Healthcare Reform

The great debate ongoing in Washington captures an aspect of American culture, the dissonance of two widely held beliefs, but obscures them with politics. Democrats seize upon the belief that people want a better healthcare system. Republics seize upon the belief that government operations are inefficient.

There are many people protesting and vocalizing concerns very loudly. Some Democrats suggest these are planted by opposing organizations or that these people represent a smaller portion of the population than the majority that wants healthcare reform. Either are lame attempts to ignore opposition. Some Republicans claim parts of the legislation will pose morally questionable compensation structures and there could be problems attaining access to care for those that need it. Neither claim has a solid basis and both are lame attempts to shift focus away from whether there should be reform or not.

Both sides as out of touch. People dislike the quality of care they receive, healthcare bills are the basis for the majority of bankruptcies, and the problems inherent (too many people needing too much care with not enough providers resulting in an unbalanced cost structure) have no foreseeable improvements. However, pointing to Medicare as a model for how to insure more Americans makes no sense given Medicare will soon go bankrupt. The frequently referenced motive to increase the number of people with access to healthcare is a moral stance one can defend but claiming that more demand will decrease prices is against the basis of economic theory (which says to increase demand prices need to be lowered).

There is an abundance of piecemeal lifting from other industries to apply to healthcare. All are flawed to some degree; healthcare is unlike an other industry because it literally deals in life and death decisions. There is almost no limit to the amount that can be done to attempt to prevent deaths, nearly limitless demand and prices can go high as businesses desire because demand will not decrease. Pretending to apply economic theory is wrong, this industry needs governmental intervention to prevent the sector from consuming immense resources from the overall economy. Healthcare spending in the United States represents 15% of GDP and is already on a steady pace to reach almost half of GDP by 2050 and could consume all GDP in 2082 at this rate. This means the entirety of all profits from all sectors for the entire country would all end up recycled back into healthcare spending someday. This is truly not a sustainable trend.

The need for government to do something is far from free reign to do whatever it sees fit to enact. Bills should receive careful consideration and be clearly communicated to the public to allow review and commentary before anything ever reaches the Oval Office for signature. As Daylight Savings proves, items written into law are harder to write out once enacted. It is hard to say precisely what the proposed changes will be once Congress finishes its arduous process. The latest development is the probable abandonment of the "public option" - a government operated alternative to existing insurance plans. The "single payer" option is not even debated anymore. Carving out those reform measures leaves measures aiming to cut costs, but a July review by the chief budget analyst for Congress indicating no significant decrease to overall healthcare spending and increased costs with the expansion of coverage to millions of uninsured.

The uprising of popular dissent for increased spending by the Federal government comes in the wake of the intelligence errors resulting in the Iraq War, on the tail of massive bailouts to the tune of trillions for corporate entities without real gains reaped by individual citizens. Combined with this massive distrust of Congressional oversight is an economy that continues to lose jobs instead of create real wealth. The willingness of Congress to spend while unemployment remains high further isolates Congress from how families budget spending.

Here is a simple chart from a Gallup poll that expresses this distrust:
Citizens have ample opportunities to be leery of increased government intervention into healthcare. Here are a few items that might dissuade people from embracing federal oversight of healthcare reform:

• Medicare patients enjoy benefits according to polling, but the rest of the population pays for the difference in prices Medicare patients receive, and the system will go bankrupt in a few year.
• Ask the veterans you know why they do not use the VA hospital system, it is unpopular for a reason.
• If you hate post office lines you probably did not care for the President's analogy to explain why a public option would not put private insurers out of business.
• A visit to the DMV reminded me how confusing government websites and rules can be, and also how the lack of incentive for a public employee to be customer-service orientated can be very frustrating.
• The IRS tax code is so convoluted that Congress members who sit on the committee overseeing it make filing mistakes. Congress is not known for making sense.
  
• There is still no direction for the remaining prisoners at Guantanamo Bay. How can the fate of millions of citizens be any easier to decide than a few hundred known terrorists?
• Arguably the most famous governors in the nation include scandals in New York (Spitzer), South Carolina (Sanford), and Illinois (Blagojevich). In addition to squandering public funds these types of events represent lost opportunities to focus on real problems.

That is a spread of unrelated reasons citizens may distrust the government, but there is not a strong counterargument of reasons citizens should trust the government. That does not mean Americans do not want healthcare reform. Escalating costs represent a stark threat to our nation's economic viability. The rhetoric heard most often misses this mark by aiming at either profitability for the healthcare sector or targets the manner in which reimbursement happens for procedures. Decreasing costs for a business, like less paperwork due to increased electronic filing, represents an increase in profits and there is no incentive to pass on the savings to patients if the market already set prices higher. Likewise, the arguments about private insurers/government option/co-ops all fail to attack the reasons why costs are high. The presumption that a stronger hand will be able to compel costs downward is ignorant of healthcare practice where a decrease in reimbursement in one place is made up for by a reimbursement in another. Moreover, the existing systems lack controls necessary to prevent fraudulent activity.

The attack on healthcare costs will be to address demand. The number of patients seeking aid determines the market. A small percentage of the population represents a majority of the spending and the top culprits are heart disease, pulmonary disorders, mental disorders, cancer, and trauma. To affect any or all of these causes is to alter the landscape of healthcare costs, if that is possible.

The Mayo Clinic outlines five means to prevent heart disease; do not use tobacco, be active, eat healthy, maintain a healthy weight, and regular screenings. At first pass these seem like individual responsibilities, however the government possesses influence through its power to set the rules of the game. Tobacco is the easiest target. FDA oversight could make more meaningful limits on servings if it had the backing of Congress. Exercise and weight may be harder, but innovative strategies could be explored.

The National Lung Health Education Program lists the three main causes of pulmonary diseases include smoking, hereditary risk, and large inhalation of dust at home or work. Again the government can exert control over smoking as well as work or home conditions.

Trauma has a multitude of causes, but some are more frequent. The American Trauma Society lists a few methods to help prevent possible causes of trauma; bicycle helmets, no drunk driving, seat belts, obeying speed limits, safe gun storage, and child safety.

Cancer causes also vary, but known causes mean strategies to prevent some cancers exist; avoid smoke, use sun screen, eat health, reduce red meat intake, avoid alcohol, exercise, check family history to know what to look out for, healthy work environment, safe sex, and regular screenings.

The causes of mental disorders vary, though some known links could be targeted such as alcohol abuse.

Preventative care is effective yet incredibly difficult to legislate. Tying physician reimbursement to non-events (the healthy) begs for errors and fraud. Binding citizens to compulsory care goes against the grain of independence born so strongly in every section of the country. Education alone, as effective when taken, is very hard to implement. Yet these are the known pathways towards reducing the incidents driving up healthcare demand in the United States.