Tuesday, March 23, 2010

Health Care Hangover

A major Health Bill passes, but few are satisfied. Worse, we see a breakdown in civil discourse, replaced with angry outbursts inside and outside of Congress.

How did we get here? Back a year or two, and the nation was behind some form of health care reform. Be it the ever rising cost of health care, the high cost of insurance if you don’t get it at work, or people dropped from insurance, or others who can’t get it due to “pre-existing conditions.” One bad illness can drive an uninsured family to bankruptcy. Does this make sense in the richest nation on earth?

But now we have a bill that promises many changes: keeping your children on your insurance until 26, preventing rejecting coverage for “pre-existing conditions,” and subsidies for some who can’t afford insurance, among others. Yet, there are so many vocal opponents.

How We Got Here: Three reasons:
  1. Politics
  2. Politics
  3. Politics
Both parties chose to blow this out of proportion. Republicans and many ad-hoc groups (some of which are labeled “tea party” folks) see this as the wedge issue that can unseat many Senators and Representatives. And they hit the issue hard, early and often. They went heavy negative. They got media attention by being loud and to the point. And they gained a lot of support.

On the other side, the Democrats made this a “must pass” bill. Much as I believe G. W. Bush felt he almost had to invade Iraq to finish what his father started, Obama was painted into the corner of getting the bill past somehow, some way, at whatever cost.

With stakes so high and politics ruling the day over the interest of the people, there was zero hope of reasonable bipartisan reform.

Our National Loss: Civility? Have we lost the ability to have a national debate on major issues in a civilized manner? The thing that was great about this wonderful land we live in was our freedom of speech and our ability to have different points of view heard. Back when I was in high school, we had a great 10th grade social studies class where the teacher encouraged the airing of all sides of the issues. We had conservatives, liberals and moderates. And we had some very impassioned, yet civilized, debates on the issues of the day.

Right now, I fear that America may be lost. As a Libertarian and American, I believe we need to have respect for everyone’s Freedom of Speech. I wanted to hear the arguments for and against the bill and the various provisions.

But, what I heard was a lot of bullying: shouting down speakers in town hall meetings, including the epithets used against some representatives. When I wanted to hear the rational reasons why the bill may ill-conceived, I heard too much hyperbole or exaggerated claims (government takeover of health care, “baby killer” and “death panels”), and this strange concept that Obama is a fascist trying to obtain totalitarian power over the nation. Only occasionally, in the mists of the sonic bombardment of the opponents, could I once and a while find some rational substance why provisions of the bill are ill-advised.

Sorting Out Some Perspective: If we can leave the shouting behind, here is my perspective on the bill:
  • Some of the desired reforms that will provide one way that more people can obtain health insurance. It’s not the only road to reform, but it is a road that does have the Federal and state governments have a heavier hand in the making it so. (So, as opponents claim, there is an expansion of government’s role in this bill).
  • I’m glad that something’s being done about “pre-existing” conditions as I have one. I can’t get life insurance anymore (luckily, I bought it when I was young). But the most ridiculous thing about it is my pre-existing condition is a little dot of skin cancer (about the size of the eraser on your pencil) that was removed in a couple of minutes in the doctor’s office. It was truly itsy bitsy, but because it was the BIG “C”, I can’t get insurance. So, I’m inclined to use anything, including the expansion of the Federal government to banish this “existing condition” provision!
  • It remains to be seen how it will be paid for. Right now I don’t believe a single politician on either side about how the costs will work out. But where there are subsidies, the revenue has to come from somewhere.
  • I don’t yet see a threat to the typical employer-based health plans like I have. Maybe some union jobs still have “Cadillac” plans (that will be eventually taxed), but not my cheap employer! We pay a lot and have high co-pays, but at least I have insurance! The funny thing was listening to one conservative opposing reform as it might do away with their great employer-based health care plans, as he had really low co-pays and it was about as perfect as it could be. But only 1 1/2 years ago conservative Republican candidate John McCain campaigned on health care reform that would get rid of the employer-based system and we’d all have to compete on the free marketplace to find a plan. Short are some people’s memories!
  • Notice that the insurance companies are silent. They know there’s more regulation, but there’s more customers coming. I’ve already seen TV ads encouraging people to apply for new plans that will be available under this new bill. The insurance companies will make out on this. First, they get more revenue from customers. But there is little to stop them from frequent increases in premiums, so there is more revenue. So, even if regulation cost them some additional overhead costs (to figure out all this red tape) or some limits on plan costs, they can make it up by increased revenues.

So, Is It Good or Bad? A pure Libertarian would say it’s inherently bad as it uses government to create reform, thereby expanding the role of government. And it forces people to buy insurance in a nation that should leave everyone alone. (Then again, a pure Libertarian would take us back to the 4 original Federal Departments (Defense, State, Treasury and Justice) and jettison Education, Commerce, Labor, Transportation, Environmental Protection, etc.

But I’m not a pure Libertarian. I believe government is a tool. It’s not the solution to all problems, but it can be a good solution to some. For example, who would really propose selling off the nation’s roadway system to private interests because government at any level (federal, state, county, or local) shouldn’t be in the transportation business?

So, what to do about health care? Republicans gave us the health care savings account. They assume we have a crystal ball and know our health care needs for the upcoming year. They like tort reform – always some ridiculous settlements that get any reasonable person to say “enough!” But how much will that really save? They like expanding the sales of insurance across state lines.

But that still doesn’t get to the fact there is not real capitalism (many buyers, many sellers) when it comes to health insurance, as there are too few sellers and any one individual is in a weak negotiating position. It’s not like going to the farmer’s market and bartering for price of 10 pounds of potatoes.

In the absence of true capitalism, often our nation has turned to the power of government regulation to try to level the playing field. This goes back to regulating the railroads when they had the collective monopoly on the nation’s transportation. Then, starting in the 1930s (and again in the '50s and '60s with the interstate system) the government stepped in with the “public option” of the day: federal funding of highways. But I ask you, who among the Republicans, conservatives, or tea party folks want to repeal the “public option” in transportation? Public roads represented a big expansion of government into a sector (transportation) that previously was highly privatized. But were public roads the death of freedom in America? Quite the contrary, as the car commercials portray driving on public roads as “freedom.”

So, I have to say I am not philosophically opposed to the hand of government in health care. I don’t believe it is the “wonder drug” that will make things perfect. But, we still needed to do something. I’m not too happy with the bill that passed, that’s why I’m feeling this health care hangover!

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