Politicians seem weary of hurling half-truths and insults at each other in their years-long shouting match over health care. Nobody won. All of us lost. It’s easy to blame them, but conversations with a physician friend helped me realize that lawmakers can’t work well together until voters agree on our values and goals. My hope is that this column will shed some light on key questions and help readers think through them with family, friends and neighbors. Let’s open our minds, listen, and look for ideas on which we can agree.
Three important questions are: 1) Which kinds of health care (if any) should be basic rights guaranteed to all Americans? 2) Who will pay for it? and 3) What can we do to make health care more affordable?
Hospitals and doctors practicing there are required by law to provide certain emergency services without regard to a patient’s ability (or willingness) to pay. The cost is built into the prices paid by benefit plans and by individuals who do pay. That is very clearly an undocumented tax on everyone who pays for health care. Any health care that is promised by government as a right for all Americans will be taxpayer-funded, one way or another.
Our decisions regarding which kinds of health care will be a basic right need not be an “all or nothing” choice. We could conclude that government (taxpayers) will fund some kinds of health care but not others. A government-guaranteed plan must have a way to update which services are covered based on our values, goals, scientific advances, and budgets.
By providing wellness services such as vaccinations and screening with no out-of-pocket cost, we might improve our health and reduce our long-term costs. Colonoscopy is an example of a screening that might prevent enough colon cancers to reduce lifetime costs, but it doesn’t make financial sense for short-term, employment based insurance because the savings come later in life when someone else (likely Medicare) is paying the bills.
There are high cost services that are of questionable value. Suppose that a cancer treatment has a 20 percent chance of extending a patient’s life for not more than three months at a cost of $500,000. Maybe that treatment wouldn’t be included as a government guaranteed service. That wouldn’t mean that you can’t have it. It simply means that you have to pay for it yourself through a supplemental insurance plan or out of your own pocket. Insurance companies and Medicare are already making those coverage decisions today.
The Obamacare individual mandate to purchase insurance is an attempt to answer the “Who pays?” question and (according to the US Supreme Court) it is a tax. But why do we want to levy special taxes to fund whatever health care we guarantee as a right for all? Generating government revenue is a budget issue, not a health care issue. Compare this to the way we pay for public safety. We’re all guaranteed a good, basic level of protection by law enforcement agencies and we don’t pay a special tax for that or tie eligibility to employment. If you are wealthy and want more protection you can pay for a gated community or private security. Why should paying for health care be different from paying for public safety?
The third question, regarding making health care more affordable, deserves serious attention. American health care spending is roughly double that of other high wealth nations. All of them guarantee a broad range of health services to all of their citizens. The astonishing truth is that per person American government (taxpayer) spending exceeds all health spending (including government, individuals and employers) in Australia, Canada, France, Japan, and the U K.
The reasons why our health costs are so much higher than other nations is a subject for another day. For now, I’ll just point out that citizens of other nations are getting more care for far less money. We would be wise to carefully study how they are doing that before we make up our minds about the future of American health care.
Please engage your friends and family in the discussion. What health care do they want for you if you fall ill and have limited financial resources?
CLICK HERE for the OECD website where you can explore the cost of health care, who pays and health outcomes in most of the world’s developed nations.
Below are three comparisons that I created as research for this column. You can see international comparisons and track how US spending has changed since 2010, when Obamacare was just being created. Click the chart to expand it.
TOTAL SPENDING BY NATION
GOVERNMENT SPENDING BY NATION
PRIVATE SPENDING BY NATION