Saturday, February 02, 2008

Healthcare: Myths, Rights and Duties

While healthcare is on everybody's minds, and on every candidate's lips these days, few seem capable of finding their way out of the house of mirrors built by opponents of healthcare reform. So here is a list of common myths and disingenuous arguments against serious reform, and how to handle them.

1) The "consumerism" argument in support of market-driven healthcare

Some, and president Bush is one of them, maintain that the government should stay out of healthcare and let "consumers" and providers negotiate access to and cost of healthcare services. The other part of the "consumerism" argument that the president often makes, is that people have no incentive to save under the current system. In his mind’s wonderland, people have no incentive to shop around for better healthcare. We need better consumers, and we need to entrust them with making savvy decisions.

Beside the obvious fallacy and dishonesty of equating "consumers" and patients, something that only a person of the president's deviousness and intellect is capable of doing, the obvious flaw in this argument is that the provider (doctor or hospital) and the payer are not one and the same. The patient has no one to negotiate with. The patient can only choose an insurer or a plan. The current healthcare system, much like the political system that gave birth to it, is built on the illusion of choice. There is nothing to choose from or negotiate, and real choice is limited by cost considerations, so that many people end up choosing not the plan they want, but the one they can afford.

Have we fallen so low as a society that we are ready to accept a system in which people get the healthcare they can afford? For a nation that claims its Christian superiority at every opportunity, it seems a mighty low standard. Brother’s keeper anyone?

2) The "let doctors and patients decide what is best" argument

This argument, which is similar to the previous one, is either disingenuous, ignorant, or both.

Those who make it apparently assume that under the current system patients and doctors are free to decide what is best for the patient, without any external interference. In fact, the opposite is true. Doctors and patients do not get to decide. The insurer decides. The news is full of stories of people who have *died* because an insurer has postponed, or altogether denied, life-saving medical care to patients. If you have seen Michael Moore’s Sicko (if you haven't, it's to everyone's detriment), you certainly remember such examples. Here's one that recently made the news, about a 17 year-old girl who died after being denied a liver transplant.

And while some doctors and hospitals do pro-bono work, this is neither acceptable nor sufficient.

3) The "best healthcare in the world" argument

Advocates of the status quo argue that the quality of healthcare services in the United States is the best in the world.

This depends on a number of variables. First of all, the qualification of best depends on what you are measuring. For example, if by best we mean the level of technologically and scientifically advanced healthcare, then perhaps the "best of" argument passes. If, however, by quality one means the median level of care received by patients in the United States, then that claim is, at the very least, highly dubious, if not altogether false.

This argument also fails to account for the price we pay, as a society, for the incredible number of people (15%) without coverage, which we subsidize through higher insurance costs and through Medicaid; and it does not begin to account for the even higher number of people who are underinsured, meaning that they think they have sufficient coverage, until they find out otherwise, when the insurer denies payment for services or needed care.

4) The "free-market does it best" argument

Proponents of free-market healthcare assume that, all things being equal, private companies provide a better service than the government.

This is a devious argument, because under certain types of governments it can be true. For example, many people have gotten the impression that the government should not be engaged in disaster relief, given its performance in the days preceding and following Hurricane Katrina. But that picture suffers from the initial bias that the administration injected against principles of good government.

During his seven years in power, president Bush has seemed hell-bent on dismantling effective government agencies. In many cases, he slashed their budgets. Often he assigned incompetents to lead them. Social services and programs, in particular, have been "outsourced" to faith-based organizations (thus funneling money to natural supporters of the president’s party). And, wherever possible, he reassigned their duties to private companies under no-bid contracts that give no assurance that the chosen company was the best for the job, or the one that could do it most cost-effectively.

The simple answer to this argument lies, as is often the case, in facts. For example, administrative costs for Medicare and Medicaid patients are, typically, lower than comparable costs in the private sector, even when making allowances for disparities in what counts as an administrative cost in different public v. private healthcare. Not to mention the large costs that the private healthcare industry (doctors, hospitals, insurers, pharmaceutical companies, etc.) passes on to "consumers" (patients, as I still like to call them), for example marketing and advertising costs.

Another inconvenient, but not less truthful fact is that the industry claim that costs are high as a function of research costs is largely exaggerated. In fact, the general public subsidizes the cost of medical research which is often conducted by government agencies, or by universities under government grants. And patient outcomes, costs being equal, are often worse for U.S. patients than for patients in many foreign countries, in spite of the fact that per-capita medical expenditures in the United States are higher than in other countries, often double or higher. Do you feel twice as well as the French do? You would like to think so. I highly doubt it.

And, finally, my favorite argument to dismantle.

5) The "personal freedom argument" against universal healthcare

This argument usually relies on this, or a similar premise: "Why should a twenty-year old have to pay for health insurance he does not need? He would rather spend money on booze, or travel, or pretty women, and he should be able to do so instead of contributing to a mandatory system.

This is such an infantile argument, that it hardly deserves an answer. I will give you the only answer you will ever need, so you can silence those that make this ignorant argument, or go on your way to the liquor store, airport, or local strip club: I have no children. Why should I have to pay school taxes for somebody else's children to go to school?

If you answered this rhetorical question with "Exactly", you are a moron and you should have to buy health insurance on principle, as punishment for your stupidity, while the rest of us get it through a government-run plan.

Opponents of healthcare reform have many arguments like the ones above, and many more yet to use against you. Don’t let their arguments sway you.

They will use Reagan’s famous scare words "I'm from the government, and I'm here to help" to convince you. Tell them that your idea of good government is neither Reagan's nor Bush's government. It is the government of The New Deal or of The Great Society.

They will level accusations of socialism against single-payer proponents (look up "corporate socialism", and learn about "the privatization of profit and the socialization of risks and misconduct" for your rebuttal. Then, make them do their homework).

Finally, they will make you believe that we are in a fight for freedom. They will make you believe that anything short of letting the free-market govern itself is tantamount to surrendering your freedom to the government. Really? Just ask yourself, and them: What freedom? The freedom to be excluded from coverage, or to pay higher premiums for pre-existing conditions? The freedom to keep your health coverage for eighteen months after you lose your job, if you can afford it? The freedom not to leave your current job because a job you would prefer has worse benefits?

Remember: Access to quality healthcare has nothing to do with freedom. It has everything to do social justice and with rights. Not individual rights, but collective rights, rights of all people:

  • The right not to live in fear;
  • The right to be treated equally, regardless of income, as far as your health and the health of your family is concerned;
  • The right to have undeniable access to healthcare for you and your family;
  • The right not to become a slave to a credit card company or to a bank, or an employer when you, your spouse or your kids fall seriously ill.

Rights that you and I do not have. Yet.

There's going to be an election, soon. You have the right to vote, and the moral duty to do so.

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