Sunday, November 7, 2010

Business or Government: Who should run healthcare?

This is the big question that divides us when we talk politics these days, especially where I live, in Athens County, where unemployment is high and many people are uninsured. Do I really trust the government, I am asked. I respond, do you trust big business? The current system of health care is market based, which means profit is the goal, the prime motivator. Profit for the company, be it a pharmaceutical manufacturer, a health insurance provider, or a physician group, requires cutting excess, making choices that maximize profit, and beating the competition. I would argue that these modes of operation all have their down side, and are extremely susceptible to corrupting influences that place profit above outcome of the recipients of health care. When human nature is added to this mix, which I believe is flawed intrinsically; we have a recipe for unethical behavior. How about government? This too is made up of flawed human beings who are susceptible to the corrupting influences of lobbyists and personal drive for power, position and wealth. But, with our system of government, we at least have some public accountability for elected officials, which is minimal or absent in the business world. You can be assured that one’s opponent in a political campaign will highlight every flaw and mistake, real and concocted, that the incumbent perpetrated. And I have a say in the makeup of the government by my vote. Our government is made up of people who we, the people, have hired to do a job. If we don’t like the job they have done, then we can vote differently next time around. Government has unfortunately come to be seen as an opponent in the health care debate, rather than our instrument, an extension of our will to accomplish what we want to do as a community, a society. This no doubt is partly due to the idea that once our elected favorites make it to office, they fail to follow through on what they told us they would do. I suspect that this is due to the fact that things that were black and white during the campaign become a shade of gray obscured by a fog once they get to work. This grayness is partly influenced by the desire to maintain ones position for more than one term in office, and that, in the background, from the day of election, a re-election campaign is in the making. This leaves one especially susceptible to influence from lobbyists who promise support in future campaigns, as well as assured employment after leaving public office. And of course, the lobbyists with the most influence are those with the most money, i.e. big business! So, we could say more; we could discuss the Canadian, the British and the Cuban systems, pluses and minuses. We could point out the flaws in our system; the 40,000 million without insurance and the long waits for those without insurance and without money. We already have rationing of health care based on socioeconomic status. Those with money get what they want in a timely manner. We already have death panels in place run by the private sector insurance industry who denies care based on preexisting conditions and other fine print in their policies. Actually, most seniors are relatively satisfied with Medicare, a government run health care system. My office staff says that Medicare is the easiest insurer to work with, rarely denying claims or treatment, requiring very little of their time administratively. The guidelines are clear and easy to manage. And their administration costs are much less than the private insurance companies that pay large salaries to their CEOs and dividends to stock holders. Not a perfect system, but not bad! So, who do I trust? Neither government nor big business, but at least with government we have more accountability and more influence. So I support a government run health care system not based on profit as its measure of success, but one that follows the model of public service that we see in our police and fire fighters, and our public education system. Physicians would be public servants. Local governments would employ first tier physicians for their local hospitals. The states would manage major centers and the educational system. The federal government would administer the insurance and research system. Would it be perfect? No, but I see this as the lesser of two evils. Would this be accepted in the U.S.? Probably not. Big health care business is already too well established. But how about this for a compromise, a two tier system: expand Medicare to cover everyone for basic care (which would require a difficult debate to decide what basic care is), and offer private insurance for the extras; for the expensive treatment and procedures that are not likely to be successful, but yet in great demand? Taxes would need to go up, but health insurance premiums for basic care would disappear. We can afford this if we have the public will! Look what we spend on political campaigns, Starbucks and bombs! Thoughts from Athens, Dave Drozek