The House has passed its healthcare reform bill. The Senate has one out of committee. The two don't match. Why can't the members of Congress agree on what to do?
One reason is that we have apparently rushed to "reform." Reform what? Who has been the voice to ask "What is the problem?" or "What are the problems?" or even "What should the ideal future look like?"
Instead, it seems like individuals have their pet peeves with items under the umbrella of healthcare. We need tort reform? That's a fix. What's the problem and its cause? Some would say that lawsuits are too costly and drive up malpractice insurance costs. Ah, here is a cause for the problem lurking below the solution. How about another problem? We must reduce unnecessary medical procedures. Oops, that's another fix. What's the problem? Is it fear of lawsuits causing doctors to cover their unclothed hospital behinds (a problem every patient can relate to)? Ah, yes, another cause pokes it heiny out. But wait, is it the real cause? What about the poor coordination and information sharing among medical providers that causes duplicate testing ("We only trust 'our lab'"). Do we have more than one cause for the same problem? If so, which solution do we use, or do we need multiple solutions? Are these even the top priority problems? No. They are merely easy examples of what seems to be a non-systematic approach to the entire issue.
The rush to fix a system that is suboptimal is overdone. The current system may be imperfect, but it is not on life support. It seems unbelievably optimistic that legislation hammered out in a matter of a few months will effectively deal with such a mammoth and complex issue as healthcare. Particularly when it is brought to us by the same body that cannot make Medicare financially viable in the near future.
Even the terminology belies the insufficiency in the approach. People talk about healthcare "reform." You can "reform" a lump of clay, but it is still clay. You can "reform" an alcoholic, but he is still an alcoholic. You can reform healthcare and simply substitute one symptom for another. What we need is healthcare "improvement." Reform can be worse than the current situation and still be reform. This isn't just picking on terminology, it goes to the whole perspective being applied to the effort.
Bob Corker, the senator from Tennessee, made a short statement on TV news. He correctly pointed out that the current bill is hugely deceptive in its costing. The revenue support portions are due to start immediately to pay for the program, while the actual program itself does not begin for four years. Ten years of revenue vs. six years of costs is blatant distortion of the operating costs for this legislation. How can any reasonable Congressperson subscribe to this mockery of intelligent administration? No one in business could do this without being labeled a fool or a liar. This is nothing short of political camouflage for fiscal irresponsibility of the worst order. And, if I have this correct, Congress will maintain its own independent healthcare coverage after they "reform" it for the rest of us. A dose of its own medicine might cause it to cough up a more realistic result for everyone. Tell your Congressperson you want Congress to participate personally in the reform by using the system it creates. While you are at it, ask them to list the problems they are fixing and the causes of those problems.
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Tuesday, November 10, 2009
Wednesday, September 2, 2009
Healthcare Installment #9. Please start with post of 08/25/09.
Nationalizing / Socializing vs. Privatizing Health Care
In basic terms, "nationalizing" healthcare means having the government as the single payer that reimburses services provided by private providers. Private enterprise still runs the service sector. "Socializing" healthcare means the government owns the healthcare facilities and its employees (doctors, nurses) are on the government’s payroll. Failure to distinguish between the two leads to a lot of confusion about the extent of the government’s involvement in healthcare. To make matters worse, both can be referred to as "universal" healthcare. For example, Medicare is a nationalized system for post 65 yr. olds who can go to virtually any private provider. The Veterans Administration healthcare system is a socialized system – veterans go to a VA hospital. Some foreign countries have nationalized systems and some have socialized ones which complicates comparisons.
Persons advocating nationalized or socialized care have probably not read the newspapers in countries with those systems. Those papers report complaints about the problems inherent in such systems. Healthcare appears better on the other side of the border, regardless of which side you stand on. The more healthcare is "free," the more it will be used and the more difficult it can be to get. Private, for-profit practices spring up to fill a void in nationalized countries the way free clinics fill an opposite void in a private healthcare country. "Free" systems end up adding copayments.
It helps to keep in mind when making comparisons with other countries, the economic and political positions of those countries. The United States is the world’s leading democratic country, and as such, shoulders the burden for the defense of democracy. Whether or not you agree with U.S. policies, it nevertheless spends much more than other nations to extend an umbrella of protection over other democracies and to protect itself because it is the primary target of terrorists. Countries not devoting as much to national defense are able to use tax dollars/pounds/euros/yen for healthcare.
