The Economic Morality of Health Care Systems

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Why is health care so expensive? Each American citizen, each identifiable taxpayer, pays about $7,000 per year for health care. On average, that means American families normally pay about $14,000 a year for health care (with some of it paid by employers) where other countries, far less affluent than ours, spend about $8,000…and that is being very generous to Americans in the comparision. Even if we make our system as universal as possible, it still would not have many of the much easier and more secure features of many European health care systems, and in some cases, far, far fewer amenities.

T.R. Reid is a former Washington Post reporter who lived for many years in Japan and also in Great Britain. When it became obvious to him, as it should to all of us, that our health care delivery had begun to show very significant stress–exorbitant costs, lack of services, fraud, and limitations on delivery…informal but substantial rationing in a variety of ways…by insurance companies, he decided to study the policies of the other countries around the world, both where he had live and elsewhere, that did not have the same problems as Americans. He created a program for Frontline on PBS called “Sick Around the World.” Below is an interview with T.R. Reid on C-SPAN network, one in their series on health care. 

This program is about an hour. If you have not seen it, we suggest you find time. If you find time, find more time to forward it to others. This interview, which everyone should see, can be watched in segments, of course, by simply noting the time you left off and picking up again from that point. This is the simplest, clearest and best explanation of the difference between our health care services and the real health care delivery systems around the world. 

Morality, Necessity and Economcs

The economics of health care are very important. But often we are trapped into arguments from people on the Right Wing. In other words hospital groups, health insurance groups and their lobbyists, whom we know are spending $1.4 million a day…that has been documented in many places…to hire people like FreedomWorks to simply create diversions. The Right has organized protests by people of varying antagonisms, religious groups, anti-immigrant groups, hard core anti-tax groups, anarchists of varying kinds, white supremacist groups, and others…only a small number of which are actually protesting against health care reform.

So why are politicians so scared? Because if you take all these groups in one place…even though the Washington D.C. police said that the supposedly enormous march in early September 2009 was actually fewer than 90,000 people…then politicians get nervous. A politician from a small state that is roughly fifty-fifty, Republican and Democrat, becomes worried that this mood will sweep into the next election and people will be stampeded into voting against him or her on lack of understanding of this issue, or by being falsely associated with groups against issues popular in that geographic area, such as gun ownership, or jobs versus environment.

Why don’t politicians stand up for what is clearly right…health care in some affordable form…not a sham, designed by a health insurance industry that thinks it can pretend to be interested but behind the scenes is working againt the people as hard as it can? You can say that it is lack of intellectual honesty or moral courage, but the congress person will ask you if you would rather have a Republican in that district, working with and sometimes for the insurance companies. The hard work…what needs to be done…is to explain to those to whom the issue is important what the real facts are and what the the results will be if we do nothing. The people must step up and remind the politicians…must physically take action…make a call, send an email…in order to let politicians know that 75% of the people want health care reform and don’t believe all the nonsense about the dangers of “socialized” medicine.

Some people are going to take a hit economically and some changes must be made that will cost the American people money. Here are two examples. Surgeons are not going to make the same kinds of incomes that they have been making. It simply cannot happen. There is a cost and a cost plus-reasonable-profit that can be built into doing surgery. But the kind of procedure that now exists where health insurance companies simply pay whatever is demanded by specialists, and to cut costs simply deny coverage will not be acceptable.

And that is why there are in these national systems there are no liability suits of any size, nor any need for high liability insurance. Currently the system rewards highly intelligent and highly skilled individuals and then punishes them if they make a mistake. Since the system is all about making money, if they are good, they can be rich, but if they are rich the punishment is monetary. Big hits to their incomes. The alternatives could only be two fold. Either let people die from medical errors with impunity for the perpetrator, or put them in jail. If we gave them a buy-out of jail, it would still amount to a very large sum, because how do you value a limb or a life? In the other systems, people recover damages that have to do with living their lives and everyone participates in those costs, not just the doctors…society at large. The system repairs itself because it is focused on the people, not on who makes money and how much. Doctors make somewhat more money than other occupations and have more respect than many other occupations, but it is not because of their enormous wealth.

To say that all or even most of Americans who are harmed by accidental…for the most part they are legitimate…accidents…by surgeons or doctors (except for fraudulent doctors who eventually go to jail anyway) who are doing their best in difficult situations. Where the situations are not complex…and that is infrequent…then there is clear incompetence…but in those cases the damage is often not serious. So, liability will be taken care of by all people who will have access to grievance procedures and will need fewer services of expensive attorneys.

The second big change, among many of course, is that we will have more doctors, particularly more general practitioners, often called family doctors. Because everyone will have access to a physician, more physicians will be necessary. In our new wisdom, we will see that only the best and the brightest…and most dedicated…will be accepted into medical school. The unintended consequences of American Medical Association policies will aide us. For years, certainly since the early 1980s and perhaps earlier, as society grew, the American Medical Association dictated that the medical schools would grow only at a rate that was acceptable to them.

For example, the population of a Midwest city in 1950 might have been 150,000, but by 1980, after the baby boom, it might have tripled to 450,000. But in the medical schools the same 200 chairs for accepted students would often have grown by less than ten percent, if at all. This meant that each graduating class of, say 7,000 nationwide medical school graduates each year would be able to fill only half of the 14,000 resident slots in hospitals. And so we would, each year–year after year–import medical doctors from India and China and Korea and elsewhere in the world that good medical schools exist and produce qualified doctors.

The bad news is that our own American students, some with incredible skills and intelligence, were denied a medical school education. The good news is that often those imported doctors were not only the winners in their medical school lottery but were the winners in admission to their colleges and prior to that, to their special academies for exceptional students and prior to that had been selected from the brightest of the elementary schools. So we got very bright people. They settled here and now they have very bright children coming into the system, or some already in the system.

From now on, however, as a part of national policy, we must create more opportunities for physicians, pay for their education, expect public service for a time rather than monetary repayment, and insure that the kinds of qualifications that one physician has is as equal as possible to that of another anywhere in the country. We need more doctors and our new system will give us more American doctors. The American Medical Association can no longer act a cartel, controlling the distribution of medical services only to those who can pay the most.

The question we must ask is this: what would an authority do if it were based on the principle “Do unto others as you would have others do unto you.” What would a citizenry be expected to establish as a medical system if the guiding principle was first and last: “do no harm.” What would a society do that stated that it was “one nation, under God, with liberty and justice for all.” We all have liberty, pompous, irrational metaphors notwithstanding. But do we all have justice, fairness, equal opportunity in our current medical health care situation? Does someone laid off have equal opportunity? Does someone who had a childhood disease that is uncovered and now cannot get health care insurance have equal opportunity? Does someone who is cured of cancer and then must take a new job and is denied the company’s health insurance or some procedure under that insurance have equal opportunity?

Remember this. We all accept the fact that there should be in this country a separation of church and state. But no where in our Constitution, nor anywhere is it written in the vast papers of government by this time in our history that there is a separation of morality and state. Morality, our concern for our fellow citizens, dictates that we all have equal access to health care.