I rarely write about politics, and I probably shouldn’t be writing about it now. All of you people thinking, “Who cares what you think about politics?” have my permission to stop reading right now. Because I’m quite sure that I don’t know all of the complexities of this issue. And I also have to admit that I don’t have any answers for this particular issue, only questions.
I’m glad that Scott Brown won in Massachusetts, because it likely means putting the brakes on health care reform as it’s currently defined by the House and Senate bills. Because I don’t believe that they get at the root of the health care problems in this country. I often hear people say (about this issue and others), “Well, it’s better than doing nothing.” And I certainly understand that feeling, and in many cases, doing something is better than nothing. But doing the wrong thing is worse than doing nothing. There. I said it. Throw tomatoes at me if you want.
Yes, I think it’s wrong that children don’t have decent health care in this country. And yes, I think we have a responsibility to take care of sick people who can’t afford to pay for health care. And yes, I think it sucks that someone with a chronically ill child can’t get health insurance when they get a new job after their old job was eliminated (or “made redundant” as they say in my former world.)
But I think we have not yet grappled with some fundamental questions around this issue. Like, what is Basic Level of Health Care (as in, the thing we all believe everyone is entitled to)? Routine wellness care? Antibiotics when you’re sick? A cast for a broken bone? Hard to argue with those. The best cancer treatment money can buy? Even if that’s the right thing to do, how could we ever afford to give it to everyone for free? I’ve heard people say that these are just details that have to be worked out. But I believe they are fundamental questions that have to be answered before we can get anywhere.
It seems to me that one of the problems with health care in this country is that if you have insurance, you pay next to nothing for health care, and if you don’t have insurance, you pay an exorbitant amount (and the people who don’t have insurance are generally the people who can least afford to pay an exorbitant amount.) Here’s a personal illustration. When Margaret was 7 months old, she was hospitalized for 2 weeks with a respiratory infection. After about a week, they started running tests to see if anything else was going on. Now, we all knew that she didn’t have the diseases she was being tested for (cystic fibrosis being one of them.) But hey, if the doctor thinks we should do the test, then let’s do it. Particularly because it didn’t cost us anything, because we had already reached our out-of-pocket maximum. The total bill for Margaret’s hospital stay was over $40,000 (which is nothing compared to what it would have been if she had required surgery or intensive care, or both. But it’s still a lot of money.) And of that, we paid about $600, figuring in what we saved in taxes by paying for it with Flexible Spending money. We probably would have paid the same amount if she had been there for 2 days or 2 weeks. Had zero tests or a hundred.
Now I’m not saying that I wanted to pay more money. But I’m saying that I believe in economics, and economics tells us that people act according to incentives – we do what’s in our best interest. And this “all or nothing” system creates incentives for people with insurance to use as much health care as is available, because once we hit the out-of-pocket maximum, it’s free. Add to that the incentive that doctors have to run unnecessary tests because there’s no limit on what a jury can award in malpractice cases, and you have a lot of incentives to use more health care. And I don’t see any evidence that the bills in the House and Senate address that. In fact, they don’t appear to address the cost side of the equation at all.
I know I’m biased. When it comes to health care, I’m one of the “haves” (actually, when it comes to just about anything in life, I’m one of the “haves”.) I have great insurance. When I tell the doctor the name of my insurance company, the relief is evident on his face. And I’m also biased toward free markets and capitalism and all that stuff. I know that I would likely feel differently if I was one of the millions of uninsured in this country.
But it seems to me that there are things we haven’t tried yet that are worth trying before we take this leap into government-run insurance companies. Like allowing insurers to compete nationally, to increase competition. Malpractice tort reform. (Don’t get me started on how everyone else is allowed to make mistakes but doctors are required to be perfect.) Creating a relationship between the care you get and the care you pay for. Like I said, I don’t have the answers. But the House and Senate don’t either. Slow down. Bad solutions to big problems lead to bigger problems.
Ok, I’m stepping off my soapbox now.