The move toward "N/S" healthcare (our term for nationalized and socialized) is driven in part by dissatisfaction with private healthcare insurance companies who control coverage payments. For-profit insurance companies, however, are not always the villains when they deny payment for certain types of healthcare. The insurance company serves all its members in two ways. The obvious one is by covering the cost of healthcare for members. The other is controlling the price the member pays for the insurance. Individually, we all want maximum payments for our bills. Collectively, we all want lower costs for our premiums. The two are not easily compatible. The insurance company is in the uncomfortable position of allocating the limited premium dollars to its members which inevitably means some limitations for some members. Many of these are spelled out in the policy and some are determined on a case-by-case basis.
While some premium dollars turn into profits for the insurers, it may not be a significant factor in the total cost to the consumer. For example, Healthcare Service Corporation (which operates Blue Cross Blue Shield programs in four central states) earned a profit of less than five cents on its premium dollar in 2008. This is not a remarkable level of profitability for any firm. Cutting the cost of operations of insurers by using simpler, standardized, industry-wide, electronic processes might achieve more cost reduction than arguing for lower levels of profitability. Cutting the salaries of the top executives in insurance firms is an example of administrative cost reduction. Unfortunately, while individual compensation packages may look large for a single person, the savings achieved is likely to be only a drip from the IV bag in terms of total costs.
Any time we join a group insurance pool for added protection against risk, we give up some of our individual control over the decisions for members of that pool. The policy lays out those limitations. It does not matter if the pool is government insurance or private insurance. Policy provisions are the rules governing pay outs regardless of whether they are administered by government bureaucrats or corporate bureaucrats. While private insurers have a profit to protect, government administrators are known to be unbending adherents to rules and regulations to avoid favoritism. In the end, one hardly seems better than the other. Persons who want complete coverage for all forms of healthcare will only get it by belonging to an insurance pool with very high premiums.
Coming to grips with the fact that a lifesaving treatment is cost prohibitive (from a societal point of view) when an individual’s life hangs in the balance is a problem many people would rather avoid than address, but it is central to the cost of healthcare. Economically speaking, who decides what care is given and received is determined by the combination of individual wealth and/or the policies of an insurance provider. The only way to keep your healthcare fate completely in your own hands is to have the money to pay for it yourself. Lobbying for the government to mandate total healthcare for everyone shifts the economic burden to the entire society through taxation, but that may be a tax burden too great for the society to bear for the benefits it receives. Medicare, as it currently operates, will not be able to sustain itself after 2019 according to a 2007 report by the Medicare Trustees.
Those who advocate for increased government involvement in healthcare bring pros and cons into the debate. A single-payer system such as Medicare offers some "systematizing" benefits that reduce administrative costs. However, any government program is subject to "corruption" by public and political pressures in a way no private plan is. An example of this is the addition of the prescription benefit to Medicare by Congress without any adjustment to the federal budget to pay for it. In short, to please the public, Congress added more debt to be paid in the future by the taxpayers. President Obama said exactly this in his town hall meeting in Colorado in August 2009.
When the government becomes a larger and larger participant in the healthcare marketplace as an insurer, it exerts pressure on the other insurers. One view is that this pressures private firms to hold down their costs. That may be true. Unfortunately, pitting private enterprise against government may not be a fair game because of inherent differences in the cost structure of each.
Increased government involvement in health insurance is the proverbial slippery slope. If instead of competing successfully with the government, private insurers fail, the government becomes the dominant insurer/purchaser. The market now has a monopoly purchaser of services who can dictate terms to the providers. This is called a "monopsony." Eventually the private providers work only for this one customer. At that point, it seems unnecessary to separate the insurer from the providers and in the name of efficiency, the government takes over the suppliers. At this point, "nationalized" healthcare becomes a "socialized," government paid, government run enterprise. Private suppliers exist on the fringe providing services to those individuals with the personal financial resources to buy their own supplemental care. This scenario is what opponents of expanded government dread. In it they see the rise of big government and the death of personal control of healthcare. The inability to predict this future makes proving or disproving this possibility nearly impossible and stymies the resolution of the healthcare problem.
