Health Care Again - pt. 2

All of the debates about healthcare, and the discussion we had in the previous article, seem to lead us back to the issue of providing healthcare insurance to those who couldn’t afford it, in order to keep people from ‘dieing early.’  But that really is two separate things, isn’t it?  Is the ACA really an effort to prevent people from ‘dieing early’ or is it an effort to make certain that everyone has health insurance?  The difference is important.  Those with large amounts of extra money (the ‘rich’) really don’t need health insurance – if you have $50 million in the bank earning 2% interest every year you don’t need health insurance.  And, in fact, some 240 million to 250 million US citizens were covered by health insurance of some sort or another before the ACA.  The ACA is supposed to add 30 million citizens onto the list.  Why the government didn’t construct a system that addressed all 60 – 70 million (there are 311 million US citizens) is a bit of a mystery to me (not that I want them to, but it is curious).

But at the same time there is no effort to increase either the total quantity or the overall quality of health care.  So, the ‘goal’ of the ACA is in reality ‘more people with health insurance’ while making no efforts elsewhere to improve healthcare.  Ask yourself this question: if the goal were to improve overall health of American citizens and increase life spans, is this how you would have gone about it?

The ACA expands the amount of money the federal government pushes into healthcare each year without otherwise addressing the fundamentals of healthcare.  That translates into expanded federal control. That seems to make it fairly clear that the ACA is about issues of control and mandatory insurance is a vehicle for that control, and that actual healthcare is secondary to the issue of control.  (For those who doubt that government bureaucracies equate ‘money’ and ‘control’ you need to go look no further than education; the federal government has repeatedly asserted that it can dictate terms to private schools if any student at the school accepts federally guaranteed student loans, whether the school knows of the loan or not.)

It is worth noting that every single person in the US already has access to critical or crisis care through Medicaid.  But it is also worth understanding that long before Medicaid / Medicare, or the Department of Health and Human Services, or its predecessor the Department of Health, Education and Welfare, were created, or even gleams in some bureaucrat’s eye, hospitals across this country operated within the confines of a strict moral and ethical code that demanded that they treat everyone who showed up at their doors.  Further, every doctor in the country individually operated under the same code.  The fact is that if people could get themselves to a doctor’s office or a hospital they would receive care.  When money became a problem, ways were found around it.

What was missing from healthcare were: 1) a program to pay for annual physicals as a preventative to further problems; 2) some sort of coverage to address catastrophic illness; and 3) a means to address the shifting demographics that left certain segments of the population physically isolated from medical care – in particular inner city poor as hospitals expanded outside urban centers and doctors and nurses moved away from urban centers.  The ACA sort of covers #1, in some cases may cover #2, and ignores #3. 

The ACA does not address the issue that the young – who are predominantly healthy – feel they don’t need healthcare insurance, except by taxing them (which only serves to underline George Washington’s point that in the end governments are really only about force – forcing people to do things. (It also serves to point out Washington’s point, that governments must, therefore, be kept on very tight leashes)).  Using taxation to force certain behavior is both a favorite tactic of governments throughout history, and hardly the mark of a limited government.

If the issue were to improve healthcare, and there was a real desire to improve the quality of healthcare might it not have been better do have done something like this?

1)             Every dollar spent on healthcare insurance – no matter your income level – is deducted from your gross income, thereby reducing your taxable income, creating an incentive for people to buy healthcare.

2)             Everyone is free to buy any insurance they want, in any county or state – no arbitrary federal, state or local regulations protecting this or that insurance company.

3)             Provide tax breaks for retirement age doctors and nurses, creating incentives for them to remain in practice.

4)             Provide ‘fast-track’ procedures for foreign doctors and nurses to immigrate and receive accreditation, working with the AMA and others as necessary to maintain standards.

5)             Work with the AMA, the universities of the US, US hospitals and American industry to provide opportunities to found new schools and expand old schools of medicine, and to expand the various residency programs.

6)             Work with hospitals, clinics and industry to develop an improved, streamlined process for the FDA to approve new drugs and new treatments.  The FDA approval process is currently one of the slowest and most cumbersome in the world.

7)             Work with universities, hospitals and industry to expedite new technologies and new techniques that improve healthcare.  Expedite in particular the approval of those treatments that exploit technologies that utilize non-medical personnel, as well as ‘remote’ technologies that allow more medical care to those people physically distant from treatment centers.

8)             Provide tax incentives for doctors, nurses, other medical personnel, and companies across the entire medical industry to provide healthcare to the poor; ensure that these incentives are easily tracked and that the paperwork is not onerous.

9)             Develop legislation that provides caps or limits to malpractice liability claims – for individuals and organizations.

This is a start.  There is more, but we should begin here.

We need to realize is that shoveling more money at healthcare while expanding government control is unlikely to work; it hasn’t worked in the past and why it would mysteriously start working now is beyond me.  But especially ludicrous is the unspoken premise that ‘healthcare can be fixed,’ that the government can mandate some sort of solution and then it’s fixed, that the solution the government comes up with today will work just as well in 5, 10, 20 or 50 years.  The fact is that healthcare, as with a great many other problems, is a very complex set of issues that not only defies easy characterization, it defies nearly any characterization at all.  There are large segments of the healthcare industry that, far from being broken, are performing superbly.  Any action by the government in these areas is likely to make matters worse, not better.  More to the point, we need to accept that in anything as vast, as complex – and as personal – as healthcare there can be no ‘right’ answers, no answer that is adequate and appropriate for every person, no answer that once given will never change.  Instead, every answer is constantly evolving, as technology and treatment change, and as we as individuals and as a society change.  The answers to healthcare do not lie in the offices of politicians or bureaucrats at all; the only thing government can do is to, as best as possible, ‘clear the field’ and allow the ingenuity and creativity of people across the nation to continue to refine and develop healthcare.  The real answers can only be found among patients (that’s all of us), doctors and nurses, and inventors and engineers; let’s go there for the solutions.