Vermont Senator Bernie Sanders offers a chance to understand the thinking motivating those who overtly propose to create a new "access to health care insurance" entitlement/mandate as a stealth approach to universal, government run health care. He suggest that not only is our health care system collapsing but as the title implies, health care is a right, not a privilege.
Let's be clear. Our health care system is disintegrating. Today, 46 million people have no health insurance and even more are underinsured with high deductibles and co-payments. At a time when 60 million people, including many with insurance, do not have access to a medical home, more than 18,000 Americans die every year from preventable illnesses because they do not get to the doctor when they should. This is six times the number who died at the tragedy of 9/11 - but this occurs every year.
Hm, patients don't make appointments in a timely fashion? Maybe part of the health care reform will be to mandate yearly physicals and then make it, as an example, illegal to drink alcohol if your liver enzymes are elevated or illegal to eat McDonald's if your cholesterol is over 200. As someone who lives in New York and has seen first hand the paternalism of the Bloomberg administration (first they came for our cigarettes, then for our trans fats...) the theory that if the government pays for health care they can determine our behavior has already been established in this liberal bastion of uncommon sense.
In the midst of this horrendous lack of coverage, the U.S. spends far more per capita on health care than any other nation - and health care costs continue to soar. At $2.4 trillion dollars, and 18 percent of our GDP, the skyrocketing cost of health care in this country is unsustainable both from a personal and macro-economic perspective.
At the individual level, the average American spends about $7,900 per year on health care. Despite that huge outlay, a recent study found that medical problems contributed to 62 percent of all bankruptcies in 2007. From a business perspective, General Motors spends more on health care per automobile than on steel while small business owners are forced to divert hard-earned profits into health coverage for their employees - rather than new business investments. And, because of rising costs, many businesses are cutting back drastically on their level of health care coverage or are doing away with it entirely.
Further, despite the fact that we spend almost twice as much per person on health care as any other country, our health care outcomes lag behind many other nations. We get poor value for what we spend. According to the World Health Organization the United States ranks 37th in terms of health system performance and we are far behind many other countries in terms of such important indices as infant mortality, life expectancy and preventable deaths.
Although there are probably good reasons to question Senator Sanders's numbers, and he is overtly incorrect about some of his suppositions (recent studies has shown fairly conclusively that Cancer victims live longer in America than in our neighbor to the North or our relatives int he UK, where National Health Insurance is indeed a right.) However, even if we accept his premises, the article is disingenuous. First, as is typical of most articles about the plans to reform our health care system, the issue is actually all about actually paying for the health care we receive. There already exists universal access to health care. No one, by statute, is turned away from an Emergency Room in this country. Who pays for the care received is the issue.
After setting up his premise, that the "health care system is disintegrating" Senator Sanders trumps his nonsense with this:
As the health care debate heats up in Washington, we as a nation have to answer two very fundamental questions. First, should all Americans be entitled to health care as a right and not a privilege - which is the way every other major country treats health care and the way we respond to such other basic needs as education, police and fire protection? Second, if we are to provide quality health care to all, how do we accomplish that in the most cost-effective way possible?
I think the answer to the first question is pretty clear, and one of the reasons that Barack Obama was elected president. Most Americans do believe that all of us should have health care coverage, and that nobody should be left out of the system. The real debate is how we accomplish that goal in an affordable and sustainable way. In that regard, I think the evidence is overwhelming that we must end the private insurance company domination of health care in our country and move toward a publicly-funded, single-payer Medicare for All approach.
Sanders is at least more honest than those who profess to be in favor of preserving a private insurance option.
Our current private health insurance system is the most costly, wasteful, complicated and bureaucratic in the world. Its function is not to provide quality health care for all, but to make huge profits for those who own the companies. With thousands of different health benefit programs designed to maximize profits, private health insurance companies spend an incredible (30 percent) of each health care dollar on administration and billing, exorbitant CEO compensation packages, advertising, lobbying and campaign contributions. Public programs like Medicare, Medicaid and the VA are administered for far less.
I am thoroughly annoyed and disgusted at the outsized compensation packages of the Insurance company executives who were allowed to monopolize the field ever since Hillarycare set the stage for them in the1990s, but Sanders's comments are risible. Is he actually claiming that Medicare, Medicaid, and the VA are more efficient in their approach to health care than private insurers? If that is the case, perhaps he can explain why it is so hard for new patients to find Doctors that accept Medicare and Medicaid. (The VA model, of hiring Physicians to work in VA facilities, may be workable system but is not being suggested as a model for reform; further, the VA system has traditionally been staffed by those more comfortable seeing Medicine as a 9-5 job rather than a vocation.)
Ultimately, however, where the Sanders approach breaks down is in its misapplication of its title, the bait-and-switch whereby a right to health care becomes a right to have it paid for by others, with prices set by fiat rather than by the market. It will be fascinating to watch how the debate takes form and as the provisions necessary to make health care a right collide with the reality of the cost of health care and people's right and responsibility for their own health care choices. Increased coercion will almost certainly ensue.
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