In the free enterprise system, the role of government is to regulate the marketplace, not to be a participant in it. Virtually every entitlement program (Social Security, Medicare, etc.) costs more than projected when it was passed, grows with the addition of more benefits over time, and either leads to increased taxes or debt. Social Security, when passed, set 3% as the tax on personal wages and employers effective in 1948. Today that rate is 6.2%. Tennessee’s version of Medicaid (TennCare) began in 1994 with a budget of $2.6 billion. Ten years later it cost $8 billion – about one-third of the entire state budget. The number of insured parties remained fairly constant around 1.3 million persons, or about 1 in 4 residents. In 2005, the program went through massive change because of its unsustainable cost. Good intentions created mixed effects on the road to expanded healthcare.
Gains in administrative costs achieved in N/S healthcare systems, can be negated by the political expansion of benefits. We end up spending more than we save. For that reason, more direct government intervention in healthcare does not seem like a long-term, cost-effective solution. Finding ways to increase the efficiency and reduce the costs of private healthcare would seem to be a way to achieve the gains without the political problems.
In basic terms, "nationalizing" healthcare means having the government as the single payer that reimburses services provided by private providers. Private enterprise still runs the service sector. "Socializing" healthcare means the government owns the healthcare facilities and its employees (doctors, nurses) are on the government’s payroll. Failure to distinguish between the two leads to a lot of confusion about the extent of the government’s involvement in healthcare. To make matters worse, both can be referred to as "universal" healthcare. For example, Medicare is a nationalized system for post 65 yr. olds who can go to virtually any private provider. The Veterans Administration healthcare system is a socialized system – veterans go to a VA hospital. Some foreign countries have nationalized systems and some have socialized ones which complicates comparisons.
Persons advocating nationalized or socialized care have probably not read the newspapers in countries with those systems. Those papers report complaints about the problems inherent in such systems. Healthcare appears better on the other side of the border, regardless of which side you stand on. The more healthcare is "free," the more it will be used and the more difficult it can be to get. Private, for-profit practices spring up to fill a void in nationalized countries the way free clinics fill an opposite void in a private healthcare country. "Free" systems end up adding copayments.
It helps to keep in mind when making comparisons with other countries, the economic and political positions of those countries. The United States is the world’s leading democratic country, and as such, shoulders the burden for the defense of democracy. Whether or not you agree with U.S. policies, it nevertheless spends much more than other nations to extend an umbrella of protection over other democracies and to protect itself because it is the primary target of terrorists. Countries not devoting as much to national defense are able to use tax dollars/pounds/euros/yen for healthcare.
The move toward "N/S" healthcare (our term for nationalized and socialized) is driven in part by dissatisfaction with private healthcare insurance companies who control coverage payments. For-profit insurance companies, however, are not always the villains when they deny payment for certain types of healthcare. The insurance company serves all its members in two ways. The obvious one is by covering the cost of healthcare for members. The other is controlling the price the member pays for the insurance. Individually, we all want maximum payments for our bills. Collectively, we all want lower costs for our premiums. The two are not easily compatible. The insurance company is in the uncomfortable position of allocating the limited premium dollars to its members which inevitably means some limitations for some members. Many of these are spelled out in the policy and some are determined on a case-by-case basis.
While some premium dollars turn into profits for the insurers, it may not be a significant factor in the total cost to the consumer. For example, Healthcare Service Corporation (which operates Blue Cross Blue Shield programs in four central states) earned a profit of less than five cents on its premium dollar in 2008. This is not a remarkable level of profitability for any firm. Cutting the cost of operations of insurers by using simpler, standardized, industry-wide, electronic processes might achieve more cost reduction than arguing for lower levels of profitability. Cutting the salaries of the top executives in insurance firms is an example of administrative cost reduction. Unfortunately, while individual compensation packages may look large for a single person, the savings achieved is likely to be only a drip from the IV bag in terms of total costs.
Any time we join a group insurance pool for added protection against risk, we give up some of our individual control over the decisions for members of that pool. The policy lays out those limitations. It does not matter if the pool is government insurance or private insurance. Policy provisions are the rules governing pay outs regardless of whether they are administered by government bureaucrats or corporate bureaucrats. While private insurers have a profit to protect, government administrators are known to be unbending adherents to rules and regulations to avoid favoritism. In the end, one hardly seems better than the other. Persons who want complete coverage for all forms of healthcare will only get it by belonging to an insurance pool with very high premiums.
