I always distrust any health care overhaul that is based in platitudes or talking points and does not address fundamental issues before us.
This debate is fundamental in another way: American. The American spirit is based in risk taking, but great reward. So we are grounded in a private health care system, that is, you pay for what you receive. The reward is that our system has a huge upside. We have the latest technology with the highest availability in the world. The downside is, of course, the risk of being American is that if you do not succeed, you cannot afford care. This oversimplification has been confused by the link of health insurance as an employment benefit and multiple government programs, namely Medicare and Medicaid, which have gradually changed the public perception from health care as being something you earned to health care as an entitlement. There have been some who have even confused this entitlement with a fundamental right. Unless those who design health care reform understand this core issue, that is health care is not a right, nor are we entitled, no debate can really proceed.
This being said, we can as a society decide for the common good that we will provide care for those in need. When my father practiced in the 1930s, 40s, and 50s he saw many patients who could not pay. But they were grateful. They did not come into his office demanding care and show a card that indicated someone else was paying their bill. His system has been replaced by Medicaid and Medicare. When my father cared for patients in need, I feel this represented something else that is very Amercian. In order for any democratic capitalistic system to survive, it depends on the kindness and generosity of its citizens. Pick someone up when they are down, and they will do the same. It is impossible to write a law to define what exactly is meant by “being down” or when we will define “being picked up.”
Unfortunately, the Medicare sytem has become unsustainably top heavy. We now have lower income workers who have no net worth paying for the health care, and in many instances the prescription drugs, of wealthy older Americans. This is not only unsustainable. It is fundamentally unfair. I say this as one not far away from receiving these benefits.
The healthcare industry had seen a huge increase in expenditures, particularly as our population had aged and our technology and drugs choices have expanded. And yet this has been delcared a “crisis.” It has also been described as ruinous to our economy. This can only make sense if one does not believe that good health is in high demand and that health care is somehow not a part of the economy. Of course, both of these are true. It could be more efficient, but a high demand item will necessarily trump other expenditures. And many people will be employed providing that service.
I am very puzzled by doctors who want us to throw in the towel and just go ahead with universal coverage. How easy it would be to have one payor source and everyone who walked in the door would be covered. Doctors have been fighting Congress for many years to fix the erroneous payment formulathat determines their Medicare rates. Of course, with some health care bills this formula may be fixed, but my concern is that this represents the struggles they would face for years to come. These would be fundamentally political struggles, not marketplace struggles that determine the value of their service. If you believe in what you do, then you have to believe that what you do is valuable. This will get lost. It already has.
So as a practicing physician, I agree we can and will find ways to take care of those in need. But unless I see a health care debate that addresses the fundamental issues I have mentioned, I mistrust these efforts and cannot support them. The “public option” is just a small piece of the erroneous fundamental thinking about this issue.
James P. Farrell, MD