Health-Care Reform Debate Stuck in Zero Sum Game Thinking
Posted by Michael A. Kamperman on July 29, 2009
The current health-care reform debate is stuck with one-dimensional thinking. For example, President Obama is stating that if we don’t reform health-care then the Medicare Trust Fund will run out of money within 10 years. But doesn’t the “Medicare Trust Fund” exist on paper only. It’s not like the Medicare Trust Fund is an endowment with a diversified portfolio. For years the federal government has been including the revenues collected for Medicare and Social Security in its budget and issuing them IOU’s in the form of Treasury bonds. Let’s face it, both Medicare and Social Security are programs of the federal government and neither will run out of money unless the federal government runs out of money. The federal government is not going to run out of money within the next 10 years. The next form of one-dimensional thinking is that national healthcare expenditures that are rising faster than the overall rate of inflation is “bad thing” for America and its economy. It would be if we imported most of our healthcare. But in fact the vast majority of health-care spending in America is geared toward our domestic economy. In fact, health-care is the only sector of the economy that is still growing jobs. As long as the quality of care keeps improving it doesn’t matter if it costs more. If I am willing to pay up for a big screen HDTV, why shouldn’t I pay up for high-tech health-care? Will America be better off if we cut health-care spending and send even more people to the unemployment lines?
The next form of one-dimensional thinking is that most of the Americans that are without health insurance are suffering. Nothing could be further from the truth. Everyone who needs medical attention can walk into an emergency room and receive treatment, whether they can pay for it or not. A friend of mine is a surgeon. He told me he has 5 different rates for removing an appendix. The first price is his stated full price. This is the price that someone without health insurance, but with money, pays him. He says almost no one ever pays this rate. The next price is the price large insurance companies negotiate with his practice. The next price is the price Medicare dictates it will reimburse him for an appendectomy. Then, an even lower price is the price Medicaid will reimburse him. And finally, there is the charity price, which is $zero. He gets up in the middle of the night if the hospital calls and removes an appendix regardless of what portion of his fee he will be collecting. So health-care insurance reform is only geared to the non-payers and the full price payers. Since I have health insurance, the higher fee Blue-Cross/Blue Shield pays him covers the lesser fee paid by others. I am already “taxed” by my health insurance premiums by paying a higher rate for an appendectomy. The working poor, whether they are legal citizens or illegal immigrants, have no money and they don’t pay because they have few if any assets at risk to a lawsuit. Healthy young men and women often go without health insurance because they don’t perceive the cost/benefit of having a policy as being worthwhile. So the only people health-care reform will really benefit is the middle-class with assets to lose and no policy due to choice, pre-existing conditions, or because they were dropped by their existing policy holder due to risks and costs. And, the ones who are unfairly gaming the system are employers of the working poor who pay nothing for their workers health-care even though they all receive because of the health insurance “premium tax” paid by others.
Why don’t we have hospitals build clinics for the working poor funded by savings from treating sore throats in the emergency room and by a tax on employers that don’t provide health insurance? Why don’t we tell the insurance companies it is illegal to drop coverage for health reasons for anyone they gave a policy to? Why don’t we offer a subsidy to health insurance companies to help cover the costs of a mandatory window whereby anyone with a pre-existing condition has to be offered coverage? Why don’t we tell insurance companies everyone must be offered the same rate for health insurance whether they are an individual or a large employer? What I don’t want to see happen is some grand cost cutting experiment with health-care that drives the country into an even deeper depression as nurses hit the unemployment lines. What I also don’t want to see is an America that goes to Vegas to gamble, goes to the Super Bowl, goes to get tummy tucks and manicures and pedicures, but then turns around and tells Grandma she needs to walk off into the woods to die because we can’t afford end-of-life care.