Coming to grips with the fact that a lifesaving treatment is cost prohibitive (from a societal point of view) when an individual’s life hangs in the balance is a problem many people would rather avoid than address, but it is central to the cost of healthcare. Economically speaking, who decides what care is given and received is determined by the combination of individual wealth and/or the policies of an insurance provider. The only way to keep your healthcare fate completely in your own hands is to have the money to pay for it yourself. Lobbying for the government to mandate total healthcare for everyone shifts the economic burden to the entire society through taxation, but that may be a tax burden too great for the society to bear for the benefits it receives. Medicare, as it currently operates, will not be able to sustain itself after 2019 according to a 2007 report by the Medicare Trustees.
Those who advocate for increased government involvement in healthcare bring pros and cons into the debate. A single-payer system such as Medicare offers some "systematizing" benefits that reduce administrative costs. However, any government program is subject to "corruption" by public and political pressures in a way no private plan is. An example of this is the addition of the prescription benefit to Medicare by Congress without any adjustment to the federal budget to pay for it. In short, to please the public, Congress added more debt to be paid in the future by the taxpayers. President Obama said exactly this in his town hall meeting in Colorado in August 2009.
When the government becomes a larger and larger participant in the healthcare marketplace as an insurer, it exerts pressure on the other insurers. One view is that this pressures private firms to hold down their costs. That may be true. Unfortunately, pitting private enterprise against government may not be a fair game because of inherent differences in the cost structure of each.
Increased government involvement in health insurance is the proverbial slippery slope. If instead of competing successfully with the government, private insurers fail, the government becomes the dominant insurer/purchaser. The market now has a monopoly purchaser of services who can dictate terms to the providers. This is called a "monopsony." Eventually the private providers work only for this one customer. At that point, it seems unnecessary to separate the insurer from the providers and in the name of efficiency, the government takes over the suppliers. At this point, "nationalized" healthcare becomes a "socialized," government paid, government run enterprise. Private suppliers exist on the fringe providing services to those individuals with the personal financial resources to buy their own supplemental care. This scenario is what opponents of expanded government dread. In it they see the rise of big government and the death of personal control of healthcare. The inability to predict this future makes proving or disproving this possibility nearly impossible and stymies the resolution of the healthcare problem.
In the free enterprise system, the role of government is to regulate the marketplace, not to be a participant in it. Virtually every entitlement program (Social Security, Medicare, etc.) costs more than projected when it was passed, grows with the addition of more benefits over time, and either leads to increased taxes or debt. Social Security, when passed, set 3% as the tax on personal wages and employers effective in 1948. Today that rate is 6.2%. Tennessee’s version of Medicaid (TennCare) began in 1994 with a budget of $2.6 billion. Ten years later it cost $8 billion – about one-third of the entire state budget. The number of insured parties remained fairly constant around 1.3 million persons, or about 1 in 4 residents. In 2005, the program went through massive change because of its unsustainable cost. Good intentions created mixed effects on the road to expanded healthcare.
Gains in administrative costs achieved in N/S healthcare systems, can be negated by the political expansion of benefits. We end up spending more than we save. For that reason, more direct government intervention in healthcare does not seem like a long-term, cost-effective solution. Finding ways to increase the efficiency and reduce the costs of private healthcare would seem to be a way to achieve the gains without the political problems.
Tuesday, September 1, 2009
Healthcare Installment #8. Please start with post of 08/25/09.
Immigration and Healthcare
A sore point with some taxpayers is the use of government funds to provide healthcare for immigrants. There are two kinds of immigrants – legal and illegal. Legal immigrants are supposed to be supported by their sponsors so that they do not need government healthcare. That has been government immigration policy since the founding of the republic. In practice, it does not always happen that way. Illegal immigrants, by definition, fail to meet that requirement.
The result is that less-educated, lower-earning immigrants (more illegal than legal) place a burden on healthcare because they cannot afford to pay for it themselves. The nation gets the benefit of cheap labor that lowers consumer prices, but at the cost of subsidizing some immigrants’ healthcare. It is unrealistic to expect sick immigrants not to want medical care and to get it if they can. We are all human. The solutions to this burden on healthcare costs are to clamp down on immigration or to help immigrants earn wages where they can pay for their own care. The former solution would appear to be much faster to implement than the later.
