Just for sh*ts and giggles, let's consider health care

Joe Conason has a piece up on Salon.com about how right-wing opponents of health care reform are brainstorming how to market their position.

Maximizing fear is the true message…Groping for that fear button, Luntz asked his polling sample, "Which two concepts or phrases would FRIGHTEN you the most?" The first was healthcare rationing, an idea that isn't being contemplated by either the Obama administration or congressional Democrats (although healthcare is rationed by price under the current system). The second was "one-size-fits-all healthcare," a phrase that is devoid of any content but that conjures images of federal regimentation. Third came "healthcare by lobbyist," the plan that has been implemented by the insurance and pharmaceutical industry, with eager collaboration by the Republican leadership, for decades.

"Socialized medicine" came in a feeble fourth, barely ahead of "politicized healthcare," and scaring only about a quarter of the respondents, which demonstrates once again that the S-word has lost most of its terrorizing mojo. ("Hillary-care," presumably included for old times' sake, scares only about 10 percent of voters.)

It would be really nice if we could have an honest debate about health care reform in this country. And by “honest” I mean free of influence by people whose fear of losing their jobs or political clout. I would just be in heaven if the conversation about health care centered on what was best for the health and prosperity of our citizens, and not some lobbyist’s or HMO’s bottom line.

I’m still trying to educate myself on this, but this is what I understand so far: in a “single-payer” system, the single payer is a government agency, which negotiates directly with the health care provider. In other words, instead of your doctor’s office billing Blue Cross, they’d bill Agency X. Everyone would bill Agency X. Presumably, your doctor’s office would then charge less for services because running everything through Agency X is a hell of a lot cheaper than dealing with 47 dozen different insurance companies. From what I understand, your actual medical care at Fill-in-the-Blank Family Practice shouldn’t change at all.

We already have single-payer programs in this country in the form of Medicare and the VA. Results vary. But no more than they do at my local public hospital, or with my private allergy doctor.

There’s also the related issue of medical records. In Taiwan, every member of the single payer system has an electronic card containing his or her information. Taiwan.

I have the same issues with government-administrated health care as I would for government-administrated anything. Namely, public systems usually don’t move very quickly – there are just too many layers for them to go through. Before I could really get behind any form of public health care, I would need to have confidence that the parameters of that health care wouldn’t swing back and forth with every election: now abortion is covered (for instance), and now it isn’t.

That’s all the pragmatic stuff. There are larger philosophical issues as well… And maybe the theory doesn’t have a place here, but it’s something I’d like to consider anyway. The people who oppose public health care talk about “moral hazard,” kind of the flip side of the “problem of the common” that we liberals are always going on about. Both deal with the alleged tendency of people to take advantage of the public pool, using more than their share. In practice, many conservatives warn that any form of public health care will be a blank check for patients or doctors to run up unnecessary procedures, clogging the system so that actual sick people can’t get the care they need.

If you dig deeper into their argument, you find the real worry: that people who don’t contribute to the system will benefit from the system, which in their zero-sum mentality would mean that the people who do do what they should don’t get their fair share. In my first year at college, in a debate on this very subject, one of my opponents argued as much – why don’t I pay for mine and you pay for yours, and we just leave it at that?

My answer? There’s more than one kind of moral hazard. For some, the prospect that someone somewhere might be getting something he/she may or may not “deserve” (based on someone else’s judgment) is unconscionable. And then some of us think that a working family having to declare bankruptcy because of their medical bills is even worse. I guess it just depends on your point of view.

(That’s why you never hear conservatives complain about the VA. Military service people and their families have earned medical care in their view, and the poor and elderly on Medicare haven’t.)

There’s also the quite valid argument that public health care changes the way citizens relate to their government. It goes from being a tool to stabilize society by allowing individuals to pool resources to being a monolithic entity that truly governs from the top down.

As I said, I think this is a fundamentally important conversation that our country needs to have, free of ideology and influence-peddling. Not that I foresee that happening any time soon, but it would be nice.