Preexistence

Healthcare is in the news again – this time for passage of a Congressional House bill that few if any had read and none had had the opportunity to determine its costs or likely effects.  What little that is known is that the rich will receive a significant tax cut, while the old and most vulnerable – including those with preexisting conditions – will suffer  substantially.  The bill was criticized by the AMA and opposed by the health insurance industry.  Under the present Congress, the mentally ill have the right to own guns, but not to receive health care.  The only logic to apply to this anomaly is that Congress supports the concept of the Darwin Awards.

Rather than rant further, I suggest that we follow the old-fashioned and conservative approach to the issue, which is to weigh the importance of the issue, consider the alternative solutions and craft sensible solutions that serve the public in a meaningful and cost-effective manner.

Many consider effective healthcare a human right, and it is recognized as such in many countries, including most of Europe and even in poorer lands, such as Cuba where healthcare is one of the nation’s sources of pride.  The noticeable absence of the US from this group is defended by some under the concept of “personal responsibility”; that is,  we should all live upright lives, so that we will not get sick.  That logic, if one deigns dignify it with the word, fails in the face of most accidents and diseases that afflict individuals and it certainly holds no sway in most other countries.

The truth is that wealth or the simple luck of the insurance draw is all that protects the fortunate here.  Surely we can agree that neither should determine who should live or die.  Considering the lifetime full coverage that Congress gives itself, it is fair to conclude that they deem it so.

Healthcare is too expensive to provide to all Americans, some say.  The fact is, however, that much of the world disagrees, and 36 countries actually provide healthcare superior to ours under objective standards.  These range from most of Europe to Japan, Columbia and even Morocco.  That said, it is the case that healthcare in the US is by far the most expensive in the world.  Costs here are 30 percent higher than even the second most expensive country – Sweden, which ranks substantially higher than us in the quality of care.

Healthcare here takes up almost 20 percent of economic output, which is dramatically more that even what we spend on national defense.  To see how we might do better, we need merely look at other examples.  Experts categorize the alternatives into four groups.

Under the Beveridge model countries like Great Britain provide and fund most healthcare.  Hong Kong still uses this approach, and neither country has been accused of using “death panels” and other silliness.  England is one of the countries that provides better and less costly care than here.

The Bismarck model from Germany and Japan relies on government and employer health insurance.  Most insurers are nonprofit, which holds down costs.

National Health Insurance in countries like Canada is paid into by its citizens.  This primarily single source option is the reason that prescriptions there are available at costs tempting to Americans, who shop there for their pills.

There is also the out-of-pocket model which exists in most impoverished countries.  One gets care if he or she can pay, and only to that extent.  Until the Affordable Care Act, the poorest in the US operated mostly under this model, while those fortunate enough for employer-provided insurance received care as long as they remain employed or until their COBRA coverage (paid at their own cost) expired.  Medicare and Medicaid existed for limited other social classes, if they qualified.  Interestingly, both have proven relatively cost-effective over many years.

I don’t believe anyone claims that our current system is a worthy model, but what some now call “Trumpcare” is anything but that.  Surely any honest, thinking person who read and voted for it (if there are any) can rationally defend it.

Don Henley wrote that “we get the government we deserve”, a line penned first by Alexis de Tocqueville.  Whatever one’s political leanings, surely we can agree that we need responsible adults legislating for us.

I have read that marches, letters, tweets and such do little to sway politicians.  It is money that talks, and it is time, I believe, to speak up.

 

 

 

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The Last Word

After all is said and done, more is said than done.

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