At the end of my first post on America’s healthcare system I concluded that the acceptable solutions to the healthcare mess depend on one’s ideological leanings. Let’s begin by examining how those on the ideological extremes, Libertarians and Socialists, feel about healthcare:

• Libertarians (ultra conservative): Let everyone die because it is nobody’s business whether people have healthcare or not. Survival of the fittest! Healthcare Darwinism!
• Socialists (ultra liberal): Government should provide healthcare for everyone and their pets, and patients should be given a snuggly bunny and a box of Twinkies when discharged from the hospital.

OK. Let me start again.

• Libertarians: The Libertarian Party’s website states that “Libertarians believe that healthcare prices would decrease and quality and availability of healthcare would increase if providers were freed from government meddling and control. ” In other words, the government should not be involved in healthcare at all. Individuals, insurance companies, and healthcare providers should be responsible for healthcare decisions and healthcare should be like any other commodity. I choose which automobile to purchase without government involvement and I can decide based on price, quality, fuel efficiency, and color. They believe we should be able to do the same with doctors and hospitals (well…except for the fuel efficiency thing).

I don’t want to get bogged down in free-market theory, but I do know that applying it to healthcare is difficult. Under the free market I get to choose what good or service to purchase, but if I’m unconscious in an accident I lose that choice because someone will make it for me. If I live in an area with only one hospital or doctor, my free-market options are limited. And, to safeguard against bankruptcy resulting from illness, the free market pretty much forces me to purchase insurance and when I do so I surrender much of my decision making to the insurance company that, quite honestly, has profit rather than my best interests in mind. And unless there is a government regulating that insurance company I cannot be guaranteed that it will actually pay for my care. There goes the free market.

For a more in-depth explanation of why the free market will not work in healthcare, read this.

• Socialists: The Socialist Party’s website states: “The Socialist Party stands for a socialized health care system based on universal coverage, salaried doctors & health care workers, and revenues derived from a steeply graduated income tax”.  The Party also supports eliminating private health insurance companies, supports government take over and control of the pharmaceutical industry, and supports public funding of all medical care including vision, dental, mental health, and alternative medicine practices.

This view considers healthcare a basic right (like speech, religion, and voting) that should be guaranteed by the government. Consequently, everyone would receive care regardless of their income or economic status. To provide such care taxes must obviously be increased.

The major arguments against fully socializing medicine are that it takes away personal responsibility for our health, government is in essence inefficient and delivers services poorly, and during times when the economy is waning the government must reduce all spending, so healthcare availability would depend on the health of the economy.

This is a pretty good summary of concerns over socialized medicine.

Are These Options Viable?

The truth is that we are not likely to adopt healthcare plans supported by either Libertarians or Socialists.  Instead we will continue seeking something in between. Again, the acceptable “in between” solution depends on whether one is liberal or conservative, whether one believes healthcare is a “right” to be protected and guaranteed by government, and at least to some extent on one’s personal socioeconomic status.

WHAT CAN WE DO?

Continue with Obamacare

The Affordable Care Act (Obamacare) reduced the number of uninsured Americans significantly, mostly because of Medicaid expansion adopted by 31 states, and it ensured that insurance companies could not reject applicants for pre-existing conditions and that young people must be covered by their parents’ insurance through age 26. Obamacare also required insurance companies to cover several healthcare costs such as lab tests and infant care.

A good summary of Obamacare’s provisions may be found here.

Americans are evenly split on Obamacare, about half supporting and half opposing it’s policies. Americans generally believe Obamacare should not be eliminated, instead favoring a line-by-line review and reform by Congress (which would be unique since most members didn’t read it initially). As is to be expected, Democrats tend to think favorably of Obamacare and Republicans tend to think poorly of it (but remember that almost half of Americans are not Democrats or Republicans). Americans overwhelmingly agree that reducing individual healthcare costs should be a priority; today Americans spend an average of 35% of their income on healthcare, and according to some reports our average individual costs have increased under Obamacare.

There are other problems with Obamacare, some of which may be found in this summary by The Heritage Foundation, a conservative think tank.

The bottom line is that a large number of Americans are still uninsured and healthcare costs continue to climb.

SO?

