Expressing opposition to Universal Health Care is a bit like opposing the Flag, Mom, and Apple Pie; it is generally seen as indicative of a cruel and cramped attitude toward the less fortunate. Furthermore, with the price of health insurance and health care acting as a major factor in the increasing anxiety of the middle class, such opposition is a political loser of the first order. Yet the American public is being sold a bill of goods when it comes to Universal Health Care. If Hillary Clinton gains the Presidency and is blessed with a Democratic Congress, the American Middle class is in for one of the great "bait-and-switch" scams of all time.
It is a useful approximation to consider the American health care system as a 3 tier system as follows:
Tier 1: The highest level of health care, with state of the art technology, pharmacology, and personal care, complete with continuity of care, exists for the wealthy and those who have very good insurance. This gold standard is the level of care afforded to our Senators and Congressmen and is very expensive.
Tier 1A: Available to those with good insurance, Tier 1A offers all but the very newest technology and the most expensive of new drugs. This is the level of care that most middle class Americans have been accustomed to; there are some trade-offs, especially in terms of continuity of care. As Doctors have become squeezed by pressures on reimbursement, they have aggregated into groups which decrease expenses but make it harder to obtain timely appointments with the Physician of choice. Thus far this has been a tolerable trade-off for most Americans. Of special note, when Medicare was initially introduced, it was a Tier 1A system; it no longer can be considered such.
Tier 2: Available to those with merely adequate, lower cost (though still expensive for most people) insurance, including Medicare and most managed care health plans, Tier 2 offers some assurance of timely care, very little continuity of care, increasing limits on cutting edge technology and medication, and features significant rationing via such limitations as well as via the administrative road blocks that effectively deny payments for a significant fraction of all claims.
Physicians have been "voting with their feet" for the last decade; those who can afford to have been abandoning Medicare in droves. The result is a decreased availability of Physicians and an overall diminution of quality as those Physicians who can attract a more well-to-do clientele make the difficult decision to leave the system.
[As a Physician who has remained in Medicare by choice, and is preparing to leave the system in 2008, for me the expense of accepting Medicare was not the problem. I have always tolerated the decrease in fees mandated by the economic magicians in Congress but have finally decided to leave because the time and energy spent trying to work with the bureaucracy has finally passed my limits of tolerance.]
Tier 3: The lowest tier of American health care is available to anyone, including Medicaid patients, uninsured people of limited means, illegal immigrant, et al. Tier 3 offers excellent state of the art care in emergencies and merely adequate health care for non-emergencies. Those who enter this tier must be willing to tolerate long waits for appointments, crowded waiting rooms in which to spend entire days waiting for routine care, minimal choices of medication and Tier 2 level technology only in the very rarest of cases. This level of care is unacceptable to most Middle Class Americans.
Robert Novak reports on the ongoing attempt by Hilary Clinton to stealthily introduce Universal Health Care to the American people. In 'HILLARYCARE' IS ALREADY HERE, Novak points out that the government control over American health care has been accelerating out of sight for several years and is likely to increase markedly even before the next election:
THERE is no need to wait until a new president is elected next year for the great national health-care debate. It's underway right now, disguised as a routine extension of an immensely popular, non-controversial 10-year-old program of providing coverage to poor children. In fact, this proposal is the thin edge of the wedge to achieve the longtime goal of government-supplied universal health insurance and the suffocation of the private system.
One could argue that Novak is overstating the case but as someone who has watched the slide of Tier 2 health care toward Tier 3 quality over the last 25 years, I would suggest that current trends are heading in a very unhealthy direction.
The Democrats, of whom it may be most charitably said that many of them probably have no clue when it comes to economics, are counting on the ignorance of the electorate and their anxiety over health care costs to press for Universal Health Care, which can be nothing but a disaster. Of course, Republicans, recognizing a losing political issue when they see one will hop on board the express as it heads for the cliffs.
Here is the essential problem: UHC will be offered as a plan which implicitly suggests the availability of Tier 1A coverage for all. That is the only way it can be sold to the American middle class. Yet anyone who has spent any time giving even the most superficial thought to the question will recognize that any affordable UHC will be at best a Tier 2 system, like Medicare, which, have I already mentioned?, is rapidly on its way to Tier 3 status.
And the worst will the long term effects on innovation and creativity. The attacks on the drug industry, which have been mostly in the realm of public relations up till now, will certainly escalate. Rules and regulations will metastasize in order to keep costs down, thereby limiting the profits of the industry that has done more than any other to keep people healthy. As innovation stalls, chronic illnesses which should be curable in the next 5-15 years, will remain as expensive management cases rather than (initially) expensive cures. More money for more older people with chronic illnesses will lead to more intense pressure to curtail treatment for those who are deemed problematic (notice that in England, under their UHC system, those over a certain fairly young age can not get a hip replacement. In addition, the ranks of those who are refused treatment for various cancers and other expensive illnesses grows by the day.)
Furthermore, establishing a Health Insurance floor, as any UHC system must inevitably do, will encourage suppliers of Tier 1A care to edge toward Tier 3 care (since Tier 2 will be slowly disappearing.) Since Tier 1 and 1A effectively support the bulk of innovation in Medicine, this movement will further constrict the moneys available for difficult and expensive research. Even those in Tier 1 will suffer by the loss of life saving innovations.
It will all be sold as fulfilling the credo that is almost universally fed to young people in the health care system, that "Health Care is a Right, not a Privilege." Sadly, the only way to make this privilege a right is to offer almost everyone the same level of care, and that way lies disaster.
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