Taking on Right-wing Health Care Lies

Recent Republican scare tactics are frightening in how downright silly they are. I take it as a hopeful sign that they have been reduced to such strategies.

Government Takeover

Even the most radical left-wing proposal ever seriously considered in the U.S. doesn't imply a government takeover of medical care. It means a government takeover of medical insurance. Who provides your medical care (a doctor, a hospital) is a completely different issue from who pays for it (you, your employer, an insurance company). And the current proposal doesn't even suggest a government takeover of insurance, merely offering a government insurance plan which would compete with existing private plans. The only measures that could fairly be called a takeover of private insurance are additional regulations limiting the ability of private insurers to deny applications due to pre-existing conditions and to deny care.

The only government-run health care in the U.S. is the Veterans Administration hospitals. Ironically, this system used to be derided as poorly run and inefficient. It is now one of the most advanced systems in the U.S., particularly in its use of electronic medical records, and it's patients are generally pleased with the quality of care they receive through the VA.

By the standards of this fear-mongering, all that is being threatened is a reversal of the insurance-company takeover of medical care that has already occurred.

"Rationing"

"Rationing" means that some people get certain kinds of care while others don't. The claim here seems to be that with public insurance, there may be a drive to apply limits to who can get what care, e.g. should an 80-year-old get all the same treatments as a 20-year-old? Many other countries answer that question "no". And how it is done in other countries is that published, national standards are applied consistently to everyone.

Currently, in the U.S., health care rationing is done on the basis of who can afford what quality of private health insurance, who can retain a job which provides good quality coverage, who qualifies for Medicare/Medicaid, and who is not covered by any system. This de facto rationing is arbitrary, inconsistent, and unfair.

There is also rationing by way of the coverage denial process within insurance companies. Different companies deny coverage more or less aggressively. Even with one company, different patients have greater or lesser capacity and knowledge to fight for coverage resulting in some patients eventually getting care covered while others cannot.

No health care reform proposal on the table now suggests any level of policy-based rationing. But even if it were, a non-arbitrary, policy-based rationing system makes more sense than the current arbitrary, affluence-based one.

Bureaucratic Medicine

Currently, with private insurance companies, there is a "utilization review (UR) analyst", typically a nurse, whose job is to deny care wherever possible on any pretence (e.g. improperly filled-out forms, as opposed to medical appropriateness). The UR analysts are rewarded for saving money, regardless of whether the medical care is helpful to the patient.

A typical hospital spends 30% of its budget on the clerical/office infrastructure to extract payment from the range of insurance companies, all of which have different systems and different standards for reimbursement.

One could hardly imagine a more confused, "bureaucratic" system than the one that exists now.

Socialist Medicine

Medicare is socialist. Medicaid is socialist. Social Security is socialist. The public education system is socialist. Subsidized state universities are socialist. Most police and fire protection is socialist. The construction of most roads and bridges is socialist. I don't hear many people suggesting that all these systems should be eliminated (although there are a few honest right-wing extremists out there). Most "conservatives" are not suggesting the elimination of these systems for a good reason: most people approve of them and depend on them (although they may gripe about the exact cost).

"Socialism" means taking a sector of the economy partially or completely out of the private market, and funding or subsidizing it with tax money. When this is done, it takes all the rules, policies, decisions, and regulation in that sector out of private, profit-driven hands and puts them in public, politically-driven hands. Frankly, neither profit nor politics necessarily produce good results, regardless of where they are applied. What matters more is that whether it is in private or public hands, accountability must be built in.

The issue with health care is that it is a service that does not fit well with normal free-market forces: the consumer has no choice about needing the product, the consumer is normally not the party paying for the service (Medicare/aid or private insurance is normally doing that), and the party deciding what to provide (the doctor) is neither the consumer nor the party who is paying. There is no one party that can easily be made accountable. Add to this the various moral/ethical dimensions about letting people die who don't have the means to pay, and it is no wonder that a free-market approach to health care is doomed to fail. This makes the health-care sector a rational and appropriate candidate for "socialist" solutions (just like the police, education, and pensions.) All other modern, industrialized countries in the world have come to this conclusion.

And again, there is some fearmongering going on here in the deliberate confusion of two words. No one is suggesting that the U.S. adopt socialized medicine. At worst, the health care reforms being discussed now would mean partially socialized medical insurance.