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Tuesday, 03 January 2006

The Universal Healthcare Tradeoff

category_bug_journal2.gif As was easy to predict, every “lifestyle” columnist at every medium and small town newspaper in America is writing this week about aging baby boomers. A large number of them have focused on the boomers’ huge and negative impact on the healthcare system…

…and their hysterical tone suggests it will happen by tomorrow afternoon.

Will these paid fear mongers please get a grip. It’s not as though every one of the 78 million boomers became senile on 1 January 2006. In terms of averages, as of today about 22,000 have turned 60 and as the boomers like to say, 60 is the new 30.

These reporters may be hazy and lazy about the effects of a growing elder population on our healthcare system, but they are headed in the right direction. Boomers may not believe it yet, but age does bring with it increased numbers of ailments, minor and serious, and we must find ways to treat them all while not shorting children and mid-life adults. And we must do it soon.

A far better approach for journalists who are over-enamored with the boomers would be to do some serious homework on the crumbling healthcare system and suggest some remedies. Those of you who read yesterday’s post here know that I favor universal healthcare. In fact, I don’t just favor it, I believe it is the only possible solution.

Two readers – one from Canada and one from the U.K. – left comments describing how universal healthcare systems work in their countries. Ell of the pomegranate tiger blog explained how Canadians pay a small monthly premium on a sliding scale, determined by income. Koan of multidimension.me described Britain’s free national health service.

To meet the health needs of their populations, obviously both are subsidized by other kinds of taxes. And that means tradeoffs – which will also be necessary when the Congress finally – with our badgering - wakes us to this need in the U.S.

Available dollars go only so far and as every average-income adult knows, no one can have it all. Priorities must be set: saving for a down payment on a home; saving for the kids’ education; saving for a new car; or a long-dreamed-of vacation means other desires must be set aside. And so it must be with the federal budget.

There is nothing more important than providing healthcare for every American citizen and it is a good idea for each of us to think about what we are willing to do without – personally and nationally - to gain it.

Eliminating Congressional pork projects such as last year’s Alaskan bridges to nowhere is a good idea. Jimmy Porter, in a comment on yesterday’s post suggested decreasing military and weapons spending.

Increasing corporate taxes and disallowing registration of corporations in no- and low-tax countries overseas is another good idea. Rescinding the Bush tax cuts for the wealthy would help a lot.

As with our graduated income tax, it has long been a tenet of American social justice that those who have more, pay more into the system. This has been eroded under the Bush administration and the richest one percent of the population now holds 40 percent of the all the country’s wealth while paying much lower taxes than before Bush. The haves - who almost entirely run the federal government - must ask themselves how much is enough and start giving some back.

In a minor variation of the 20/80 business rule, ten percent of the population accounts for 70 percent of healthcare spending. The smaller number who use more of the health system deserve no less care than the rest because, as I said yesterday,

Healthcare is a human right and a public responsibility we all share. It is our moral obligation, individually and collectively, to ensure that every citizen has access to healthcare and if we do not guarantee that, if it is available only to the rich, we have failed as human beings and as a nation.

The obscenely wealthy along with the ordinary wealthy must realign their priorities, but the rest of us average Americans shouldn’t get off scot-free. It is crucial to ask ourselves what we - in our personal lives and in government expenditures - are willing to give up, and where we are willing to pay more to gain universal health coverage. Any suggestions?

RELATED POSTS:
Healthcare is a Human Right
Politics, Relgion and Universal Healthcare
The Right to Healthcare - A Dissent
Bipartisanshp and Healthcare


Posted by Ronni Bennett at 05:24 AM | Permalink | Email this post

Comments

Yes, universal health care is a must. What you ask are we willing to give up? After practicing as an RN for over 40 years, I can tell you that this is tough. Will Americans, especially baby boomers, willingly relinquish their abuse of food, alcohol, illegal & legal drugs, & cigarettes? If so, half the struggle is over. Other very simple ideas: do not re-invent the wheel, i.e. make universal healthcare a part of Medicare & do not allow physicians or drug companies to participate in the plans. Professional nurses should play a major role in the entire planning process & yes, I admit a certain bias in my opinions! I do so like this blog for the rush it gives me! Dee

Ronni, you have undertaken a noble cause, I admire you for it, support in it, BUT, it ain't gonna happen. Not with the people we have in office.

Ronni - the UK's NHS is "free at the point of delivery" - i.e. to the patient needing treatment - it certainly isn't free to the general population, i.e. it is paid for out of Income Tax and National Insurance contributions, which are themselves income related. So, unlike the Canadian system described by ell, we don't pay a separate "health tax" - but we *do* pay for it.

All that said - I believe we pay a sight less for it than health insurance seems to cost US citizens - and we know that we won't be refused essential treatment, nor bankrupted as a result of having to have it. On that basis, I am happy to help fund the NHS - for the nation, and for me - out of my taxes.

Thank you for the clarification, Koan. I was a little too loose with my language; I meant that, different from Canada, U.K. citizens do not pay a monthly premium in addition to taxes that are levied. I didn't mean to imply that they don't pay in other ways.

