The view from the other side re health care

I had a fascinating conversation yesterday with a physician who fervently supports the proposed health care plan — at least in theory, as he admitted he didn’t know what was actually in the 1000+ page bill that seems to be the House front-runner.

He and I began with a few points of agreement.  He and I both agree that medical costs are out of control, and that this lack of control reflects a perversion of the market.  As matters now stand, the current system does (as Obama so inarticulately said) give an incentive for unnecessary treatment.  I’ve always seen that in the way in which elderly relatives of mine get their health care.  Because their doctors are compensated by office visits, the doctors refuse to relay information over the phone.  Every test requires a follow-up office visit to be told the test’s results.  The doctors are also hugely in favor of giving tests.  When my mother had ulcer symptoms, rather than trying a two week round of Prilosec (which, if it controlled the symptoms, would have been pretty good evidence that there was an ulcer), the doctor insisted on an expensive and invasive scoping — which showed an ulcer.  I suspect this excessive testing is also a reflection of malpractice concerns, but there’s no doubt that profit figures in there too.

This doctor and I were also very supportive of the Kaiser model.  I happen to be a Kaiser patient and am extremely pleased with the care I receive.  Because the doctors are salaried (and salaried well), their only goal is to give appropriate care.  Giving unnecessary tests doesn’t provide any benefit to them.  Nor does withholding tests save them money.  Because Kaiser is so large, it owns all the necessary labs and equipment, so tests are pretty much a fixed cost.  Also, because it’s so big, it can negotiate cheaper pharmacy costs.  I’m sure people have had bad experiences with Kaiser — it is, after all, run and staffed by humans who are fallible — but overall it is an incredibly highly ranked medical care provider.

Aside from those agreements, though, my doctor friend and I strongly parted ways at a philosophical level.  I believe that legislation can be created to change the incentives in the marketplace — or that, at the very least, we should start with that experiment, before diving into a wholehearted destruction of the current system.  My friend, however, believes that our current system creates “social injustice” and that the only way to remedy it is through government intervention.  To the extent doctors and companies profit from the current system, he believes these profits are immoral.  When I mentioned the marketplace determining what is just and what works, he said that’s just wrong.  The government, he said, is singularly well-suited to deciding which treatments (and, by extension, which profits) are just and which are not.

Incidentally, as part of the social injustice issue, this doctor believes that it is appropriate to extend the plan to cover illegal aliens.  He likens the Mexicans who come here and send money back home to Jews trying to escape the Nazis by immigrating illegally to Palestine in the 30s and 40s.  That is, he thinks the Mexicans are in precisely the same situation as death camp refugees and that we are morally wrong to deny them free ingress.

The doctor had a very interesting take on the current uninsured.  I said that a lot of people are opposed to the proposed plan because they recognize that those numbers being bandied about regarding uninsured are false.  That is, the 45 million (or whatever) uninsured aren’t uninsured simply because of poverty.  The vast majority are either illegal aliens (and you can see his views about those above) or voluntary uninsured.  As to the latter, my friend thinks they’re the real problem.  He understands that these people are voluntary uninsured because they are young and healthy.  They’re gambling that they won’t need insurance.  Or they might be marginally insured, in that they buy a $10 policy with a $10,000 deductible, just in case something really bad happens.  They are not putting money into the system.

What this doctor likes about mandatory universal health care is that it forces the voluntary uninsured into the system.  He thinks it grossly unfair that they are not paying into the system, while people who need insurance are paying.  If there were more money in the system, the person with a preexisting condition would not be required to pay as much for his insurance.  In other words, he thinks that the insurance system should be a cross between an uninsured motorist requirement and social security.  He freely admits that this is a government mandated spread the wealth approach, and one of which he approves.

Because he has a philosophical approach that requires everyone to be in the health care market, whether they want to be or not, he is unperturbed by CBO numbers projecting vast increases in the cost of health care under the new plan.  He thinks the CBO people, being accountants and not doctors, have no idea what they’re talking about.  What he envisions is a brave new world in which the government simply provides more insured people who will use medical services.  He finds it inconceivable that universal health care (which is a system by which all people are insured, but medical care providers continue to be privately owned) can shade into a single payer, government-owned system.

He does not believe that having the government as an insurance provider will change the system and drive out private insurance.  Nor does he believe that, even if all private insurance is gone, with the government being the only bill-payer, that this will do anything other than purify the private medical system of the current social injustices that plague it.  He also refused to believe that, in other countries that have socialized medicine, there are treatments that are denied to people, not because the treatments don’t work, but because the people are deemed (by government mandate) to be too old or too ill to be worthy of treatment.  As for government lists of treatment, he says we have them already, because every care provider is in thrall to Medicare and related government programs.  He did not see a difference between the fact that Medicare sets prices, but does not yet set age or health boundaries for providing treatments.

He is very disturbed by the opposition to the health care plan, which he sees as the product of Republican cabals who are shipping agitators into local town hall meetings.  The absence of any concrete evidence of such busing (such as buses) does not change his mind.

I explained that people are also concerned that they’re being sold a bill of goods that is not as promised.  The rush to pass a bill (three weeks “deliberation” to change a sixth of the economy) didn’t bother him at all.  “That’s how things go.”  When I raised specific concerns about the existing bill (the inability to stick with your insurance if you change jobs, the incentive for employers to dump insurance and drive people into the government system, the government decision boards re treatments, the enhanced access the government will have to our finances) he just didn’t care.  He thought those were petty concerns and was sure I was wrong.  He also discounted the hidden taxes in the bill.  “Obama promised that he’d veto any taxes.”

The doctor also dismissed the fact that many of the bill’s proponents — including the president himself — are on record as supporting single-payer care (which is different from the universal care this doctor supports).  He denies that Obama lied at the New Hampshire townhall when he when he said ““I have not said that I am a supporter of a single-payer system,” despite several past instances of his having said precisely that.  “There’s no lie there,” said my doctor friend.  “Obama did not say that he ‘never’ supported single payer care.  He’s talking in the present tense.  He doesn’t support it now.”  I said that, if that’s what the great communicator meant, that’s what he should have said, including explaining why he’s changed his mind.  “Nah,” said the doctor.  It was clear.

The conversation ended there.