Paying for Healthcare
Solutions to the healthcare problem are many and varied and endorsed and denied by various groups. One reason for this diversity is the variation in the prices paid depending upon who does the paying. What you think may depend upon how you get and pay for your coverage. Here are some examples.
A sore point with some taxpayers is the use of government funds to provide healthcare for immigrants. There are two kinds of immigrants – legal and illegal. Legal immigrants are supposed to be supported by their sponsors so that they do not need government healthcare. That has been government immigration policy since the founding of the republic. In practice, it does not always happen that way. Illegal immigrants, by definition, fail to meet that requirement.
The result is that less-educated, lower-earning immigrants (more illegal than legal) place a burden on healthcare because they cannot afford to pay for it themselves. The nation gets the benefit of cheap labor that lowers consumer prices, but at the cost of subsidizing some immigrants’ healthcare. It is unrealistic to expect sick immigrants not to want medical care and to get it if they can. We are all human. The solutions to this burden on healthcare costs are to clamp down on immigration or to help immigrants earn wages where they can pay for their own care. The former solution would appear to be much faster to implement than the later.
Paying for Healthcare
Solutions to the healthcare problem are many and varied and endorsed and denied by various groups. One reason for this diversity is the variation in the prices paid depending upon who does the paying. What you think may depend upon how you get and pay for your coverage. Here are some examples.
Uninsured individuals, who can least afford high prices, are charged the highest retail rate for services. (Some providers do give discounts to the uninsured, but not the equivalent to the discounts they give large insurers.) Uninsured people fall into four groups:
- Ones who pay their own way.
- Ones who get some form of government or charitable support.
- Ones who get service and simply do not pay for it.
- Ones who do without.
Insured parties get a better price, the savings being proportional to the influence of the insurer in the negotiation process (Medicare vs. Blue Cross Blue Shield).
- Employees of many larger employers have a larger portion of their premiums subsidized by the employer.
- Employees of small employers pay a larger percentage of a larger premium (more total dollars) because small employers lack the bargaining muscle to get lower premium rates.
- Self-employed persons pay the entire premium, providing they can find an insurer to cover them.
The end effect is that the same medical services are paid for at vastly different rates causing issues for both the providers trying to do the billing and the patients trying to pay the bills. Everyone from individuals, to employers, to insurers, to providers has incentive to shift the cost to the other parties in the process. This is the reason some people fear that companies would drop insurance coverage if the government offered an open-ended program. Unless maintaining insurance provides a competitive benefit by attracting better workers or retaining healthier ones, firms will transfer the cost of healthcare to the government, and thus the taxpayers. Cost and coverage still serve as incentives for employees to switch from smaller to larger employers.
So, who really pays what for healthcare?
- Individuals pay some or all direct costs and premiums depending upon their employment and insurance status.
- Employers pay a varying amount of premium charges.
- Taxpayers pay for those covered under government programs (Medicare, Medicaid).
- Contributors to charity pay for the indigent.
- Healthcare providers who donate services pay for the indigent.
- Healthcare providers who are not paid for billed services in effect make a charitable contribution to the non-payers.
- Users of healthcare providers pay "extra" to make up for those who do not pay at all (just like paying shoppers pay for shoplifters).
The government acts a charitable intermediary on behalf of society to provide care for those unable to pay. Ultimately we pay directly as individuals for our own care, or indirectly through taxation, charitable giving, or "upcharging." for the care of others. Only people who pay no medical bills, pay no taxes, and give nothing to charities get truly free healthcare. Everyone else pays. The questions are:
- "Who should get charitable support?"
- "How much should they get?"
- "What is the fairest way to do so?"
Thursday, August 27, 2009
Healthcare Installment #3. Please begin with post of 08/25/09
Is Healthcare a Right?
Further complicating the issue is the question of whether healthcare is a "right." The Declaration of Independence lists the rights to "life, liberty, and the pursuit of happiness." It is doubtful that healthcare was debated in 1776, so it leaves us with a contemporary question unique to our times.
Rights, however, are always balanced with responsibilities. Our rights to liberty and voting are balanced with our responsibility to be law-abiding citizens. Shirk the responsibility, lose the rights. Those who advocate a "right" to healthcare will also need to enumerate the responsibilities required to enjoy it and not abuse it.
