Thursday, September 10, 2009

Arguments against the arguments (for not having national health care in the US)

I'm not in the US, but I've been watching the debates for and against national health care with interest. My friend (the one who had to go back to England) and I used to talk about it all the time. In England and Australia it works quite well. Someone on Etsy argued for not having National Health Care, then someone replied to those arguments. What do you think?

These cons are *possibilities* not likelihoods, and some of them are remote possibilities. Furthermore, there are existing government services that contradict some of the posited cons.

*1*There isn't a single government agency or division that runs efficiently; do we really want an organization that developed the U.S. Tax Code handling something as complex as health care?

--- Talk about choosing examples of convenience... Your government also runs your military. Apparently the US military system has been deemed to be well run/effective/efficient by the repulicans (and even other nations.) Who's to say that healthcare would "look" more like the failings of the tax system, rather than the successes of the military system?

*2*"Free" health care isn't really free since we must pay for it with taxes; expenses for health care would have to be paid for with higher taxes or spending cuts in other areas such as defense, education, etc.

---- Nothing in life is ever free. Who said this healthcare would be free? The healthcare would be paid for by the users. Overall costs are reduced when "wholesale" prices can be negotiated. These prices can only be negotiated if there a significant number of users making use of a single system. Some users might find they have more services available at a lower cost in a public optioned system (if there are a large enough number of users to create leverage to reduce overall costs of services.)

*3*Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness.

------- Erm... It appears the opposite is true in the current American healthcare system. On average, American healthcare costs are nearly double that of Canadians, who are currently under a public system. In fact, the very reason why system reform has become an issue is because healthcare costs have contravened the traditional trajectory of free market systems. As such, it appears that somehow, somewhere, the structure of healthcare in America is fundamentally flawed, or run from an economic system that is not capitalist at its root.

*4*Government-controlled health care would lead to a decrease in patient flexibility.

--- Patients are already complaining of a lack of flexibility with the current system. As such, this con is complaining about a problem that already exists, and would not be new. A system with increased number of contributors would actually *generate* flexibility when care options can be purchased wholesale... reduced costs overall for basic treatments means that even expensive treatments that are relatively rare *could* be covered.

*5*Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now.

--- This con is referring to "frivolous use of services." While it is true that there may be a flood of "new" patients in the initial months/years, this is simply due to those individuals who will be seeking treatment for existing conditions/checkups because they could not do so before. This initial flood will wane after time, and a normal "flow" of patients will settle. Generally patients under a public system make no more or no fewer visits than patients who are insured. Another point to consider is that patients may actually have *fewer* visits if we consider healthcare over the lifespan... preventative care early in life generally leads to LESS dependence on healthcare services later on since minor conditions/or risky behaviours are LESS LIKELY to develop into long term chronic conditions.

*6*Just because Americans are uninsured doesn't mean they can't receive health care; nonprofits and government-run hospitals provide services to those who don't have insurance, and it is illegal to refuse emergency medical service because of a lack of insurance.

--- apparently 46 million americans are unable to obtain insurance. Lack of insurance means that americans cannot take preventative measures to maintain their health. lack of prevention explodes into chronic illness. if one is admitted to emergency due to illness, their condition has reached a life threatening stage, and they may die from what may have been preventable. furthermore, emergency services don't provide follow-up care, or respond to chronic conditions that only require medical maintenance (as opposed to treatment.) Can charities bear the burden of care for 46 million americans? a better question: *Should* charities bear the burn of care for 46 million americans?

*7*Government-mandated procedures will likely reduce doctor flexibility and lead to poor patient care.

--- Possibly, however this isn't the case in all the other developed nations who enjoy their universal access to healthcare. Certainly, there are complaints about poor services, just as there are complaints about poor services in any other industry where humans interact. Also, doctor flexibility may be increased, since they will be able to provide treatment to patients without having to consider which components of a treatment, or which treatments, a patient can afford. Essentially, a doctor's prudence, and patient choices of treatment options, will dictate care; rather than the amount of money a patient has in their bank account.

*8*Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, etc.

---- Certainly. And those who don't mountain climb, or ride bikes will have to pay for the costs of those who incur injury as a result of their hobbies. Also, those who are hurt in heavy industry jobs will "cost" those who have less risky desk jobs. So what's the issue?

*9*A long, painful transition will have to take place involving lost insurance industry jobs, business closures, and new patient record creation.

---- certainly some jobs will be lost, however other jobs will be created, as is the natural flux of job creation in capitalist systems. is this "con" suggesting that the current (failing) system should be immune to the freemarket economy... somehow by "staying afloat" even when it is clear the services offered/affordability are failing its customers? and in any place where there is change, transitions are expected to be relatively difficult, simply because what is being done is "new." Are we suggesting, in this con, that America, the land of innovation, abstain from "transition" simply because it might lead to personal discomfort? Wasn't americal "built" on personal discomfort of a sort?

