Why is Health Care So Expensive?
This is a multipart series on health care reform. You may find it easier follow the discussion from the beginning. If you haven’t already read the introduction, you can find it here.
First, we need to define what we mean when we say that health care is too expensive. Do we mean that it costs too much to visit the doctor for a checkup, or an x-ray, or a flu vaccine? Do we mean that the average person can’t afford any type of health insurance? Do we mean that if you get cancer or some other major disease or need major surgery you can’t possibly afford to pay for all the medical bills you will incur? Or are we talking about the fact that the percentage of the nation’s Gross Domestic Product (GDP) spent on heath care continues to increase every year and is much greater than what is spent in other Western countries?
When we break it down this way, we can see that in some cases, heath care is not “too expensive” for the average American. Most people, even those without health insurance, can afford to visit the doctor for minor or routine medical care. Sure, it might cost more than we’d like, but then again it cost me more than I’d have liked to replace the clutch in my Toyota, but I accept that as the normal cost of owning a car. If you take on the responsibility for anything, be it a car, or a house, a child, or your body, eventually you will have maintenance costs and you just have to plan for such things. Although the price of a doctor’s visit is actually more expensive in real dollars today by about a factor of two than it was in the early sixties (later we’ll discuss the reasons for that and the fact that it’s not an apples to apples comparison) the cost is still not out of reach for the average person. Likewise, while the cost of what we call health insurance (I’ll explain later why it isn’t really “insurance”) continues to increase, almost 85% of the U.S. population is able to obtain health insurance either on their own or through their employer. True, there are huge problems with health insurance that need to be addressed, but generally health insurance is still somewhat affordable for most people. Of course there is a small percentage of the population, the very poor, who can’t afford any health care or health insurance, though many of them can obtain some basic health care through existing Federal and State programs.
Here’s some other important facts you might not be aware of. Health care costs and health insurance premiums, while continuing to rise, are actually rising more slowly than in the past. In 2001, heath care costs were rising at about 9 percent annually. By 2008, that annual rise was about 5 percent. In addition, according to a McKinsey Global Institute report “between 1960 and 2006 the share of personal health expenditures paid by patients directly out of pocket fell from 47 percent to 13 percent”.
However, when we look at the cost of major surgery or treatment of serious diseases, we see that these items are indeed too expensive for those without insurance and in many cases even those who have it. Likewise, our nation as a whole spends a higher percentage of our GDP on health care costs than at any other time in our history, and that percentage increases yearly. So, why is this so?
If you ask most people this question, you’ll probably hear some combination of the following:
- Health Insurance companies are greedy and are motivated only by profits.
- Pharmaceutical companies are greedy and are motivated only by profits.
- Doctors are greedy and are motivated only by profits.
- Those who don’t have health insurance go to emergency rooms for treatment. That costs much more and we all have to pay for it as the costs are shifted to those who can pay.
- Because of frivolous lawsuits, doctors’ malpractice insurance is very expensive and they have to pass the costs to their patients.
- Because of frivolous lawsuits, doctors have to practice defensive medicine and therefore order more tests and recommend more treatments, etc. to guard against being sued.
If you believe that any or all of these are major factors in the huge increase in health care spending we have seen over the last three decades, you’d be in the majority – and you’d be wrong. While some of these may play a role in increased health care spending (especially 5 & 6) they are not the major (or even a large) factor. I realize that previous statement may seem counter-intuitive, and certainly not what we are being lead to believe by the various special interests and spinmeisters who daily show up on the airwaves. But it is true.
The real reason we spend so much more on health care now than we did three decades ago is what Arnold Kling (who received his PhD in Economics from MIT) in his excellent book, Crisis of Abundance: Rethinking How We Pay for Health Care
Of course, one could reasonably ask whether all this premium medicine is making us increasingly healthier in direct proportion to the increase in costs. The answer is, probably not. Certainly, advances in medical care have increased our longevity. Survival rates for many illnesses keep increasing year after year. New medical breakthroughs are now the norm rather than the exception. While many medical advances are clearly beneficial, there is no doubt that at least some of this increase in diagnosis and care isn’t worth the extra cost. Arnold Kling describes this as the ‘gray area’ of medicine which includes services that are neither entirely necessary nor entirely unwarranted. Some services are beneficial, but these benefits are so small that our limited resources might be better spent elsewhere. Additionally, a range of medical protocols is often possible and one may be more cost effective than another. The further problem is that a clear cost-benefit analysis is often difficult when it comes to health care. The relative benefit of a service is based on the probability of success and the amount of benefit received. Furthermore, the results cannot be known in advance.
