Monday, March 26, 2012

Healthcare - The Right

The Supreme Court began its first day of hearing arguments on the Patient Protection and Affordable Care Act, popularly coined "Obamacare" by the Republicans.  I will refer to this by its proper acronym PPACA from here-on... you don't have to remember that here; just remember that if I use some weird acronym that might remind you of alpacas: I'm referring to this 2010 healthcare law.

Here I will take a step back to 2010 to consider some of the Republican proposals, whereas an accompanying post (intended to be read after this post) will address the Democrats' proposal which ultimately became law and, today, is what is now before the Supreme Court.

My basic position on the Republican offerings is that, ideologically, I largely support their efforts; but in practice I find some significant faults with their proposals which I have yet to hear any sound response.

From the Right

So with that: many of the proposals that came out of both the Left and Right back in 2010 were both very reasonable, even if they represented somewhat opposing sides of the spectrum.  Each represented a different approach to a problem.  The Right proposed shifting the costs toward the consumers and private sector, thereby using market forces to direct consumers to healthier lifestyles & private sectors to streamlining their operations and cutting costs.  This could vastly reduce government costs if the government requires citizens to be responsible for themselves, and personal responsibility is something I can identify with.

Of course, the drawback is that people aren't responsible (proof).  People who don't get health insurance can still get sick; they can still get injured.  And when they go to get healed... who pays if the patient can't?  The way it's functioned in our country before is for us to simultaneously bankrupt the patients & for the government to ultimately cover this cost... this adds up.  I haven't heard a clear argument for what happens to these people if the government does not cover it, other than at a 2011 Republican Primary debate when Ron Paul very narrowly avoided the answer but the crowd offered it for him (video).

But do we let the uninsured die?  What if we do let the uninsured die?  It sounds horrible, but if you believe in personal responsibility: it's not so far-fetched.  A part of me looks at all the warning labels we have... just run a search for "Absurd Warnings" or even check out (admittedly poorly designed, but there you have it).  What ardent libertarian or science-loving Darwinist wouldn't loathe such nannyism?  But on the other hand, is a first-world country really the sort of place that lets its citizens die?

I'm a bit sickened hearing an audience cheer letting people die as happened to Ron Paul, but if we were having a calm discussion I could actually find myself listening to a case that an individual chose to accept the risk of death, and now pays the consequences.  I can't say I'd support it; but I can't say I'd necessarily oppose it, either.  It's your choice as to whether you want insurance or not.  It's free market vs. the sanctity of life, which pits two of the core Conservative doctrines at odds with one another.

Let the Uninsured Die

But there are some for whom they might still not have such a choice.  What of those whom can't afford insurance?  Do we just let the poor die?  Could there be healthcare subsidies to those with lower incomes, or perhaps a public option to provide them with coverage?

What if medical bills overrun what the insurance covers?  Medical treatments are expensive, and sometimes they can vastly outweigh what your coverage provides.  I have seen this happen among those with aging parents or chronically ill children -- the bills eventually stop being paid by insurance & start arriving at your doorstep.  What if you give birth to a sick child: she spends years confined to a hospital bed but has a smile, a personality, and lives each day as best she can.  Then your insurance runs out.  Do you walk out the room, turn out the light, and call it quits?

What of those with  preexisting conditions and are denied coverage?  Do we just let them die?  Do we require insurance companies to cover them, or again: do we provide them with a public option?  Speaking as someone with a hereditary blood disease: even my Darwinist leanings have to come face-to-face with the fact that if I have any sons: he'll need a major operation at some point in his life.  Not many folk could easily afford that.  So I'm a bit biased... but think about it: do you have anything in your family that might rule you out?  Heart problems?  Strokes?  Cancer?  What if you were denied coverage and someday find yourself unable to pay?

Let the Insured Wait

Now if you've made it through those sections above and still feel safe, here's how this could still affect you: is it advisable to verify every patient's insurance before beginning a procedure?

This may not be so bad if you're in for a routine visit or if you're there to check out some minor symptoms you've been having... but what if you suffer a heart attack or stroke?  What if your daughter lands on her head doing gymnastics?  What if your son is out hiking and gets bitten by a snake?  What if your toddler ingests something beneath the sink?  The difference between life and death might be in the range of seconds; minutes if you're lucky.

The hospital doesn't treat people if they're uninsured, but no worries: you're covered.  But... do you want the hospital to tell you to wait while they verify your insurance?  Do you have those seconds or minutes to spare? What if you lost the life of a loved one simply because the computers were too slow to give the A-OK?  And of less concern to you, but a thought on my mind: could telecommunications providers be liable if their networks slow down and result in deaths on account of it taking too long to verify insurance; or nurses / staff if they're too slow to key in numbers; or a caretaker if they're too slow to produce the card?

The Economics of Death

And whether they die by being unable to afford care or if they die because it took too long to verify insurance: a lost life doesn't just carry its spiritual implications or sorrows & grieving... admittedly, that's not the federal government's prime concern.  But with the deceased does go their economic productivity: the cost to save them could have been justified by the revenue they would have generated over time.  From a free market macroeconomic standpoint: letting your citizens die is not usually, in the long run, a sound economic strategy.

Ideologically Sound; Practically Fleeting

As I said: I can strongly identify with many of the Republican proposals at an ideological level -- I love the idea of embracing individual responsibility.

But in practice: I have yet to hear a clear case from our elected officials as whether we would indeed let people die & how this might address the economic impacts of death; or if we don't let people die then who pays the bills?  Nor have I heard a clear case as to how to address the societal impacts to the poor, the chronically ill, and those with preexisting conditions; or even to those whom are insured but find their time limited by the waiting room.

To address these requires some degree of a middle ground, be it a public option or subsidies to cover those left out of the system or to ensure that doctors can continue to respond immediately without first waiting for the paperwork to go through.  This is what requires elements of the PPACA.

[Part II - My thoughts on the PPACA]