I was verbally jousting about health care on another blog recently when a commenter challenged my support for the Public Option. He charged that the PO would not reduce costs, that is unless I intended it to entail “rationing”. Surely, he said, I didn’t mean that. Ah, but I did – in a sense.
Health care costs way too much in this country, more than double what comparable or better results cost in socialized countries, but except for bemoaning the soaring national debt, most Americans don’t seem to care. If they have insurance, very few options are closed to them and their own pocketbooks are mostly unaffected regardless of what kind or how many tests or medicines they are given. Their doctors are likewise unconcerned about costs, unless that is, as often happens, the doctors themselves own part of a lab or testing facility or have accepted favors from pharmaceutical companies. Want a third MRI to confirm the other two? No problem. Want to try the latest anti-cholesterol drug you saw on TV last night instead of the generic, even though it costs 10 times as much? No problem.
Health care consumers generally fit into one of two categories – they either get their medical care through their employer or they simply ignore health insurance and rely on an Emergency Room when they (inevitably) need it. The latter method works just fine, except that it simply transfers the costs to those who are insured. How did this happen?
When hospitals began “dumping” non-paying patients for lack of ability to pay, society reacted in 1986 by letting Congress enact EMTALA and extorting hospitals into caring for the poor. But that simply transfers the cost to those who are insured and is a major contributing factor in the soaring costs. Should we repeal EMTALA? Any politician who advocated that would be toast in the voting booths. They might as well try to cancel Medicare and Medicaid, those two very socialist programs which are so immensely popular. This is why I have touted a return to considering the Public Option as the solution.
What is the Public Option? It has been referred to, among other things, as the “Medicare You Can Buy Into Act” and that means just what it sounds like. You would have to give up some autonomy. You would have to defer to government doctors who might tell you you don’t need a third opinion or a third MRI. You might have to take a generic instead of the latest twist on some big pharmaceutical company’s expiring patent. But the government doctor telling you those things would be working for a salary and not trying to grow his own business.
My blogging adversary accuses me of ignorance and claims that Medicare and Medicaid are “bankrupt” themselves. But, they aren’t. They can’t be because they are not for-profit programs. They are tax-supported social services. If you take the position that such things should be self-supporting in the sense that tax receipts should match all services, then how would such a system cope with economic downturns like the Great Recession or the dot-com bubble of 2000? Simply turn people away from medical care? Then shall we now eliminate Social Security because its receipts are scheduled to fall behind outflow requirements? That would be a Libertarian world, but it’s not the world I want.
If you are on Medicare or other government insurance you receive something called an EOB, which stands for “explanation of benefits”, a form that spells out what treatment you got from a provider, what the provider charged, and what the government decided was a fair price the provider did get. In almost all cases the actual amount paid is a mere fraction of what was sought. What’s the message? The government saved you a bundle of money.
Under the present laissez-faire system, many doctors do not follow the best or the most efficient practices. If you don’t believe that, consider this from a recent USA Today newspaper article. (emphasis is mine)
In one case, gynecologists in Sacramento are being trained to perform less-invasive hysterectomies or risk losing their patients to doctors who know how.
“A minimally invasive procedure, when appropriate, is much safer for the patient. There’s a much quicker return to work, less chance of infection, a shorter length of stay and it’s less costly,” says Rosaleen Derington of Hill Physicians Medical Group in Northern California.
Vast amounts of money are at stake. The Banner Health system, which has hospitals in seven states, has instructed doctors they can no longer use a certain product designed to prevent abnormal scarring during cesarean sections, saying it does not improve patient care. The effort has saved more than $1 million so far.
The idea behind the Public Option is not to put private insurance companies out of business but rather to give them meaningful competition so they will seek out cost-saving best practices similar to the above example. I don’t blame the insurance companies for fiercely lobbying against the notion of meaningful competition – life has been very good for them under the present system. But that system is bankrupting the country. Unless you are like my blogging adversary who sees government as mostly a bad thing and Medicare/Medicaid as socialist programs to be eliminated, and who apparently would relegate health care for the poor to the mercies of charity, I invite you to join me in supporting a fresh look at the Public Option.
Related article: A Poll on the Public Option