Thursday, July 12, 2012

Our Nation's Health System Still Sick

(From the July 12, 2012 issue of the Grand Haven Tribune)

If there’s anything most people can agree on with regard to health care, it is that our system in this country needs to be reformed. But the health care legislation that was recently passed and mostly upheld by the Supreme Court has me concerned.

First, the fact that the Supreme Court upheld most contested portions of the legislation as constitutional does not settle the matter. For example, I’m not convinced that the government forcing people to buy a product is within its role either under the commerce clause or its power to tax. I’m not a lawyer, but I’m reasonably intelligent, and I find some of the justification of the court suspect. Obviously, people will disagree even as the nine justices did.

But more importantly with regard to the court, the decision does not prove the health care reform is good. The court’s majority only said the health legislation was legal, not that it was good policy or would solve the problems we have. Let me explain some of my problems with it.

I don’t like the way it was passed. A lot of information was in the bill, and it was pushed so fast that most legislators barely read it before voting. In fact, Nancy Pelosi, Speaker of the House, said congress needed to “pass it so we can find out what’s in it.” Huh? Legislation in the U.S. Congress is not supposed to be a piñata or gift-wrapped surprise. That Pelosi could say that with a straight face is only possible because of the botox she recently had injected. We can only wonder if her congressional health plan had the taxpayers on the hook for that. Also, Obama as candidate said he would post all legislation on line so not only elected officials but voters could review it before it was voted on. Add that to the long list of unmet promises by this President.

It’s also unsettling to me that many of the corporate, union, and state government leaders who campaigned for the legislation have subsequently asked for and received waivers. In other words, they worked to pass health care reform for others but are excused themselves from abiding by what it dictates for others. There’s something sick about that.

Now that it is passed, I am skeptical of its positive effect. Those who pushed it said it will mean more people will have health care. Not so fast. More people will have health insurance policies because the law forces them to buy them. But having a policy does not mean having good health care. The policies people can afford to buy may or may not have good coverage.

Employers are being forced to provide coverage for employees or face a fine. People should recall that employers offered health policies years ago as an incentive to get the best people to apply for positions. Notice how over time a free market incentive gets turned into a government mandate. It’s yet another example of well-intended bureaucrats overreaching into the private sector and most likely making matters worse. This will make it less possible for many employers to hire new workers at a time when unemployment is already high. Also, there is already talk that many people will be told by employers to seek health care themselves on a health care  “exchange” that many states will set up as part of the new law. So if you like your policy and want to keep it, as Obama promised, that may not be the case.

A lot of the underlying problem is that the government, and by extension many in the public, confuses health insurance with health care. Insurance is about managing risk. The idea is that people put money into a pool and if you get sick you can access funds to pay for health care. What this policy does is remove the “if.” If every person and business is required to buy insurance, and every insurance company will be told who and what they cover, it ceases to be insurance by definition. It seems that’s ultimately what the government wants though—not private insurance but another huge government program that will be costly but not necessarily better.

The government is involved because they want to ensure more people have access to health care. But with regard to the poor, we should look at eliminating fraud and waste in Medicaid and Medicare and also enable more nonprofit health organizations to help the poor. With regard to those who can afford insurance but don’t get it, I still believe in the combination of liberty and responsibility over government trying to force behavior in paternalistic fashion.

People use health insurance for too much now. I’ve always considered insurance something you buy and hope you never use. But health insurance is involved in everything from a short office visit to routine health products. It’s as if our auto insurance paid for gas, after all the paperwork that would be required.

Health care would be better it went back to the free market for the majority of things, such as cold and flu, check-ups and other minor and routine medical issues. Insurance should only be tapped for expensive prescriptions, disease, and accidents that involve significant medical complications. A combination of government and nonprofit programs that are means tested would help the minority with no access to health care.

That would be simple and effective. But in the meantime, we have a legislation that includes 59 items, many of which we’ll find out about in the next two years. If we don’t like what’s in it then, I wonder if Nancy Pelosi and her colleagues in Congress will be willing to change it.

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