Let’s take this example from Crisis of Abundance
Suppose you have a heart problem for which it is recommended that you regularly see a cardiologist and each visit costs $200. The annual benefits of seeing a cardiologist once a year might well be in excess of $200. So that’s $200 well spent. But should you see a cardiologist once a day? Not unless the benefits from doing so are at least $75,000 a year, which is highly unlikely. Perhaps you should see the cardiologist once a week, once a month, or once a quarter. The decision as to whether you should see the cardiologist more often than once a year should be based on how much additional benefit you are getting from each visit and whether those benefits are worth the extra $200 for each visit. But this is often difficult to determine. Additional visits to your cardiologist fall into the ‘gray area’.
For most people, however, these questions are not really much of a consideration. The test or treatment is available, and if there’s any chance it will help, they want it. And who can blame them. Life is precious, and in most likelihood, they’re not paying for it out of their own pocket anyway.
Which brings me to the other major reason health care is more expensive than it used to be – health insurance (including “public” health insurance such as Medicare and Medicaid). We’ll talk about health insurance coverage as a whole a bit later, but for now we’ll concentrate on the effect the third-party payer system has on prices. Third-party payer means that a patient with health insurance (or government paid-for care) does not directly pay the fee for his medical care out of his pocket at the time that service is provided. Rather, the doctor bills a “third party”, the insurance company or government, for the costs sometime later. Compare this to fee-for-service where the patient pays the cost for his health care directly to the doctor out of his own pocket at the time of service.
So why does the third-party payer system drive up the cost of heath care? The answer is something that economists call “moral hazard”. This is a phenomenon where the parties involved in making a decision are not held responsible for bearing the full costs arising from that decision – and they act differently than they would if they did bear the costs. In the case of health care, patients with health insurance are much less price conscious and less likely to shop around for a less expensive provider. Likewise, they are more likely to opt for additional tests or treatments regardless of whether those additional services will truly provide additional benefits (services in the ‘gray area’). As we’ve discussed, patients often don’t have perfect information as to whether these additional services are needed, they rely on their doctors. But doctors don’t have perfect information either. Plus, they’re prone to the pressures of making a profit and practicing defensive medicine. So when doctors know that insurance will pay the bill, they have little incentive to be conservative in recommending services or implement cost saving measures. The moral hazard of health insurance affects the behavior of doctors as well as patients. Additionally, patients with health insurance are more likely to seek medical treatment for minor ailments that don’t necessarily need medical intervention and, as this study suggests, some might even be more likely to engage in risky lifestyle choices like smoking and overeating, knowing that should they get sick, their health insurance will be there to pay for their treatments.
There is case to be made that moral hazard does not play a significant role in situations of a catastrophic illness or accident. As John A. Nyman argues in Is ‘Moral Hazard’ Inefficient?, “conventional (moral hazard) theory makes sense for health care such as cosmetic surgery or drugs to improve sexual functioning or designer-style prescription sunglasses, but not for serious treatments such as coronary bypass operations or organ transplants”. To an extent, Nyman is correct. When health insurance pays for treatment in the case of serious illness or accidents, moral hazard may not have as significant an effect since patients in these cases are not opting for services that they could or would otherwise decline. But as we have seen in the examples above, there still may be some moral hazard at work even in these situations. While basic lifesaving treatment may not be optional, other treatment efforts may indeed fall into the ‘gray area’ and be subject to a cost-benefit analysis and that analysis is certainly colored by a consideration of who will be paying the bill. If the health insurance company is on the hook, it is much more likely that doctors will recommend, and patients will accept, treatments which may or may not provide proven and significant benefit. Also, as discussed above, when someone has health insurance and knows that they will be covered if they fall ill or have a serious accident, they may be more likely to make lifestyle choices that increase their risk. More simply put, while you might not have much of a choice once you do get sick, you certainly can make good or bad choices that increase or decrease your chances of falling ill, and knowing you have health insurance can affect those choices.
