Is Health Care a right or a commodity?

Yesterday the House of Representatives passed the "Health Care Bill", which among many other things, will require all Americans to either get Health Insurance, or be taxed heavily. One Health Insurance option will be what I understand is a Government Plan run and managed by the separate states. This option will only be available to small businesses with less than 10 employees the first year, then small businesses with less than 20 employees the next, but by 2014 the general public will have the option to buy government-run Health Insurance.

My previous post touched on what boils down to two main issues: 1. What does "health care" mean, and 2. Is it a "right"? I want to write a little bit more about these two issues because I think they deserve far more attention than either the liberal or conservative medias are giving them.

NPR continues to make statements like, "a landmark Health Care Bill which will provide Insurance Coverage for all Americans," and the local conservative station here in Houston keeps complaining about how, "It is unconstitutional for the government to force Americans to purchase a commodity." So, which is it? A universal God-given right to which everyone, including the poorest poor, should have access, or something you can shop around for in a market, put stock into, sell, trade, invest in, and profit by?

First, we need to define what "Health Care" is. Well, I can't exactly do that because I am just one lone housewife without any legislative clout. All I can do is define what I think it should be. I certainly think that a hospital should be required by law to admit anyone, regardless of ability to pay, in life threatening emergencies. I'm not sure if hospitals must admit all patients in non-life threatening cases, as they currently seem to be, but I can see a whole mess of problems resulting in allowing them to turn away patients. For example, if the people who get to decide what "life threatening" means are in charge of who gets admitted, therein lies a huge conflict of interest. So, I think that maybe the current system of hospitals needing to treat patients regardless of their ability to pay is necessary. But is it "Health Care"?

My mom is outraged that currently over 30 million Americans (this number seems to jump every time I turn on the radio...31 million, 32 million...I'm not sure where this number comes from, honestly) use the ER as their "primary care physician". Which is extremely costly to everybody, most of all the patient, and is one of the major problems with our current system. People can't afford to pay premiums, but they get sick or hurt anyway. So they go to the Emergency Room (when they SHOULD go to an Urgent Care Facility), rack up a bill that is easily 300-400-500 times as expensive as preventative care or non-ER care, and guess what. At the end of the day, surprise surprise, they still can't afford to pay the bill, so they go on a payment plan with the hospital. Often, people can negotiate their debt. If they can pay it off quicker, the hospital will often reduce the bill by 20-50%! But usually, what ends up happening is the hospital is forced to raise prices on everything just so they can balance their budget, which means ridiculously inflated prices. Example: after delivering Jane, I had a tylenol in the hospital. Later, looking at the bill, one pill's worth of tylenol cost me $4. That's enough for a bottle of 100 tylenol pills! Makes you wonder what other procedures and medicine have inflated costs. (But none of that information is available because currently there is not schedule of costs of procedures available to patients, which I think is immoral. You should know how much something costs BEFORE you decide to get it!).

When the hospital's costs go up, private insurance carriers raise their premiums, and so everybody pays more. Clearly we see that "Health Care" as Emergency Hospital Care is not a sustainable model, is costly to all consumers not just the uninsured, is inefficient (who here has waited 4+ hours in an ER to get seen for a broken bone?), and may not be the best way.

For a moment, let's move on to the next question: is "Health Care" a right or a commodity? I don't think a sane soul could argue that the right to "Health Care" has a Constitutional basis, but as a Democratic Republic we surely have the ability to decide if something should be a "right". We could vote on it, and amend the Constitution to include "health care". So far, I have never heard this discussed in any public forum by anyone. All the liberals I know assume it is automatically one's "right".

I cringe when I hear anything declared as a "right". I don't think we should use that term lightly. I can agree with any liberal democrat that health insurance coverage for everybody (provided it is affordable and realistic) would be a "good thing". Personally, I can't swallow the term "right" because it certainly isn't ordained of God like life, liberty, and the pursuit of happiness. I can probably agree that health insurance coverage should be the "responsibility" of each citizen, though.

