Universal Healthcare: A Response

My last post calling out Christians for not supporting Universal Healthcare when it seems like such a “Christ-like” action generated some comments that I’d like to more fully respond to because they are interesting and I hear a couple of them a lot, though I don’t agree with them, and so a new more Universal Healthcare oriented post is warranted.

Ovi writes:

I understand your point, but I would think the Christ-like decision would in fact be to support the church helping people in their own way, not by order of the King/State.

I don’t think Universal Healthcare in general works… There are people in Canada who have it and cross the border to the US because they have to wait to get treatment in their country… Countries in Europe who have similar systems get most of their medicine from the US because the best medicine and technology comes from the efficient competition-based free market of the US.

When you see stats about people who don’t have healthcare, keep in mind that some people don’t want it and others can in fact afford it, but just don’t get it for whatever reason. So the people who really need it and don’t have family and friends to help them and don’t go to current free clinics that are available, there are a very few of.

Lets take these one by one. First off, the bible is pretty clear that Jesus supports paying taxes (though certainly more vague about voting for legislation that will create taxes). We can extrapolate from this that either Jesus is in favor of bowing to power when taxes are concerned, or in general not opposed to taxation. So I stand by my statement that Jesus would vote for Universal Healthcare, and so supporting it would be a very Christ-like thing to do even if it increased taxes.

Secondly, I think before we can decide whether Universal Healthcare works, we need to define what “works” means. It is my belief that the goal of health care is to provide medical services that extend life, and that the best solution will extend life the most with the least cost. Literally every other industrialized country in the world has some form of Universal Healthcare so we should be able to compare our situation to theirs and determine at least if what we have works better than what they have.

Canadians do see a wait time for elective procedure (emergency procedures are of course handled immediately) but not all of the countries that have single-payer systems like Canada’s have the same problems, and the elderly in the US who use our single-payer system, Medicare (named after Canada’s) certainly don’t see any longer wait times than then non-elderly in the US. The proposals on hand don’t mirror the Canadian system very much, so this isn’t really on the table as an option anyways. I’d be willing to more thoroughly cover this if there is interest.

I haven’t run into any references to new medical technology production in Europe vs. the US but I have done some review of the production of new pharmaceuticals, often referred to as New Chemical Entities or NCEs. This study for example shows that the US dominance in the pharmaceutical industry is a myth and is in fact continuing to wain. Some argue that this isn’t because of the US’s high priced free-market so much as Europe’s ability to run more efficiently, though no one is positing why that is yet. Also we shouldn’t discount that most discovery research in the US is done largely with the $28 billion dollars in research funds provided by the NIH every year, the pharmaceutical companies tend to pick up drugs only after they’re ready for clinical trials. The NIH is a tax funded institute of the US government.

So lets compare the metrics of other countries with the US for health/cost to determine which system works better by my definition of works. The US spends per capita more money on health care than any of its industrialized counterparts, in fact nearly twice as much. The US also sees 60% of its bankruptcies related to medical bills, something that simply doesn’t happen in other developed countries. The argument here goes that we see better outcomes, that is, you get what you pay for. But this simply isn’t true either. The US has the lowest life expectancy and highest infant mortality rates of any of its industrialized contemporaries. We spend more on health care as a percentage of GDP than any other country in the world yet the WHO ranks us as 37th out of 191, just above Slovenia.

The waiting lists in Canada are used as form of rationing health care usage over time, and is rightly pointed out as such, but arguing against rationing is not arguing against Universal Healthcare. The US has rationing too, but it’s done more amorally: we let poor people die. Other systems spend less, get better outcomes, and quite frankly evince more compassion than our system.

Finally, making the statement that a significant number of the 35+ million Americans who don’t have health insurance, or even more so the roughly 45,000 Americans who die every year due to it’s lack, don’t want health insurance seems seriously absurd, but may be worth investigating. I couldn’t find any research addressing the question and I don’t think it’s overstepping to speculate that its because everyone thinks it’s obvious, but I would support research into the issue.

I invite Ovi to contradict anything I’ve said here and to more thoroughly support his points as well. Also I’d be interested in his thoughts on taxation in general so that I could more thoroughly understand them. For example, “Do you seek to remove all taxes?” Also if anyone has more questions or wants sources for the things I didn’t provide (which are plenty) I’ll gladly dig em’ up again (this is a standing invitation for anything I write).

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12 Responses to “Universal Healthcare: A Response”

  1. John Jensen Says:

    There is not a free market in health care payments, and people who claim that may be fundamentally misunderstanding the problem. One aspect I think a free market requires is cost exposure. That simply doesn’t exist under an employer-based insurance model.

