Some thoughts on health care talking points

When even Newt Gingrich admits the GOP has “zero ideas” for alternatives to the Affordable Care Act, and when it’s a given that health care spending is the main source of unsustainable deficit spending in the out years, it’s frustrating to try to have an intelligent conversation with people on this subject when they thoughtlessly dismiss “Obamacare” because of uninformed ideological bias.

What to do? Here are some thoughts on educating our fellow citizens on the health care issue.

There are three basic models for delivering health care that are economically viable. (Note this only addresses economics, not ethics, as you will see.)

Model 1: Everyone is responsible for their own health care costs. Under this model, which America followed before World War II, market forces would indeed hold down the cost of health care. If everyone had to pay for visits to the doctor or hospital or their own medicine, or for their own insurance, market forces would certainly reduce costs. (What would happen to quality is another story.)

Although this sounds attractive at first blush, especially to free market purists, it must be emphasized this only works economically if you accept the bad with the good. You would have to eliminate employer-provided health insurance, since it clearly destroys the market linkage. Those who consume something must pay for it themselves for markets to work. Somebody shows up at the emergency room that can’t pay? The hospital must refuse them service. An accident occurs and someone is bleeding to death? If you can’t pay, goodbye. Talk of “charity care” in this model is ludicrous. The vast majority of what we call “charity care” is paid for by a de-facto tax on paying customers. If you doubt this is a tax, try opting out of the “charity” portion of your next hospital or doctor bill. Any deviation from harsh market realities causes this model to break down, because if people can receive free care, what’s the incentive to take personal responsibility?

The current system in America, which operates under the illusion that we use this model but which is so contaminated that market forces are almost non-existent, proves the folly of thinking a free market system can work that leaves any room for compassion. Our bastardized system has more waste and costs more than any other industrialized country, and we rank comparatively low for what we pay for. A market-based system must be heartless or it will not work economically.

Model 2: Single payer. In America, this idea is commonly proposed as “Medicare for all”. In this model, some sort of tax (most commonly a payroll type tax) is created, and this tax is used to pay for universal health care. Traditional Medicare is one way this could work. Another (the German model) would use the tax to pay for vouchers, which individual families could use to purchase basic health insurance. (Note the German model actually has more of a true market structure than ours, since insurance companies must compete for customers, and customers, not employers, hold the purse strings.)

Costs are controlled in this model mainly by budget: The society in question decides how much they will spend on health care, and providers must figure out a way to make the money stretch. It largely eliminates the incentive for overtreatment that exists in a fee-for-services system, but it can result in some rationing of care.

Model 3: Keep private insurance and private providers, but require everyone to have insurance. As a necessary addition, since everyone is required to have insurance, those who can’t afford it will need some sort of subsidy to join the insurance pool. Model 3 recognizes that you can’t wait until you are sick or old to have health insurance. By definition, for Model 3 to work, everyone who will sometime in their life need health care must pay into the pool.

The problem with Model 3 is in the details. The concept is simple, but the details can become complex. Who is responsible, the individual or the employer? What happens when you change jobs or are uninsured? What about people with pre-existing conditions? The Affordable Care Act follows Model 3, and dealing with those details is why it’s so complex.

That’s it. Any economically viable system for delivering health care must follow one of these three models. So, when you encounter someone who starts spouting off against Obamacare, challenge them: Which of the three models would you choose?

The complexities required by Model 3 pretty much guarantees there will be some bumps along the road in the implementation of the Affordable Care Act that will need to be tweaked. But, my fellow LDS Dems, we must not let the critics off the hook, whether those critics are Sen. Mike Lee, Congressman Bishop, or our friends and neighbors. If you don't like Obamacare, you'd better be ready to suggest an alternative.

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