Symptoms are Camouflaging Causes
The healthcare debate is badly off course because it has dealt with symptoms and has failed to address the causes. The current debate is about how to get healthcare insurance coverage (and thus care) for everyone with some question about how to pay for it. This addresses the appearance of the problem, not its causes.
Further complicating the issue is the question of whether healthcare is a "right." The Declaration of Independence lists the rights to "life, liberty, and the pursuit of happiness." It is doubtful that healthcare was debated in 1776, so it leaves us with a contemporary question unique to our times.
Rights, however, are always balanced with responsibilities. Our rights to liberty and voting are balanced with our responsibility to be law-abiding citizens. Shirk the responsibility, lose the rights. Those who advocate a "right" to healthcare will also need to enumerate the responsibilities required to enjoy it and not abuse it.
Symptoms are Camouflaging Causes
The healthcare debate is badly off course because it has dealt with symptoms and has failed to address the causes. The current debate is about how to get healthcare insurance coverage (and thus care) for everyone with some question about how to pay for it. This addresses the appearance of the problem, not its causes.
Because there are many causes behind the healthcare dilemma the country faces, it makes finding solutions especially problematic. Here are some of the contributing causes:
1. There is no healthcare "system."
2. The focus is misplaced on health care instead of healthy living.
3. The possible costs for healthcare technology and services for everyone exceed a realistic share of personal income from those able to pay.
4. The marketplace is distorted so the usual consumer-driven dynamics do not work to promote improvement and cost reduction.
5. Who pays for healthcare and how they pay is convoluted and hidden.
6. In the absence of significant personal wealth, the unpredictability of health makes risk-sharing through medical insurance a necessity.
7. An aging population naturally increases healthcare needs and costs.
8. Entry to the healthcare profession is expensive and the field is understaffed.
No Healthcare "System"
There is no healthcare "system" in the United States. A system is, by definition, "a regularly interacting or interdependent group of items forming a unified whole." There is nothing unified or whole about the U.S. medical system. It consists of a multitude of diverse providers in every locale, a multitude of insurers including the government, and a vast array of policies and procedures through which they do business – much of which is not standardized across groups. It does not rise to the level of a unified system and it is therefore incredibly difficult to increase its productivity and cost effectiveness.
Improvements to individual elements like hospitals are necessary, but not sufficient to improve the "system" as a whole. Any attempt to improve healthcare must begin with improved standardization, communication, and coordination through shared policies, procedures, practices, and information networks across the nation.
Healthcare may require a paradoxical solution – mass customization. That is, "producing goods and services to meet individual customer's needs with near mass production efficiency." In healthcare, it is standardizing operations while adapting them to the unique needs of each patient. Health services are distinctly different from industrial systems in that the incoming raw material (the patients) is subject to wide variations. (No intent here to dehumanize patients, just trying to draw a comparison.) Most processes require a consistent input to run correctly. Variations in human beings require health service providers to adapt their processes across a wide range of inputs. This complicates standardizing processes to achieve efficiencies. Healthcare providers can borrow from industry, but probably not replicate it.
As an example of changing the entire system, imagine for a moment, a USB thumb drive medical "card" that contains all pertinent patient information required when registering at a doctor’s office or hospital. It eliminates all paperwork for registration across all providers. That standard card contains the customized data for each patient. Patients, or staff when authorized, could update certain data on the drive. The drive would trigger an automatic notification to the provider regarding insurance coverage whenever the drive was used for patient registration. That would eliminate the questions about whether insurance coverage was current. The magnetic strip on a credit card works in a fashion like this. This is not intended as a flawless example, just a way to see a systemic change.
Wednesday, August 26, 2009
Healthcare Installment #2. Please read prior post.
Generosity Underlies "Free" Care
In times of surplus, the American people are especially generous. In times of financial adversity, it is difficult to be as generous. Thus, presenting costly healthcare reform in today’s economic climate could not come at a worse moment. It hugs the heels of huge deficits by both the Bush and Obama administrations. The first to fund wars, the second to fund a stimulus program filled with benefits (nice or necessary?) for which we must pay later. It is no surprise that reform requiring more government spending (borrowing) is virtually dead on arrival today as far as fiscal conservatives are concerned. The government has been selling the country’s collective financial soul to the devil of debt for too many years and some tax payers can see the bill coming due.