    The only true free market aspect of American health care is for those who are uninsured and have cost exposure. Those folks sometimes avoid treatment and frequently cannot afford treatment. Given they are in the same space as those who can get an MRI for “free” through their insurance plan, there is no pressure to lower MRI costs to open the market to the uninsured. A market cannot function correctly — and does not function correctly — with a system like this.

    The argument of American exceptionalism is appealing to many but not substantiated by the data on medical outcomes. The single aspect where American health care clearly tops other countries is cost. We have by far the most expensive health care of any industrialized nation. Combine that with access problems and no significant difference in medical outcomes for those who have access, and we can conclude that if this the market model of health care then it is broken.

    Relying on market principles is not an option for health care spending.

    Further, the argument that some people “choose” to go without insurance is obfuscation of the much more problematic case that many cannot afford it or have difficulty obtaining the information to purchase it. Every person requires medical attention at some point in their life. We cannot expect they will buy insurance the week before they are to get cancer. We cannot allow them to wait until they get cancer to buy insurance — that would be gaming the system. The only solution to this access problem is to have everyone who doesn’t have it to buy insurance with government assistance if necessary.

    I don’t understand the arguments from those who choose to rationalize our excessive spending on health care or our significant lack of access. You can argue your principles disallow the federal government from fixing the problem. You can argue a variety of methods for fixing the problems. But to pretend the problems of cost (or that, it isn’t a problem at all) and access do not exist ignores the reality all around us. Granted, these significant access problems do not exist in the employer-based insurance market. It isn’t a great secret why premiums aren’t outrageous for sick employees, why pre-existing conditions cannot be used to deny coverage, and why insurance companies cannot drop employees at any time: Government regulations.

  2. I agree with John that the current system isn’t a complete free market. The insurance model is also a problem and so is employer-based coverage. I think it would be better to eliminate both and let people deal directly with doctors, it’s the only way for individuals to have control over where their money is going.

    Josh, I don’t think I can refute your studies, but the assumption that we let people die on the street seems pretty cynical to me, and I personally don’t think anyone does that.

    My distrust in government control and too much taxation is at the root of the issue simply because I believe in giving my money directly to doctors, not politicians and bureaucrats. And the government also has a history of doing things badly… airport security, the postal service, the DMV, and public schools come to mind, I don’t want to add my healthcare to that list.

  3. Josh Wittner Says:

    Hey thanks for responding Ovi!

    I don’t think we’d want to get rid of insurance all together since it provides a fundamental service in pooling risk. Without it a lot of medical therapies that exist now would simply be impossible to afford for anyone except for the super rich. Even if you take into account that prices would be cheaper because risk wasn’t pooled, some medical interventions simply cost more money than an individual should be expected to afford. The free market would create insurance on it’s own.

    I didn’t say that we let people die “on the streets” and I certainly didn’t intend to imply that as a significant case. What I said and mean is that we let people die by encouraging an insurance system that practices widespread rescission and denial based on pre-existing conditions. We let people die by allowing hospitals to refuse service to the non-insured in all but the most extreme cases. We let people die by maintaining the status quo. There are no good direct solutions to these problems because of, well, reality so we must find solutions that are compromises. Or we’ll let more people die. There’s no individual to whom we can point and assign blame for this. This is our society’s decision. I’m no cynic on this, I just think the incentives need adjustment.

    In general I am also very skeptical of taxation as I have a strong confidence in the free market. However, when it comes to health care a comparison of our system to the others of the world provides a clear picture that government is doing a better job of solving this problem and so I’m not opposed to a government solution here. What other option is there?

    I’ve gotta verify some things before I can respond to the government’s poor handling of “airport security, the postal serivice, [etc.].”

    Btw, I’m having a rad time talking about all of this.

  4. I find your opinions really interesting, but could I supplement your knowledge on how Jesus (from the Bible) would vote on health care?

    You mentioned that you didn’t see Jesus having any problem with paying taxes. I would call that into check. When he said, “give that which is Cesar’s to cesar,” (when petitioned to pay a tax) he had an apostle get the necessary funds from the mouth of a fish. Did he then give of his earnings? Did he give to a government that which he had worked for himself?

    Jesus also taught through his apostle James that, “faith without works is dead.” Throughout scripture examples are given that illustrate for us that we cannot receive something of value for free. The whole give a fish vs. teach to fish comes into play here. There must be work applied on the side of the recipient for a lesson to be learned.

    You could argue that there were plenty of times when Jesus healed first and asked questions later, but I would check that as well. Through divinity (this is Jesus from the bible, so we must take divine interpretations into account) he could see the intent of ones heart. Can you recall Jesus ever healing an “evil” person? (hear me out, I’m not calling the poor evil here). He would often call upon those who had received charity to go and DO. To perpetuate more good in the world. So in consideration on whether or not this health care plan is something he would endorse, I would ask the question, does this plan encourage, teach or otherwise demonstrate to those benefiting most from it, how to support themselves or in other ways become more self reliant? Does

    If the answer is “no” and I’m not saying that it is. It would not be part of a purely Christ-like action. Sustained “something for nothing,” usually ends up hurting the people we want to help the most.

