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Arguing with conservatives about health care

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Note: a version of this essay originally appeared in the Bellevue Reporter (Sept 19, 2009): Obamacare has serious problems, but John Carlson's view isn't the answer. A shortened version appeared as an op-ed in the newspaper's print edition.

Surprise! I'm a Democrat and I agree with John Carlson (How NOT to reform health care, Sept 9) that what he calls Obamacare (basically, HR3200) has serious problems. I also agree that the Massachusetts model of health care is the wrong way to go.

HR3200 does prohibit some of the worst practices of insurance companies, but, like the Massachusetts plan, it mandates that citizens buy private insurance. Like Medicare D (which rewards Big Pharma) and like the bailouts (which reward Wall Street, AIG and the banking industries), HR3200 is likely to be a form of corporate socialism. It funnels tax dollars to private industry and perpetuates the broken medical insurance system. And, like the Massachusetts plan, it fails to rein in costs.

Carlson says a Massachusetts commission is recommending that the state move to a single payer system "to ration medical care." This characterization is lowball spin. The insurance industry rations care right now! They deny coverage to people with pre-existing conditions, they preemptively cancel policies based on technicalities ("recission"), and they terminate payment for treatment that exceeds norms. A Harvard study finds that each year there are nearly 45,000 excess deaths in the US due to lack of health care. Over 46 million Americans have no insurance at all -- which forces them to postpone needed care and to rely on expensive emergency room care. Millions more are under-insured, and 60% of bankruptcies are at least partly due to medical costs.

Fact is, there is only a finite amount of money available, but since everyone eventually gets sick and dies, there is nearly unlimited demand for health care. When their life and health are at stake, people are willing to spend pretty much whatever it costs to get better. Doctors want to help, but some treatments simply aren't effective enough to be worth the cost and the side-effects.

Some sort of intelligent allocation of resources is needed in any system.

The question is: Who do you trust to make the tough decisions and recommendations? The insurance companies? Or you and your doctor, in consultation with science-based guidelines developed by independent experts? The insurance companies are just out to make a buck; legally, they're required to maximize shareholder value. They do so by denying care and raising premiums.

Even Republican Sen. Olympia Snowe of Maine agrees that there is a serious lack of competition among insurance companies. They burden providers with onerous nonstandardized paperwork. Their profits, and, recently, share prices, have been soaring. They do little to rein in costs. They have no incentive to promote preventive care, since policy holders tend to switch to new insurance companies when they change jobs. Corruption and overcharges are rampant, as in all medical industries.

Insurance companies are wealthy middlemen who provide little added value. They have a good scam going, and they're spending $1.4 million dollars a day to lobby Congress to keep it going. Pharmaceutical companies are little better. They've convinced Congress and Obama to disallow the government from negotiating drug prices, which are astronomically high. Marketing costs greatly exceed research costs, but many experts think medicines shouldn't be marketed at all. And many of their drugs are based on publicly-funded research from NIH and universities or are variations on pre-existing drugs. See The Horrifying Hidden Story Behind Drug Company Profits and The Truth about the Drug Companies, where the author, a former Editor in Chief of the New England Journal of Medicine , writes of the drug industry, "Instead of being an engine of innovation, it is a vast marketing machine. Instead of being a free market success story, it lives off government-funded research and monopoly rights. "

Carlson suggests we turn to a purer market-based system that would introduce competition. He suggests Singapore as a model for market-based health care. But Singapore is a small country with a population less than that of Washington State. Its political system approximates a benevolent dictatorship. There are heavy restrictions on speech, there are no jury trials, and they still cane criminals. There is considerable central planning; government-linked companies dominate. Singapore is actually an example of a highly regulated health system, where intelligent allocation of resources has been applied, as well as prices controls. (See Health Care in Singapore.) Hardly a model of Liberty and laissez-faire capitalism.

Besides, would you really want to shop around for the best deal on open-heart surgery or even primary care?

What's the market value of your life and health? Next thing you know, there'll be a derivatives market for human organs.

