Health Reform

Health Care (“Healtho”)

Between the idea and the act lies the wasteland.   Between the theory of the best health care system lay politics. Obama and the progressives have only passed what they could get through Congress.  Obamacare may turn out to be worse than what we had — for all groups in the long run.  Sure, it was great for the millions who got free health care, but it has been worse for those whose medical insurance doubled, they got less services, and they lost their doctors.  But this systems satisfies the Progressive agenda:  take from the rich and give to the poor — that is, take from the contributors and give to the non-contributors.  The current health system may contribute to the country’s bankruptcy as well.

As Bill Clinton once said, “let’s do the math.”  President Obama said that we could expand health care to 40 million Americans, expand Medicaid, keep Medicare, providing the same Medicare services, keep the same tort system, lower taxes on the middle class, and save money, and give free health care (medicaid) to 14 million Americans.   Let’s do some Obama math:  2 + 2 = 3.  Hmmm, something sounds fishy.

The only possible argument for Obamacare is that it is better than our old health system, which we can call “Sicko.”

The main problem with Sicko and Obamacare is that it is based on free enterprise, and health care is not conducive to the realities of free enterprise. With Sicko and Obamacare, a person gets sick or is in the process of dying and she is surrounded by licensed professionals trying to make as much money as they can for themselves. And outside of this circle is a circle of profit makers — called lawyers — waiting for a mistake to happen so the patient can sue Sicko.  Then the patient can get rich, and the lawyer can get a 30% of the cash.

The reality is that a doctor is makes income from the amount of procedures he performs, the sophistication of the procedures, and the number of patients he sees. Because of this decision making process, he cannot make the best decision for the health of the patient. He will usually make a decision based on these three variables: 1) the health of the patient; 2) the amount of income he will make from the decision; and 3) the probability of a suit, which will raise his insurance costs.

The result of these realities is the characteristics of Sicko: 1) More patients are seen than needed to be seen; 2) More expensive procedures are done than needed to be done; 3) the unneeded procedures often hurt the patient more than they help him; 4) the money used for useless procedures is taken from people who really need medical care; 5) harmful and expensive procedures and tests are done for the sole purpose of avoiding expensive lawsuits; and, finally 6) Sicko costs more and does less for the health of the society than any other major health systems in developed countries.

A Proposed Health System (“Healtho”)

It is acknowledged that Healtho probably could never be passed in the U.S. Congress for various reasons. These reasons include:

1) The public’s almost religious belief that the free-enterprise system is reality’s only economic system and that it can solve any problem. That is, individual’s pursuit of economic self-interest and “the unseen hand” will create the best solution to any problem.  Thus, everyone pursuing their economic self interest — including the patient — will result in the best health care system possible. Another logical consequence of the belief in radical free-enterprise is the taboo against any form of “socialism,” that is the government solving major problems.

2) The pollution of Congress’ and the President’s mind with lobbyists. Virtually every political election is heavily polluted with large contributions from lobbyists. This includes the tort lawyers who have the democratic party in their pocket.  The result is that individual lobbyist’s interests get synthesized in the politician’s mind, and compromise his ability to think with pure reason and pursue the main goal of any authentic political leader: to create policies that are good for all groups in the long run.

The best possible Healtho — one that RG proposes — will have these characteristics.

1) Healtho will be significantly paid for by value-added taxes on unhealthy foods and unhealthy products. Thus the following foods would be heavily taxed: all meats, all foods with harmful additives, all fats, all sugars, and so on. The following products would be heavily taxed: cars without electric or hybrid motors, oil and other scarce resources, and products with harmful chemicals. Healthy foods, especially raw fruits and vegetables, would not be taxed at all, and even subsidized.  Thus organic food, solar panels, and small hybrid cars could be subsidized.

One argument for these taxes on destructive foods and products is that taxpayers have to pay for the effects of people consuming these foods and using these products.  For example, meat eaters have a significant higher probability of getting the major western diseases — cancer, heart attacks, and dementia –and those consuming sugar have a higher probability of getting diabetes.  Taxpayers pay for these costs of treating these disorders, with the proposed socialized medicine or the current mandated Obama medical insurance. In a similar way, in the long run, the products contributing to global warming have consequences — floods, fires, and environmental deterioration — and the costs of these disasters are paid by taxpayers.  Also, every person must suffer the consequences of the destruction of the environment and the killing off of animal species — especially food producing species, such as fish — which is caused by the increased scarcity of natural resources and the pollution of the environment.

There’s no reason that the people who are using these products shouldn’t pay more for their destructive consequences.

2) Healtho would be basically socialized medicine. Most doctors could be eventually be on salary and the government would pay their salaries. Their medical decisions would not be based on their profit or income but what was best for the patient. Only the highest quality of students and prospective doctors would be admitted into medical school, and one of the qualifications would be their dedication to the health of the people of the society. Once admitted, their tuition would be paid and they would be paid between $20,000 and $30,000 for attending school and going through training.

After their training, they would get salaries starting at around $100,000 a year. With this generous system, medical schools would attract the not only the best and the brightest, but also those persons who are dedicated to the health of the nation and not to their personal financial wealth.  This system could attract the best potential doctors.

Primary doctors would be paid the most and specialists less so. Doctors could be mandated to go to needed geographical areas for a period of time. There could be a draft or lottery system. The doctors would be evaluated every year by their patients and by health economists. Their salaries would increase on the basis of these evaluations. Whether they worked in their own practice or for a big clinic and how the technology would be supplied would be worked out in a flexible and reasonable way.  Doctors wouldn’t be burdened by high student debt, insurance costs, and threats of suits.

The government would pay for all costs of basic health care, leaving the businessmen and the individuals free of the costs. Basic and cost-efficient health care would be provided for. Unneeded, untested and cost-inefficient care could be provided by private pay to private doctors. The government would be responsible for basic health care and the individual would be responsible for all other, elective, health procedures.

It must be realized that if all the health procedures and medicine that modern technology makes possible were given to all people who demand them — free — the economy would be bankrupt in a short time. Also there is no realistic way everyone could — or should — receive the same health care. People will more money could always get less cost-inefficient and less essential health care.

3) There would almost be an elimination of malpractice suits. Medical malpractice lawyers would be out of business. If a medical mistake was made, or if there was a malpractice incident, the victim would be taken care of his entire life and the doctor punished in some way — perhaps even revoking her license — but the patient and her lawyer would not get rich.

4) There would be assertive public policies to increase healthy lifestyles. The general idea would be that if a person lived an unhealthy lifestyle, for instance, abusing food, alcohol, nicotine or other drugs, he would have to pay for some of the costs for his consequential health care. He couldn’t expect the public to pay for his unhealthy choices.

5)  The public would have to accept the reality of eventual suffering and death and the inability of the economy to support all the costly technological procedures that make it possible to extend one’s life a few more months at the end of one’s life.  If a person wanted to extend their life for a short time at a high cost, they could buy private insurance to cover these costs, pay for the costs out of their own pocket, or have their extended family pay for the costs.

Conclusion

With the money we spend and the talent we have, we can have at least as good of a health care system as any country on earth. And why not? If another country has a better health care system for less money, why not try their system?  On the other hand, we must avoid trying to create a health system that is unrealistically idealistic and impossible to pay for (usually with other people’s money).