Your thoughts on healthcare costs are intriguing and timely, but I am not so sure socialized medicine will be any better. Our Canadian son had a head injury and was not given the treatment that might have been given down here. Instead he was shipped with no treatment to a major transplant hospital where, of course, the inevitable diagnosis of brain death was given. At this particular hospital, an apnea test was given instead of the two major tests given in the U.S. Cost of rehabilitation was the explanation for the omission of standard treatment of such injuries in the U.S. There is only so much money to go around. We spent 4 days at this hospital and learned much about that health system as we came to know other patients and families. It changed my mind.

Like Dee, I'm also an RN and lean strongly toward universal health care. Being a home health nurse, many times I've seen patients have to make the decision to purchase food or purchase their meds. Shame on us, America.
This Administration doesn't have a clue what's needed to get back on track. Taxes and death are a given...how about some taxes on cigarettes, gasoline, etc. It might be a start. To those opposed to universal health care...no, nothing is perfect but that's a beginning to ensure that in this country nobody is denied that basic right.

In commenting on the UK's NHS, I probably gave the impression that I don't trust the Conservative Party not to wreck it every time they try to reform it - and, based on history, that's what I believe. However, just now, I cam across this article on the BBC News website, http://news.bbc.co.uk/1/hi/uk_politics/4578440.stm containing the new Conservative Party leader's thoughts on the NHS - including these words:

"Under a Conservative government, the NHS will remain free at the point of need and available to everyone, regardless of how much money they have in the bank."

Maybe the message is getting through - at least, over here. Following on from Terri's comment, it's worth noting that the UK has high levels of taxation on tobacco, alcohol and petrol.

I can hold my tongue no longer. Health care is NOT a human right. Believing that is akin to believing that a car is a human right. Health care is a consumable and as such should be paid for by those who use it.

The health care system in the United States has deeper problems than you've outlined. For example, the AMA controls the number of graduates from American medical schools. This artificially limits the number of doctors available and is sure to increase prices.

Insurance companies have a hand in this too. You're naive if you believe that people don't make decisions on consuming health care based on price. The current two-tiered insurance is a disaster because it distorts prices. For those with insurance, the cost of a doctor visit is the opportunity cost of the time it takes for the visit itself. For the person without insurance, the cost is the opportunity cost of the time, plus the cost of the visit. Since most patients are insured and doctors already have more patients than they can reasonably handle, so there's no incentive to lower prices to a reasonable level.

Health Savings accounts are not a solution unto themselves. Much more needs to be done to ensure that the prices paid for health care services are reasonable and market determined. Ensuring that price signals are once again intact will do more for the health of the health care system than anything else could. It will make sure the US will continue to be a market for health innovations.

The biggest problem with socialized medicine that I see is it's dampening affect on medical innovation. If one surveys the developed land, the vast majority of new medical innovations occur right here in the US. I'd wager that this is so precisely because of the much bemoaned income inequality and lack of socialized medicine. Inequality and innovation are inversely proportional. So socialized medicine mortgages future generations' advancements in health care for this generations unwillingness to accept responsibility for their own lives.

I leave one final thought. You can go on all you like about health care being a human right. But personal responsibility is a human duty. Those that refuse to take responsibility for themselves are the ones who have truly failed as human beings.

I believe not all human beings in need of health care have failed to take responsibiity for themselves, nor have they failed as human beings. 'Tis folly to think otherwise. Be it a right, a moral obligation, or whatever, they require healthcare.

Throughout history there have been those for whom extenuating circumstances have resulted in them having nothing, very little, or having had what they possessed taken from them. Hopefully, we have progressed to a level where health care is available for these people. Some of us could be them when least we expect it. Some of us are them, now.

Little has been done to enable or encourage saving by those in this country who most need it for some years. The numbers speak for themselves. How on earth are they going to contribute to a health savings account, too? I do like the portability aspect of such a plan, though.

I like Dee's ideas, including "do not reinvent the wheel" when we can incorporate a health system into our already exisiting Medicare (but Part D has to go!)

Away with the money draining HMO middlemen. Think of all the badly needed nurses who will be freed up to assume positions in doctors offices, clinics and hospitals.

Also, the pharmaceutical companies must negotiate drug costs. I share John's concerns about a national health plan dampening innovation, but there can be money for R&D with more reasonable profits for all. Perhaps share holders of these companies could well afford a lower return on their investment and still make money. Profits have hardly been lacking all these years.

I do not understand why anyone thinks that health insurance is a right. I do not believe that government is the answer to all of our problems. If you look at other agencies that the government handles, they are a mess!!! People need to look after themselves and their children. If you cannot afford insurance then go further in your education so you can get a better job. It is time that people started to take care of themselves and their needs and quit looking to the government and others to make their lives easier.

Isn't there a way we can organize and start our own hospitals with an entirely senior staff. This is a major part of the economy with seniors being the majority of the business. Personally, as a former hospital worker my experiences would suggest that many of the younger workers neither identify with nor care much about the elderly patients. Additionally, technology and the Internet has made many of the jobs easier as well as less costly such as teleradiography being performed in India, remote robotic surgery, and remote monitoring. I think compassionate hospital workers are what the market really wants. The Regan era idea that business can solve our problems more efficiently then government does make a lot of sense. Anyone interested in forming a nonprofit?

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