 I will assume that our goal is to find solutions that cover all or almost all Americans rather than accepting the Libertarian argument (favored by only about 5% of the public).  About 60% of Americans agree that government has a responsibility to ensure health coverage, and even the 35% who say they disagree with government involvement support Medicare and Medicaid, two government-sponsored healthcare programs. The higher one’s income the LESS likely one is to support government-ensured healthcare, so it can be assumed that those who have it or can afford it are less likely to want much government involvement. Interestingly, even lower and middle-income Republicans increasingly favor a government solution.

No rankings or indexes are perfect, but they do provide some guidance. Two healthcare rankings, one by The Commonwealth Fund and the other by The World Health Organization place the USA’s healthcare system far below those of other countries. And even if we do not accept rankings by these and other organizations, we do know that Americans live shorter lives, we have a higher infant mortality rate, and some Americans die each year because they lack healthcare.

SO?

No single solution will likely solve our healthcare problems, but there are a number of things we should at least consider trying, some of which have been successful in other countries and some of which might address our unique circumstances.

• Tort Reform: This will honestly not help a great deal but it could address frivolous litigation against healthcare providers. As I stated in Part I, doctors admit that they often over prescribe medication and procedures to protect themselves from potential litigation. The problem with tort reform is that it is written by legislators, most of whom are attorneys, so it is rarely done right because attorneys make money off litigation. To be clear, I absolutely believe that healthcare providers should be subject to litigation when they act irresponsibly, but they should not be liable for circumstances beyond their control.
• Have the national government cover preventative care (mammograms, prostate exams, immunizations against disease, etc.) as well as catastrophic care for illnesses that could be financially devastating. We could then choose to purchase personal insurance (subsidized for the poor) for stuff like the flu and minor injuries. This has been successful in Singapore and promotes personal responsibility for healthcare (which conservatives support) but also gives the government responsibility for preventative and catastrophic care (favored by liberals). And yes, I do know Singapore is unlike the USA, but that doesn’t mean we cannot consider their very successful healthcare system as a model.
• Regulate Prices. In all healthcare systems used by our peer countries, regardless of their approach to healthcare, the government either sets or negotiates prices for medicine and other healthcare services. This is the reason prescription drugs are Canada’s top illegal export to the US; Americans can buy the same drugs illegally from Canada for a fraction of the cost paid here at home. Setting prices is a radical notion but the free market only works when competition is present, and that is often not the case with pharmaceuticals or medical devices. There may be only one or two drugs or devices available for less common illnesses or injuries, so the drug companies can charge as much as they want thus creating a monopoly. And as I mentioned earlier, in some areas only one healthcare provider is available and that can also create a healthcare monopoly. Just so you know, the pharmaceutical and medical device industries have among the highest profitability margin of all American companies.

The government has been regulating monopolies since the 1870’s when railroads were targeted, so regulating medical industries would only be a next step.

• Single-Payer System: Since millions of Americans are still uninsured by Obamacare, just torch the entire system and start anew. Believe it or not, a good many doctors actually support this idea, arguing that the government should pay for healthcare (as the single payer) for all Americans. They argue that the profit-driven system has led to high healthcare costs and that the increased initial costs of moving to such a system would be offset by savings in premiums and “out-of-pocket” costs.

OK. I’ve run on too long again and I have not even scratched the surface. If you are interested in reading more about single-payer systems I suggest this piece from The Washington Post and this from The Heritage Foundation. For suggested alterations to Obamacare I found that this offered valuable insights. And this smartly written and nicely researched essay offers several ideas for reform.

I do not favor an immediate jump to a single-payer system, and most countries that have created advanced socialized medicine systems have not followed that path. A successful healthcare system must be fashioned to meet the needs of each country, and The United States is unique in numerous ways. I do believe the government must be more involved in regulating the prices of healthcare for the reasons mentioned above, and I believe the government should provide basic preventative and catastrophic healthcare for everyone. A citizen’s health should not depend on his or her socioeconomic status. People should not die simply because they cannot afford health insurance.

Oh yes. One final point. People often point to the healthcare provided by the Veteran’s Administration (VA) as an example of poor care provided by the government.  The truth is that veteran care has consistently outperformed care in the private sector and has been at the forefront of advances in record-keeping and accountability. And remember that the VA’s success depends almost entirely on politicians providing adequate funding.

I could honestly spend weeks on this topic, but I’m ready to get back to other (EASIER!) political and social topics. I hope you will offer comments or suggestions for addressing the healthcare crisis as well.

Thanks for reading!