Some Healthy Health Care Dialogue

Yesterday I spoke out about this looming public health "option," and I got some great feedback from readers! First, I want to thank all of you for reading and challenging me on the content. This blog is just as much about educating myself on issues as it is my readers. I had a reader yesterday leave me some lengthy comments, as health care is an issue that she is very passionate about, and it is also the field in which she works. This was my vision for this blog, to get people talking, thinking and educating themselves. I have learned things from her and hopefully vice-versa as well. Keep the comments coming! In the meantime, check out the dialogue. First read her comments here (it's the first two comments) and see my response below.

My response:

I knew you were going to respond to this one. This is your arena, and I was very much looking forward to what you would have to say. I actually considered emailing you the text before posting it to see if there was anything factual I needed to change. However, after reading your objections I don't think there's much I would have changed; maybe a few clarifications. Here is your requested explanation of my statement: I know I made a generalization, but I'm looking at the system as a whole. Answer me this (and this is completely anecdotal).... would you rather visit an average doctor in the U.S. or an average doctor in India or the UK? Give me your gut feeling (and don't try to define "average"). I'm willing to bet that if you pooled them all together, the doctors in the U.S. are going to be superior to those in the other countries. That's all I'm saying.

Public health is obviously your area of expertise, so you're going to have plenty of niche stories to tell about failing hospitals and/or demand data to measure "brightest and best." I could too, just look at Grady. Of course, in Grady's case you had poor management and a power-hungry board as one of the main contributing factors to their demise. There are a LOT more factors that go into a failing hospital than the effects of the overall health care system. Charity Hospital in New Orleans was a PUBLIC hospital, just like Grady. Do you see a pattern here with the government-run institutions? Why are you advocating moving the entire system to that? I respect you as a highly intelligent and educated person, and I have always valued your opinions. I especially wanted to hear your opinions on this topic (and I'd like to discuss it further in person). I just can't wrap my head around why someone like yourself could possibly advocate more government intervention in the health sector when it has clearly proven to fail everywhere it has been tried. Government intervention is one of the problems with the current system, not the solution.

Sure, there are some great hospitals in India and the UK. I never said that the U.S. has the best health care and technology in EVERY case. Can you honestly tell me, though, that their health care systems as a whole are better than our own? We could find one-off examples all day to refute both sides of our arguments. I've never said that there aren't failing hospitals and areas that need to be reformed. I'm just looking at the system as a whole, entirely appropriate for the purposes of my article.

Please re-read the last part of the statement you quoted. I said "insurance infrastructure." I didn't say "industry." The infrastructure is there to support most people. We need to make some changes to the systems that the infrastructure supports. And what is your definition of "most"? Let's say the true number of uninsured is about 30 million. There are 300M people in the U.S. right now. That's 10%. Last time I checked, 90% was "most," so how is that wrong, as you claim? I don't know what you're basing your claim on that we're one of the least healthy industrialized nations (I'm also not refuting it), but we're unhealthy because we choose to be. We're unhealthy because people choose to eat at McDonald's 5x per week. I have lived in and visited foreign countries and the eating habits and life habits of some are much more healthy than ours. I would argue that most of it isn't due to lack of care. A doctor can't make someone thin. That's personal choice.

I know the reason to care about non-US citizens, but first let me say this. I have never said that I was "better than them" because I am a citizen and have health insurance. I'm a citizen, which makes me legal and being a citizen gives me certain rights and privileges, because I pay taxes. Countries have immigration laws for a reason. Sooner or later you run out of other people's money, and the simple fact is that the U.S. cannot financially sustain having to support 20 million illegal immigrants. No, their lives are not any less important, but they are willingly breaking the law. What if an illegal immigrant came to your house every night and stole half of your food? Every night. You worked for it. You paid for it. But they need it because they are illegal and can't get a salaried job. Is that okay with you? Or are you going to let them do it, because you are not "better than them" and they should be able to do whatever they want, regardless of the law? Health care is no different, nor are government services. It's stealing, plain and simple.

I actually had the ER example in the first draft of my post, but I took it out: "The illegals DO have access to health care via emergency rooms, courtesy of the taxpaying citizens of the United States and/or hospital owners. The access that they have to health care is probably better than what they get in their own countries. The fact is that we do have incredible access to health care compared to many parts of the world." That's the part I cut out. However, that's not, like you said, a health care issue. That's an immigration issue. I agree that preventive care would solve a lot. Keeping them out of our country would save even more. They shouldn't be allowed to freeload off of our system. We don't need to give them drivers licenses though!!! We need to get them out of this country. Do you think that the illegal use of our health system is going to get any better under a public option? Where is the accountability or economic incentive? It's going to get worse! You're exactly right when you say that " when emergency room costs go up because patient volume goes up, the hospital has to charge more per visit/procedure." Fixing that is one of my solutions. Fix the problem with illegals and others freeloading off of our system and the cost of health care goes down. When the cost goes down, health premiums go down and more people will be able to afford it. It would be cheaper for me AND the citizen who previously couldn't afford insurance.

It's clear that Obama and Congress want to socialize medicine, and the fears aren't irrational at all. Yes, I will still have to pay for health insurance, but it won't be anywhere close to what I'm paying now. Under Obama's plan I will not only be paying for my own health insurance but that of other people as well. If I'm paying for my own as well as others then that means I am going to receive less in return for my money. That's a cost increase. Less care for the same amount of money will eventually equal inadequate care. Four and a half months to wait for an MRI? That's exactly what will happen, because we'll have to ration health care. I think it's irrational NOT to think that the government wants to socialize health care. I think it's completely irrational to think that it will actually work. Can you really tell me that the UK's and Canadian systems are working? They're not.

I really want to know how you can say that Medicare and Medicaid are working. Medicaid is projected to be bankrupt within the next nine years. How is that possibly "working"? I would also greatly appreciate it if you could lose the condescending tone when you put words in my mouth like "lowly medicaid patients." I never said that, nor did I remotely refer to their clientele anywhere in my post. The answer to your question, however, is yes, the fact that my doctors see Medicare and Medicaid patients DOES affect my care. It affects the cost of my care, and in some cases I could make an argument for it affecting the quality of it as well. The government reimburses doctors at a far lower rate (as in, below the actual cost of the care) for Medicare and Medicaid patients than private insurance or out-of-pocket payers. Same as in the ER, they make up for it by charging other patients more. The money has to come from somewhere. In my case, my health insurance premiums go up. Many of those people who are uninsured likely would be able to afford health insurance if the premiums dropped. If doctors were reimbursed at a true market rate rather than the percentage that they get from Medicaid/Medicare then they could potentially use that money to make more investments in equipment, thus impacting the quality of my care. They could also lower costs in general, possibly making care more affordable to out of pocket payers. Again, this doesn't involve government, but everyone benefits.

Regarding your HMO/PPO limited choice example, you are making the assumption that I'm not proposing any changes to the current system. I am ABSOLUTELY NOT saying that we don't need reform, and I made that very clear in my post (look at the 5th sentence of the first paragraph). I also never said that the current system was a free market. If it was truly free then we'd be able to buy insurance across state lines. I've seen concrete examples of plans in Iowa costing $99 and the same plan costing almost $400 in New York City. It just so happens that New York is one of the three most regulated insurance industries in the country. Do you think there's a correlation there? I'm willing to bet there is.

We both agree that the current system is not working. The solution, though, is not government.