Here is a problem I see with the new Health Care bill: soon, it will be a law that all Americans must buy Health Insurance. As I understand it, for many this cost will be so high, even with the government option, that they will not even be able to use the insurance they buy. They will not be able to afford the bill, even AFTER the insurer has paid their share. I do not see how this gets the poor any closer to actually having better health. Maybe "health care" should not be defined as "health insurance".

Should Health Insurance be a commodity? Is it ethical for a company to profit off the misery and lack of health of its members? Isn't there a major conflict of interest here, as well? If an insurance company has a stated goal of getting all of its members healthy, and it SUCCEEDS, theoretically shouldn't its premiums decrease? And in that business model, wouldn't they LOSE money? Therefore, shouldn't health insurance companies WANT their members to have poor health? Scary!

But what about car insurance? This model seems to work. It's not nearly as inflammatory an issue as health insurance; everybody seems to accept it as "necessary." Everybody is required to have it, but the states get to regulate specific requirements. If you want to have a low premium, you will need to pay a high deductible. If you are in a certain age category that is higher risk, you will have to pay much more. Then, if you get in any accidents, your rate will increase. If you are a "good student", you can get a discount. If you have multiple insurance policies with a company, you can get a discount. Ugh, suddenly I'm reminded of the lady from that commercial: "DISCOUNT!" Car insurance companies are regulated by the government, yet they are tailored to fit each individual member so they can be affordable. There is also an extremely free market for car insurance, resulting in a plethora of annoying ads, which is an indicator of fierce competition. I got an online quote from Geico once, and they sent me at least 17 phone messages and letters (I did not give them an email address, phew) begging, pleading, longing for my business. This doesn't exist with health insurance.

Health Insurance companies fund pharmaceutical companies, which fund major health research projects. My husband is working for one of those projects. If there is no competitive market for Health Insurance, who will fund the research that provides life-saving drugs and technology? What driving force can run the medical industry, if not money? We know that altruistic teachers who sincerely want to impart the love of learning is the driving force that currently runs our Education system (like heck if people go into teaching for the money!); somehow I doubt investors with multi-billion dollar pockets have such altruistic motives.

I think the problem is in the scale. When you get car insurance, there really are only a limited number of things that can go wrong. You hit him, he hit you, it's both of your faults, only one is insured, etc. But Health Insurance is on a totally different scale. Not everybody will get in a car accident every year. But almost everybody will get sick every year. As people age, they will probably drive less. As people age, they will probably get more health complications. The scale of what can go wrong with the human body is enormous in comparison. Therein lies the problem.

If a working-class small business owner cannot afford to insure his employees, should he be penalized? Or is it that he cannot afford to NOT insure them?

Quick real-life story tangent: today I went to the Harris County Tax Office to get our cars registered in Texas. I drove 30 minutes to get there, only to realize I had left some essential paperwork back home. I drove back home, got the papers, then drove back to the Tax Office. The office was dingy, dirty, and disorganized. I waited 45 minutes in line. The system here is nothing like the DMV in Provo, which gives you a number that corresponds with the type of service you need, and has tons of chairs. No, it was all standing, everybody who needed something done all together in one line, no electronic numbers flashing to let you know when it was your turn. Finally the lady called "Next at Station Seven!", I went up and presented all my paperwork, and the lady said that my current car insurance is "no fault" because it's from Utah, so it is not accepted in Texas, which information was not available in a comprehensible way to me on their website. So everything was a huge waste of everybody's time, and I left the office unbelievably annoyed.

