The fairness problem with cost shifting in health care
Bookworm on Dec 15 2009 at 6:11 pm | Filed under: Health
One of the things that ObamaCare proponents keep saying (and please add a whining note in your mind as you read the following) is that “the current system isn’t fair.” It’s not right, they say, that, in a rich country, some people have premium health care, while others are forced to go to a free clinic or an emergency room (or possibly back to their native Mexico).
What all these fairness proponents forget is that there is nothing fair about socialized medicine. Unless you want costs to be stratospheric for everybody (as in ever higher taxes) or unless you want the system to break very quickly, you have to make sure that people don’t drain the system. Morbidly obese people drain the system. Drug users drain the system. People with chronic diseases such as Crohn’s drain the system. Diabetics drain the system. Cigarette smokers drain the system. Sexually promiscuous people drain the system. You can make your own list, but it is apparent that some people are heavy health care users, and others aren’t. All of them make more demands than your average middle class, healthy suburbanite, who goes in for well-baby checks, appendicitis, the occasional pneumonia, etc.
Now, we’re a compassionate people, and we’re probably willing to pay for those who suffer through no fault of their own. We can find it in our hearts to shell out for the person who is crossing on the green light and gets hit by a car; or for someone who has appendicitis. But what about the people who could have prevented their illnesses? Do you really want higher taxes to pay for that big guy at the buffet who is loading up on fried stuff? And how do you feel about replacing the liver on that recovered alcoholic? And are you sure your neighbor isn’t going to tell you to forget having children in case one of them has your breast cancer gene? And since that’s not fair, and since the whole point of universal health care is a fair system in which everyone pays equally for and receives equally of the health care system, then someone or something (hint: the government) had better step in and control or punish high risk people.
It’s not just me saying this. Indeed, even though I had inchoate thoughts on precisely this topic, I didn’t put it together until Zombie sent me a link to a comprehensive article spelling out everything that’s wrong with the universality of universal health care. Please read it. Think about it. Forward it to friends. Use it as the basis for letters to your Congressman or woman, or as the talking point for a friendly discussion at work.
Life isn’t fair. Equality of opportunity is a wonderful American tradition. Equality of outcome is an impossible dream that eventually turns all nations that seek it into totalitarian dictatorships, intent on controlling every aspect of the citizen’s life.
Related posts:
- Karl Rove sums up the health care bill’s fiscal effect
- Some liberals admit the $1.8 trillion health care takeover will not provide universal insurance
- Must read about health care myths
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2 Responses to “The fairness problem with cost shifting in health care”
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A couple of comments:
1. You are correct. The government WILL step in and control or punish not just high risk people. And that means high cost people.
Few Americans have any idea what that is going to mean for them. Lots of Americans think they lead relatively healthy lives. Perhaps they don’t drink as much as they used to or they quit smoking or they have started to exercise on a more regular basis. Still, the damage has been done. Is the government going to quickly grant them the “go ahead” to do a $50,000-$75,000 coronary artery bypass graft? Who knows how the “right” to have that surgery will be doled out. And that is just one example.
2. I recently had a conversation about health care with a friend who voted for Obama. Note: this friend is an attorney in a field completely unrelated to health care. It did not matter that I’m the one who works full time in health care. The friend assured me that many Americans have “no access” to heatlh care.
I hear that often and have no idea what that means. I live in a small town and there are community health clinics, the public health department, and doctors that are advertising for patients in the paper.
Anyway, I reminded my friend that I had worked in an ER previously and that we were prohibited by law from turning anyone away. Sooooo, where is the access problem? Well, I was informed that people come to the hospital much, much more ill since they “don’t have access.”
This was news to me. A dozen patients would come in to our small ER every day who really weren’t all that ill: small rashes, head colds, boils, and a host of other things that could be taken care of in a doctor’s office.
I then told my friend that we get patients all the time in the cardiac unit where I work who are on Medicaid or have no insurance. Do we kick them out? Impede their “access” to care? No. I have yet to hear a doctor or therapist utter a peep about giving a patient less care because they are not insured. Perhaps it does happen but it sure is subtle.
Look. We are constantly taking care of patients who are uninsured. It is nothing to see patients come in for another round of congestive heart failure management (which can mean multiple days in the hospital) only to be told that they need valve replacement or a cath or some other procedure. They aren’t denied the care. It’s given to them.
I realize that our current system is unsustainable and reform is necessary but the argument that millions of Americans currently do not have access to health care and are denied basic (actually, not so basic), excellent quality care simply doesn’t wash.
But then, what do I know? I’m a nurse and it is now patently clear that the experts in health care are not in the hospitals but in Washington.
Deana
The “it isn’t fair” whine always raises my hackles.
What does “fair” mean? I have this feeling that it means “I should get what you have” even if I haven’t done anything to earn it.
And “deserve”. That’s another one that could use some defining.