasonable fears that the plan in its current state will not control costs. The cries from people who believe health care is a right–as if we as a country have an unlimited capacity to pay the costs of keeping a race of people alive until we are in our 80s and 90s–is naive. The country needs to control costs if it wants to guarantee insurance for all. It is a problem that France has because it does not have strong mechanisms for controlling costs. Yes, town hall crazies, there is a universal health care system that actually results in its citizens getting too much medical care!

Lawmakers should have little patience for town hall crazies’ contribution to the debate. Everyone else, meanwhile, should be asked to participate in a serious discussion over how best to prioritize care in our system. How much should we spend on procedures for people who are nearing death? Where are the most expensive health care charges happening, what is the reason for them, and how can we control them? How can we make sure reimbursement rates that the public option would negotiate with insurers would not put doctors off of a public option plan or deter them from medicine altogether (some Medicare reimbursement rates are pretty low–some of them actually do not even cover the cost of a procedure).

And in the larger picture, we should keep in mind that all of our systems have flaws, and that we always make trade-offs. Our political debate these days lacks an appreciation for this. Anyone who dismisses Canada’s or France’s or Germany’s or the UK’s health systems as terrible has no idea what they are talking about. For one, the systems differ quite a bit among each other. But all of these systems, including ours, have advantages and disadvantages. They help some people at the expense of others. And ours continues to rank lower than others on World Health Organization lists because not enough people are served by our higher quality care.

As my dad said, he voted for Obama because he was hoping that Obama would face Americans with the awful truth, i.e. reality, when making serious policy decisions. So far, that has not happened. (This blog was inspired things he has said).


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