Another quick real life story tangent: Afterward, feeling very frustrated, I decided to run another errand so that at least I would have the satisfaction of having accomplished SOMETHING today. I went to FedEx to mail our amended 2009 tax return (so we could get the first time homebuyer credit). As soon as I walked in the door, a very polite well dressed man said, "Hello, how may I help you?" He made a copy of the documents I needed to send, found me the correct envelope and form, and I waited in line for about 5 minutes to send it. If I had forgot my documents, there was a computer available for me to use, and print them out right there. The address I had for the IRS did not include a street address, so the man looked it up for me, and wrote it for me on my package.  The cost was $6, which is less than it would have been to mail it with the US Postal Service, it will get there either tomorrow or Wednesday, and I have a tracking number for no additional cost. The advertisements in the store reminded me of several self-publishing ventures I have had in the back of my mind for some time. I left feeling excited to come back to FedEx.

To me, these two scenarios represent the Government model and the Private Industry model perfectly. In the government model, I had to wait a long time, produce documents required by a bunch of red tape, which I was not able to do, and therefore I couldn't get what I needed done, and I wasted everybody's time and energy. In the private industry model, I was seen right away, my needs were quickly seen to, the cost was low, there was a mechanism for me to get whatever documents I needed, and the whole event was successful and pleasant for everyone. I suppose a better comparison would have been to go to the Post Office, but after today's episode at the Tax Office, I've had my fair share of "the government model."

Okay, so back to right vs. commodity. In my opinion, if Health Care is defined as "Health Insurance" and is declared a "responsibility" (I can't go so far as to say it should be a right) which is mandatory for all, there can be no room for the government model. Why? The government's access to taxpayer money means that we are all shareholders in its company. How can the private model compete with that? Simply put: it can't.

If health insurance is mandatory for all, there needs to be a free market for health insurance. As long as one's employer will provide the best option to you, there is no free market. What the Health Care Bill SHOULD have done is more to regulate insurance markets, more to help new co-op type insurance companies get started, and more to reduce ACTUAL costs of health care.

But no, instead it just makes people pay for a product/responsibility that they won't even be able to use. It's disgusting. I'm sorry, mom and pop, the Massachusetts model does not work. Isn't it something like 20% of Massachusettsians aren't insured because they can't afford it (even though it is "mandatory") and they are heavily taxed? To me, this is government regulated squishing of small businesses. I also heard it's something like 12% of the insured people of Massachusetts don't ever use it, simply because they can't afford to. And yet, so many sit there and pat themselves on the back because finally "everybody" is "insured". 

If the government passed a law that forced me to take out a loan to buy a ferrari, and be in debt for the rest of my life, I would be pissed too. Especially because I wouldn't be able to fix it when it breaks, yet I would be forced to continue paying for it.

1 comment:

  1. Hi Kate: I hope it is OK if I comment on this subject. I realize there is a lot of information to try and digest and that things are different from state to state, so what might be true in one jurisdiction may not be true somewhere else. For example I can't imagine where around here I could get a bottle of 100 Tylenol for $4.00. Of course that is till to high for one pill.

    Insurance companies negotiate with hospitals and other health care providers to determine the cost. For example it used to be that I could get a flue shot in my doctor's office and my insurance would cover it. A couple of years ago that changed, I don't know why. I don't think my PCP even gives flue shots anymore. So I have to go to one of the local pharmacies and and pay whatever they charge. I could also go to the a county public health office and get it for a reduced price.

    I cannot choose which lab I go to to have blood drawn. Once a couple of years ago my PCP changed the company that was doing their billing. It took the new company a while to figure out how to do it right and they sent me a bill for the amount I would have paid had I had no insurance. It was three or four times higher than the insurance company would pay for it. I didn't have to pay any more than my copay in the long run. But it seems to me that there is something wrong when people like only have to pay a small copay and the uninsured have to pay twice or three times as much for the same service.

    If in fact this bill will provide the same level of care to the uninsured as the congress now has for themselves they will be a lot better off.

    Wait a few years and see how things turn out before you make up your mind. I'm hoping the kinks will be worked out and it will turn out to be better you might now think possible.

    Health care is a need everyone has like food and sleep. Just because it can be treated like a commodity doesn't mean it is not necessary for life. It does mean, at least to me, that it should be equally available to all people


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