Conservative Common Sense on Health Care Reform
Andrew Sullivan shares a bit of common sense on the subject:
One final thing: most Americans do not want people dying in the streets.I, too, have often thought of this truth and have brought this up in a few conversations with my conservative friends. What do we do with those who simply cannot afford adequate health care and have no recourse but to seek expensive last minute care in emergency rooms? Do we just shrug our shoulders and walk away, leaving these folks to just crawl into some corner of their unfortunate realities and die? No. We would never let this happen, simply out of a sense of common human decency. So, we have very sick poor folks lining up in emergency rooms and we agree, as taxpayers, to pay for this. Fiscally, this is madness. Wouldn't it be infinitely better for the poor or indigent, and much more fiscally sound, to bring them into a public system that provides basic preventive health care that both keeps them out of the emergency room AND ensures that they are healthy enough to perhaps work through their poverty and eventually move off of the public health care option to a perhaps more thorough and comprehensive plan?
If you have guaranteed emergency room care for the uninsured at public expense, you have already effectively socialized medicine. It makes no sense not to bring these people into the insurance system, and to offer less expensive, long-term preventive healthcare. To insist that ideology stand in the way of this piece of compassionate common sense is irresponsible.
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I think it is ironic that you call it 'fiscal madness' to provide free emergency room care to poor people, but think providing much broader and more expensive care for everybody in the country is a fiscally sane idea.
Also, I'd note that the federal law entitling people to emergency room care regardless of their ability to pay has only been around since 1985. I'm glad we don't have those hordes of people dying in the streets anymore like we did back in the early 80's. Oh, wait...
Also Huck, the basic assumption here is that if these people had access to healthcare before going to the emergency room, they'd be healthier, and it would then cost us less money to care for them... But I've never understood how access to a doctor is going to change the demographic realities that contribute to most (not all) of the health maladies of poor people: poor lifestyle decisions.
I understand that it is a real problem that the cheapest food is also some of the most fattening and unhealthy food, but is having a free doctor going to change that?
Hell, just giving up a pack-a-day cigarette habit (which a poor person is more likely to have than the middle class or wealthy) would pay for a basic insurance plan that covers major illness.
If you want to design a healthcare plan, at the state level, that provides access for non-smoking healthy eaters who have physical ailments that prevent them from working, I might go along... but then we're talking about insuring a tiny tiny percentage of the population.
Eric - What's madness is spending public dollars on an infinitely costlier emergency room treatment than a much less expensive routine preventive care program. It is more costly to have 40 million Americans without any healthcare who seek medical treatment in emergency rooms than to provide these 40 million uninsured with access to publicly subsidized primary preventive care. Perhaps you would think the more fiscally sound path is to have no publicly funded health care programs, but it is madness to support a more expensive program for the uninsured (i.e. emergency room treatment) than the less expensive program of public preventive healthcare.
Finally, you mock the notion that people weren't dying in the streets prior to 1985, but how do you know this? When you look at the statistical evidence (see this CDC Report - http://www.cdc.gov/nchs/data/hus/hus08.pdf#026) what is clear is that mortality rates have declined considerably since the 1980s, especially among the poorer, all the while access to public healthcare services among the poor have increased over this same time period. As I read it, the data tell the story that poorer people, those who do not have private insurance or who cannot afford private insurance, are living longer precisely because they have access to public healthcare services. Yeah, poor folks weren't dying by hordes in the streets prior to 1985, but because they're not turned away from emergency service in hospitals when they have strokes or heart attacks or influenza or staff infections, they're able to live longer.
But I've never understood how access to a doctor is going to change the demographic realities that contribute to most (not all) of the health maladies of poor people: poor lifestyle decisions.
Think about Nudge. Poor lifestyle decisions often come from lack of information. Preventive healthcare is not just about giving vaccination shots and doling out aspirin and bandaids, but mostly about having a health care provider, someone people tend to listen to regarding their health, speak to people about health risks attendant to personal choices.
The health-related information most people get is driven not by doctors but by private corporation advertising to sell unhealthy products. Need more energy? Eat a Snickers bar. Want to be surrounded by beautiful people? Drink Coors Light. Want to be rich and famous? Make hip-hop tunes that extol violence and drugs. And that says nothing about the medically relevant information that doctors can provide. If, at my yearly doctor's appointment, it comes out that I have high blood pressure, elevated blood sugar, or high cholesterol, or a suspicious looking mole on my back, the doctor can sit me down and explain what this means to my health. If I never go to the doctor, I might never know that I'm even at risk. By the time folks get to the emergency room, a lifetime of poor choices because of a lack of information presents a very expensive fait-accompli.
Hell, just giving up a pack-a-day cigarette habit (which a poor person is more likely to have than the middle class or wealthy) would pay for a basic insurance plan that covers major illness.
You ever consider that it just might be that poor people with such a pack-a-day habit just don't really know or understand very well why smoking is dangerous to their health and how giving up smoking might help them afford health insurance coverage? People may make poor choices not just because they are lazy or stupid; but maybe because they simply don't know any better. Preventive healthcare is all about better and more timely information. And statistics show that those with access to regular physician check-ups are not only more informed and knowledgable about their health, but also live healthier lives and make better health choices.
"You ever consider that it just might be that poor people with such a pack-a-day habit just don't really know or understand very well why smoking is dangerous to their health and how giving up smoking might help them afford health insurance coverage?"
No, I don't believe that in modern American society, anybody with a television and a pulse doesn't know that smoking is incredibly bad for them. It's even written in big letters on the pack of cigarettes! I don't know a single smoker who a doctor could have talked out of smoking, and that's kind of my point.
Well, I would agree that smoking is one area where information is more readily available. But I wouldn't say the same about high cholesterol or high blood pressure or birth control or STDs. And it's not the doctor's place to talk a person out of any behavior, but rather to lay out what that continued behavior is likely to lead to in terms of their future health. And I'm sure that those who know more about their health, and who have more regular access to healthcare providers, make better decisions regarding it. That point is not a hypothetical, but is shown to be true by study after study.
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