*10* Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession.

------ All fields/industries have a natural "cap" to wages. (One can only work so many hours at a day, and the free market determines the cost of labour/service, hence there is generally an upper limit to earnings.) These wage caps, which are bread by the capitalist system, are generally a consideration for those interested in professional careers. There are other job options, if one is interested in earning more, less, or the same wages. We live under a capitalist system where people are free to choose whatever job they like, based on the considerations that are most meaningful to them.

*11*Malpractice lawsuit costs, which are already sky-high, could further explode since universal care may expose the government to legal liability, and the possibility to sue someone with deep pockets usually invites more lawsuits.

---- All of this con is conjecture, of course. Would there be more or less legal liability under a system where access to care and barriers to care are reduced? This is an important question to consider. Also, the government, under public systems, is generally a "payor" where the hospitals/clinics/doctors are private providers of service who are compensated by the payor. How is the government responsible for services that are provided by a hospital? Wouldn't it be the hospital's duty to take measures to reduce liablity claims... like having highly trained staff, or writing in non-liability in it's "care" contracts with patients (as insurance cos do at present, and as is being suggested by the GOP)? (All patients have to legally consent to a treatment, and the non-liability could be an aspect of consent, unless the medical notion of "duty of care" is contravened.)

*12*Government is more likely to pass additional restrictions or increase taxes on smoking, fast food, etc., leading to a further loss of personal freedoms.

---- having to pay more for a product does not reduce freedom in ANY manner, it simply means that a product costs more. Losing limbs or livelihood due to lack of access to care, however, may have serious consequences on the notion of "personal freedoms." Furthermore, with obesity on the increase, should the cost of nutritious food remain higher, calorie for calorie, than the cost of less nutritious food (as is the present case)? By reducing the cost of nutritious food, and increasing the cost of non-nutritious food, would we be creating "incentive" for people to make better food choices? And where diet is an enormous factor in preventing chronic illnesses like diabetes, heart disease, and some cancers, wouldn't it be somewhat *prudent* to make it more expensive (thus prohibitive) to consume poor-quality food?

*13*Patient confidentiality is likely to be compromised since centralized health information will likely be maintained by the government.

---- I don't understand how centralized health information =/= compromised confidentiality. The goverment will do as well on this issue as it does with other areas where confidentiality is expected, such as social security numbers, taxes, information collected as a part of military service.

*14*Health care equipment, drugs, and services may end up being rationed by the government. In other words, politics, lifestyle of patients, and philosophical differences of those in power, could determine who gets what.

--- At present health care is rationed to those who are able to pay. The "rationing" those who cannot afford to pay is: nothing. As such, rationing, technically, already exists. At present, politics, philosophical differences of those in power currently DO guide distribution of services; the present politics and philosophies dictate that those who are able to pay are those who should have access to services. It also dictates that those who are unable to pay need beg, borrow, or sell their material goods to afford healthcare. It also dictates that in the absence of charity or worldly goods to sell for healthcare, a person is undeserving of healthcare, unless they are dying in an emergency ward. The present system also considers the lifestyle of patients in the distribution of healthcare... those seeking insurance need fill out extensive questionaires to determine the costs and services provided under their insurance. Smokers, the obese, those with "risky" lifestyles generally pay more in insurance fees than others. Under public systems, generally each pays into the payor system based only on one factor: their income (through taxation).

*15*Patients may be subjected to extremely long waits for treatment.

---- Treatment is based on triage. Those in the most life threatening circumstances are treated first. Is there a problem with waiting for an elective procedure, such as a skin tab removal, or knee laroscopy, when a person may die if they are not treated before you are? Also, most treatments have a window where they are most beneficial... for example one can't wait too long to get a cast on a broken limb, otherwise the bones will continue to reknit, resulting in deformity, or a need to "rebreak" the bone. and one can't wait for treatment for cancer. Treatments under public systems are provided in their "beneficial window," just as they are provided under private care. Generally these windows are outlined in Medical Association approved treatment practices, which are practices that are endorsed and applied under currently existing public systems.

*16*Like social security, any government benefit eventually is taken as a "right" by the public, meaning that it's politically near impossible to remove or curtail it later on when costs get out of control.

------ Most nations with public systems understand that their access to healthcare is not a "right" in the formal sense. Moreover, public access to healthcare is considered a *privilege* of living in a developed nation. Why is America, a developed nation that prides itself on innovation and its ability to transcend virtually all oppressions, denying its citizens of a privilege that every other developed nation is currently enjoying? Is America oppressing its citizens by denying them a public healthcare option? Has America become a nation for the rich, instead of a nation for all people? These are important questions to consider.

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