The Responsibility Dichotomy Creates Friction
We are being confronted by an emerging dichotomy in the population. There are those citizens who exert self discipline and live responsibly as evidenced by healthy lifestyles and solid personal finances. Then, there are the citizens who eat poorly and exercise little and those who are unable or unwilling to manage their personal finances properly. The epidemic of obesity and the housing market collapse due to bad borrowing are two examples. The responsible citizens are growing tired of a government that seems bent on protecting irresponsible persons from enjoying the consequences of their poor decisions. They realize their prudence and hard work are being used to pay for the ignorance and sloth of the irresponsible group. This is not sitting well with members of the electorate who are asking "Where is my bailout?" When individuals, or nations, fail to exercise self-control, it opens the gate to external forces in the form of disease, marketplace corrections, or actions by other nations to fill the gap. As examples, we have diabetes, the housing market collapse, and interest by other countries in moving off of the dollar as the world currency. If we don’t get our acts together, some other force will do it for us. Too many citizens appear to be coasting on what made America great. They need to start pedaling.
Philosophical Differences Drive a Divide
There are also those citizens who are engaged and enraged by the prospect of more government, simply because they do not believe in big government. They see life as a personal challenge to be met by individual effort where success is rewarded and failure is an unpleasant fact of life that contributes to self-motivation. On the other side are those who believe government has a responsibility to the less fortunate, who through no fault of their own, are dealt a bad hand by life. When it comes to healthcare, this could be persons born with medical problems, those incapacitated by accident or disease. Since they are unable to help themselves, as human beings they are deserving of compassionate help from their fellow man. When private charity is insufficient to help this group, then government should step in. Medicare (for the elderly and disabled) and Medicaid (for the impoverished) are programs representing that philosophy. It may be impossible to reconcile the beliefs of these two groups and the final triumph may belong to the group that musters the largest political muscle in the form of votes and contributions. If the Democrats push a bill through Congress by totally bypassing Republicans, it will be this dynamic at work. In a win-lose scenario like this, the losers will not forget and resistance will continue in other ways.
In times of surplus, the American people are especially generous. In times of financial adversity, it is difficult to be as generous. Thus, presenting costly healthcare reform in today’s economic climate could not come at a worse moment. It hugs the heels of huge deficits by both the Bush and Obama administrations. The first to fund wars, the second to fund a stimulus program filled with benefits (nice or necessary?) for which we must pay later. It is no surprise that reform requiring more government spending (borrowing) is virtually dead on arrival today as far as fiscal conservatives are concerned. The government has been selling the country’s collective financial soul to the devil of debt for too many years and some tax payers can see the bill coming due.
The Responsibility Dichotomy Creates Friction
We are being confronted by an emerging dichotomy in the population. There are those citizens who exert self discipline and live responsibly as evidenced by healthy lifestyles and solid personal finances. Then, there are the citizens who eat poorly and exercise little and those who are unable or unwilling to manage their personal finances properly. The epidemic of obesity and the housing market collapse due to bad borrowing are two examples. The responsible citizens are growing tired of a government that seems bent on protecting irresponsible persons from enjoying the consequences of their poor decisions. They realize their prudence and hard work are being used to pay for the ignorance and sloth of the irresponsible group. This is not sitting well with members of the electorate who are asking "Where is my bailout?" When individuals, or nations, fail to exercise self-control, it opens the gate to external forces in the form of disease, marketplace corrections, or actions by other nations to fill the gap. As examples, we have diabetes, the housing market collapse, and interest by other countries in moving off of the dollar as the world currency. If we don’t get our acts together, some other force will do it for us. Too many citizens appear to be coasting on what made America great. They need to start pedaling.
Philosophical Differences Drive a Divide
There are also those citizens who are engaged and enraged by the prospect of more government, simply because they do not believe in big government. They see life as a personal challenge to be met by individual effort where success is rewarded and failure is an unpleasant fact of life that contributes to self-motivation. On the other side are those who believe government has a responsibility to the less fortunate, who through no fault of their own, are dealt a bad hand by life. When it comes to healthcare, this could be persons born with medical problems, those incapacitated by accident or disease. Since they are unable to help themselves, as human beings they are deserving of compassionate help from their fellow man. When private charity is insufficient to help this group, then government should step in. Medicare (for the elderly and disabled) and Medicaid (for the impoverished) are programs representing that philosophy. It may be impossible to reconcile the beliefs of these two groups and the final triumph may belong to the group that musters the largest political muscle in the form of votes and contributions. If the Democrats push a bill through Congress by totally bypassing Republicans, it will be this dynamic at work. In a win-lose scenario like this, the losers will not forget and resistance will continue in other ways.