    If the answer is “yes” then I believe you have further resolved your argument.

    So again, I’m not taking a stance on the health care system itself. I’m still trying to really understand it myself. I’m just lending a hand to an argument I find interesting. Hope this puts some food for thought on the table.

  5. Josh Wittner Says:

    Well I don’t know of any part of scripture where Jesus pays with money that he didn’t call into existence so I can accept that perhaps Jesus would not pay taxes. This however doesn’t refute that he instructs the people to pay all taxes when telling us to “Give to Caesar what is Caesar’s, and to God what is God’s.” Also in Roman’s 13:6-7 Apostle Paul is quite clear about paying taxes, “This is also why you pay taxes, for the authorities are God’s servants, who give their full time to governing. Give everyone what you owe him: If you owe taxes, pay taxes; if revenue, then revenue; if respect, then respect; if honor, then honor.”

    So my point is that if Jesus has no problem with taxes what hesitation would he have to vote for creating new taxes if he was convinced of the need? That’s where your later points come in.

    Your point is valid only if the assumption that providing health care to the poor is a charity. It is not my belief that it is, instead when I look at and analyze the system we have in place it becomes clearer that providing health care to the poor is more about righting a social injustice, more about fairness than charity. There are several reasons that I think this, but I’m gonna write em’ up in my next blog so they get more exposure because I think this brings a very important point.

  6. I sorta felt like I had to respond after you quoted me! I’m glad to add to the discussion, I’m enjoying it myself!

    To answer your query about what other options there are, here’s a great video from Reason.tv that coincidently was just released today:
    http://reason.tv/video/show/how-to-fix-health-care

  7. John Jensen Says:

    Health care is too expensive for individuals to purchase alone. A model of risk-pooling is the only logical way to pay for health care. Individuals in this country who choose to pay out-of-pocket tend to cease thinking they’re being efficient the moment they are afflicted with cancer or need an MRI. (We are all young and invincible here, I presume.) The model of having save a lifetime for health care through an HSA has a few flaws. One, people can get sick earlier in life — Josh and I have a friend undergoing chemo in his mid-twenties. Second, like any market there would have to be some penalty for not having the money to buy a given treatment. The logical market analogue would be to deny access to the treatment. Some charities and churches would step up, but many people and especially those who are poor, uneducated, and minorities would not have access to health care. No nation in the world operates without risk-pooling, and even without government regulation insurance would be the primary way of delivering health care in this country. The better system is fewer insurance entities that all have access to all providers, like in a single-payer system. I think you should reconsider your thinking about insurance.

    I agree that employer-based model makes no sense. I support a stronger individual market, which is the primary reform of the health insurance reform bill in Congress. Having private insurers compete in a government-run marketplace is different from a government takeover. Like energy or telecommunications, health insurance deserves heavier regulation than most sectors of the economy.

    Implying that we’re too delicate of a nation to let people die in the streets is wrong, considering we let tens of millions go without health insurance while a large percentage of the country worries none or actively opposes measures to fix it. Yes, it is a moral argument because fundamentally protecting human life is moral. People are not dying on asphalt but the metaphor holds: people do die in significant numbers because they do not have access to health care in this nation and do not have the help to get it (not helping is the “on the streets” part of the metaphor). I cannot accept the premise that we can have an adult conversation about health care in this country without recognizing that access problems lead directly to significant health problems including death.

  8. John Jensen Says:

    (I posted too soon.)

    Beyond dying on the streets, people are going sick on the streets and others are going bankrupt on the streets, and others are going into life-altering debt on the streets. Just like I said in my first comment, we cannot merely brush aside cost and coverage concerns. And we cannot brush aside the direct human toll that the lack of access to health care leads to. Too easily do we sweep under the rug the serious moral concerns of our health care system in an effort to talk about numbers and costs and how expensive MRIs are. Yes, people die because of our health care system and, yes, we can prevent some of those deaths. That is, in fact, largely the point.

    We have a relatively unregulated individual market and yet that is the worse market in terms of efficiency, cost, and brutal denial of coverage. The more-heavily government-regulated (and subsidized through the benefits tax exclusion) group market has cheaper premiums, better coverage, and lower administration fees. This all goes further for Medicare. The principles of a market rely on haves and have-nots, and that is a dangerous equation when one’s health lies in the balance.

  9. I really enjoyed that post, I am a little confused, and have a tiny question. May I send you an email?

  10. Josh Wittner Says:

    You can post your question here and I’ll respond to it, I don’t have a public email yet. I’m really interested in your question and I hope you do post it here.

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