(part two of two about the healthcare debate)
A great deal of the heat in the healthcare debate could be avoided if both sides would accept some simple truths, and talk about how to deal with them instead of denying them.
1. Some sort of healthcare reform bill will pass. Too many political egos and reputations are at stake, and too many voters feel it has been promised to them for it to fail. Opponents see themselves as Gandalf, saying "You shall not pass!"- but a more realistic image is that of King Canute. Spend your energies trying to get a compromise on an acceptable bill instead.
2. Stop railing against "public option" or government healthcare; we already have it- and no, I don't mean Medicaid, Medicare, etc. As was mentioned in part one , indigents receive free care from hospitals that accept government money (which is virtually all of them), and the hospitals add the cost to everybody else's bill. I suppose in some semantic sense you can claim this isn't government healthcare because your check didn't go to the IRS; but still, he got the care by government fiat, and you paid for it. In any real sense, the only difference between that and the British NHS is that they are more intellectually honest about it.
3. Stop claiming that real healthcare reform can be budget-neutral. There's not enough slop in the system that any real, improve-quality-of-life type improvements can be made by just tweaking here and there. Real programs will have to be created, real checks cut, and it will cost real money. Everybody on both sides knows this, you're not fooling anyone. Oh, you're going to claim it can be done with savings? Well...
4. Preventative care does not save money; it costs money. Preventative care is all about increasing both lifespan and quality of life for the individual, but it costs society more than merely reactive care. This is counterintuitive- we can see that it's much cheaper to catch a disease before it develops than to treat it afterwards... but what you're not seeing is that for it to work, you have to test/treat everybody- most of whom would never have caught the disease in the first place. From an article by Charles Krauthammer "Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.
That's a hypothetical case. What's the real-life actuality in the United States today? A study in the journal Circulation found that for cardiovascular diseases and diabetes, "if all the recommended prevention activities were applied with 100 percent success," the prevention would cost almost 10 times as much as the savings, increasing the country's total medical bill by 162 percent. Elmendorf additionally cites a definitive assessment in the New England Journal of Medicine that reviewed hundreds of studies on preventive care and found that more than 80 percent of preventive measures added to medical costs."
5. We're not going to see significant savings through reduced overhead by government offices over private ones. If you're thinking of eliminating profits, you should realize that the profit margins are quite low- sure, a few CEO become gazillionaires off it, but compared to the total costs of doing business with 300,000,000 Americans it's insignificant. Those costs of business include tons of paperwork, which must be filled out no matter who is paying for it... and have you ever known the government to reduce the amount of paperwork required?
6. Tort reform must be part of the final package. Malpractice insurance is a big part of the cost of medicine today- for some disciplines, the cost is so high that doctors are leaving those specialties in droves. This would be of benefit to all of society, not merely medicine. We all have our favorite gawdawful lawsuit story; mine is a local one, a local manufacturer of riding mowers that was sued by a man who lost his foot to one. The facts were not in dispute; the mower did have built in interlocks that stopped the mower when the rider left the seat, but this guy bypassed the safety by carrying a cinderblock in his lap- when he saw a can or bottle in the grass, he would stand up, putting the cinderblock in the seat to fool the mower, and jump off to kick the can out of the way, jumping back on with no time lost to stopping. One day he slipped while kicking. His claim was that the manufacturer was liable, because that was a foreseeable event, and they should have figured out a more sophisticated safety he couldn't bypass. In any rational society, the judge wouldn't even use the gavel as he dismissed the case; he'd lean over and bitch-slap him.