Tuesday, August 25, 2009
Analyzing Healthcare - Installment #1
This is the first in a series of posts looking at healthcare and healthcare reform in the USA. This material is not a proposed solution to the healthcare situation. It is an effort to clarify some of the factors and dynamics driving the situation in order to enrich the dialogue about improving the current state of affairs. Hopefully, it gets at some of the "why" behind the many divergent points of view. It does have opinions imbedded in it as well as plain facts and observations. Whether you agree or not, if this expands your thinking, it has served its purpose. Some of the points are self-evident but are included to provide a fuller framework for the discussion.
Frames of Reference
Failure to see others points of view leads to dead end dialogue. In the debate on healthcare, it is easy to see the situation and seek a solution from a purely personal frame of reference. That reference is influenced by our own personal health experiences and expenses.
If a person has enjoyed good health and lived responsibly, it is probable he believes individuals are responsible for their own health care and should not be propped up by taxpayer programs. An individual who has suffered poor health brought on by forces beyond his control may see the benefits of having care provided through government programs because there is no other affordable alternative available.
Seeing the situation from various perspectives can open up territory for exploring mutually acceptable solutions. From shared values can come common goals. From common goals can come common strategies and tactics. To find common ground means sharing the same frames of reference. Each topic that follows is an attempt to help increase our personal frame of reference. The central points that emerge repeatedly deal with: economics (cost), who gets free healthcare (compassion), how much do they get (content), who makes medical decisions (control), and who pays for it all (contribution). These five "Cs" can define a frame of reference.
Health is Priceless
Health is unique among all aspects of life since it affects life itself. Without good health, little else matters. Thus, the price we will pay for it is high and the market reflects this. In addition, it becomes difficult to view it from a strictly rational point of view when confronted with very personal circumstances.
The two objectives of affordable and universal healthcare are grand and difficult for anyone to deny. The crux of the problem is whether or not such goals are truly attainable. The devil is in the details and the current debate mixes grand visions with pragmatic problems without highlighting the difference. It appears that the people with the vision cannot complete the details to achieve it. The people who know the details see no way to achieve the vision. Debate teeter totters back and forth on this impasse. Because healthcare is not free, it becomes an economic decision as well as a medical and moral one.
More posts to follow each day.
Frames of Reference
Failure to see others points of view leads to dead end dialogue. In the debate on healthcare, it is easy to see the situation and seek a solution from a purely personal frame of reference. That reference is influenced by our own personal health experiences and expenses.
If a person has enjoyed good health and lived responsibly, it is probable he believes individuals are responsible for their own health care and should not be propped up by taxpayer programs. An individual who has suffered poor health brought on by forces beyond his control may see the benefits of having care provided through government programs because there is no other affordable alternative available.
Seeing the situation from various perspectives can open up territory for exploring mutually acceptable solutions. From shared values can come common goals. From common goals can come common strategies and tactics. To find common ground means sharing the same frames of reference. Each topic that follows is an attempt to help increase our personal frame of reference. The central points that emerge repeatedly deal with: economics (cost), who gets free healthcare (compassion), how much do they get (content), who makes medical decisions (control), and who pays for it all (contribution). These five "Cs" can define a frame of reference.
Health is Priceless
Health is unique among all aspects of life since it affects life itself. Without good health, little else matters. Thus, the price we will pay for it is high and the market reflects this. In addition, it becomes difficult to view it from a strictly rational point of view when confronted with very personal circumstances.
The two objectives of affordable and universal healthcare are grand and difficult for anyone to deny. The crux of the problem is whether or not such goals are truly attainable. The devil is in the details and the current debate mixes grand visions with pragmatic problems without highlighting the difference. It appears that the people with the vision cannot complete the details to achieve it. The people who know the details see no way to achieve the vision. Debate teeter totters back and forth on this impasse. Because healthcare is not free, it becomes an economic decision as well as a medical and moral one.
More posts to follow each day.
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