Medicine is a profession, requiring licensing and standards, and doctors want to be caregivers, not businesspeople for whom money is the ultimate measure of value. Most doctors should be on salaries; the current system perversely encourages unneeded care by tying payments to procedures and tests. Fifty-nine percent of doctors want single-payer health care -- meaning public payment with private delivery -- because they know medicine is supposed to be a healing art, not a cut-throat business in which success is measured by profits.

Most modern industrialized countries rely on some sort of government-run health care -- with far lower costs and far higher effectiveness than America's market-based system. Despite conservative claims to the contrary, their citizens are generally quite satisfied with their care.

Conservatives love to say that government is inefficient. But Medicare (a government program) has about 4% overhead; private insurance companies have about 12% overhead. Medicare has been around for 44 years, and both patients and doctors give it higher scores than they give private insurance. Why? Because patients aren't denied care, and doctors don't have to fight to get every test , procedure, and prescription approved for their patients.

Even the post office -- which conservatives love to hate -- works pretty darn well! Letters arrive across the country in a couple of days. When was the last time a letter you sent failed to arrive? Consider, in contrast, the inefficiency of private companies such as AIG, GM, Bear Stearns, WaMu, and the insurance industry, to name just a few. Wall Street and the banks failed us miserably.

But I'm not opposed to private profit, and single-payer health care is not socialized medicine. Only the payment systems are government-run. Providers can still be private. But nor do socialized services scare me at all. The police, the fire services, the armed forces, the courts, public schools, and numerous government agencies are socialized. And there are good reasons for keeping them that way.

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DFA organizer, Democratic Precinct Committee Officer, writer, and programmer. My op-ed pieces have appeared in the Seattle Times, the Seattle Post-Intelligencer, and elsewhere. See and for my writing, my (more...)

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It is clear that mos of thes people who oppose Pre... by Pulladigm on Saturday, Sep 19, 2009 at 4:55:31 PM
Your comment is as long as -- and better than -- m... by Don Smith on Saturday, Sep 19, 2009 at 6:08:51 PM
You join Chris Mathews and me in our thought to in... by Jason Paz on Sunday, Sep 20, 2009 at 4:39:19 AM
Ithink if someone gets cancer or an unknown diseas... by John Night on Saturday, Sep 19, 2009 at 8:56:31 PM
Unfortunately - what you suggest is not acceptable... by Doc "Old Codger" McCoy on Saturday, Sep 19, 2009 at 11:42:55 PM
Adults obviously bear individual responsibility fo... by ear on Sunday, Sep 20, 2009 at 3:40:40 AM
I prefer being called a "realist" if labels must b... by Doc "Old Codger" McCoy on Saturday, Sep 19, 2009 at 11:15:32 PM
Another comment worthy of being an article!Many pe... by Don Smith on Saturday, Sep 19, 2009 at 11:46:28 PM
It is difficult to compare what America might / po... by Doc "Old Codger" McCoy on Sunday, Sep 20, 2009 at 6:36:35 AM
Your arguments are well-constructed to penetrate t... by Perry Logan on Sunday, Sep 20, 2009 at 6:00:32 AM
Well said.I have a website Government is Great!def... by Don Smith on Sunday, Sep 20, 2009 at 1:16:03 PM
really? you can actually sit there and defend gove... by steve scheetz on Tuesday, Sep 22, 2009 at 8:02:46 PM
The biggest problem with health care reform is the... by steve scheetz on Sunday, Sep 20, 2009 at 7:51:36 AM
The mindset of the strong proponents for a nationa... by Doc "Old Codger" McCoy on Sunday, Sep 20, 2009 at 9:56:19 AM
It is not inconceivable that if insurance becomes ... by Bernard on Sunday, Sep 20, 2009 at 12:17:34 PM
for folks like me who are disabled and on medicare... by Hillbilly on Monday, Sep 21, 2009 at 12:20:30 PM
problems. Dr said after I was diagnosed with HIV t... by Hillbilly on Monday, Sep 21, 2009 at 1:11:21 PM