So as we can see, the third party payer system, through the phenomenon of moral hazard, reduces the incentive to shop for the most cost effective care and causes an increase in demand for medical services – and an increase in demand causes an increase in prices. This is a very important point to keep in mind as we discuss the various options for heath care reform since any proposal that increases insurance coverage for anything other than catastrophic illnesses will most certainly cause an increase in the cost of health care.
I’d be remiss if I didn’t mention another factor contributing to the increase in health care costs – our aging population and increasing life span. Older people have more heath problems and require more medical services. As the baby boomer generation ages and people live longer, the average age of our population increases. With more older people, our nation will consume more health care resources and consequently our overall health care spending will increase.
In summary, the major factors fueling the huge increase in health care spending over the last few decades are our aging population, the rise of Premium Medicine, and our reliance on a third-party payer system which tends to drive up costs by disassociating those making health care decisions from the financial consequences of their choices.
Up till now, we’ve only been discussing the cost of health care. In my next post, we’ll take a look at the problems with the health insurance industry.
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by David Boaz or 
by David Bergland, both excellent books on libertarian thought.
Comment by Brennan Murphey | October 1st, 2009
It’s a feedback loop! The better health care gets, the longer we live. The longer we live, the older the average population gets. The older the average population gets, the more health problems people have on average, which encourages better, more expensive health care to be developed, and so on ad infinitum.
So what’s the solution? Well, if we all stopped being so afraid of death, but that may not happen overnight. I think the best thing to do is take responsibility for your health. Eat a healthy diet. Exercise regularly. Don’t engage in physically risky activities. Pay attention to your surroundings. Avoid being stupid (not easy). The best way to cure stuff is to avoid creating it in the first place. But there has to be some kind of help for those who are born with serious physical maladies, and I think we should all help out with that.
So yeah, my pure opinion actually. No facts here. Woohoo!
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gp Reply:
October 2nd, 2009 at 7:06 am
Perfect first paragraph, as is the first sentence of the second. But I beg to differ on the rest.
We are indeed mechanical devices, following the classical “bath tub curve” of reliability. High infancy and end-of-life failure rates, with a generally long, low, flat stretch inbetween. The health care costs at birth and at end of life are fairly well fixed (end of life consumes close to 80% of out total life time cost).
In between, while we buy relatively little health care each year, we do consume. Consequently, improving life style choices are not the panacea to our economic problem. In fact, increasing longevity, as you point out, drive the cost curve upward.
Immortality is expensive. Perhaps our national debate on health care is really about who will have the best shot at it?
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Comment by leahjoyp | October 10th, 2009
I think the big question to ask is whether Americans believe that HealthCare should be a for profit organization or a public service one. The insurance companies are a middle man whose interest is profit and that makes it hard to truly analyze the cost benefit ratio. I believe it should be non-profit whether I am paying out of pocket or another organization is paying for me. For most people living today eating right isn’t always enough because of environmental pollutions. Diseases like Asthma is extremely common but not considered life threatening however it must be monitored constantly and the cost for treatment adds up to be very expensive. Our bodies are not comparable to a car. If our car brakes down we have the option of public transportation, it may be annoying to do but we can still function. If our body brakes down we don’t function and if we choose to look at society from the point of view that “we are only as strong as our weakest link” then we will do more to assure that we all have the fundamentals of life; HealthCare, Food and Shelter; I personally would add Education to that list but unfortunately I don’t believe most people see that as a fundamental yet.
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freedomminute Reply:
October 12th, 2009 at 6:50 am
If you are suggesting that providing health insurance non-profit would significantly impact the cost of health care, I’m afraid the numbers don’t back you up. As Rick Newman points out in a recent article in U.S. News & World Report
“the profit margin for health insurance companies was a modest 3.4 percent over the past year, according to data provided by Morningstar”. So even if you eliminated their profits, you wouldn’t save all that much on your insurance premiums.
If however, you’re suggesting that every sector of the heath care industry be non-profit, essentially requiring that everyone work for free because other people need their services, I’m not sure how you could accomplish such a thing without reinstating slavery, which we outlawed with the thirteenth amendment in 1865.
I’d also like to point out that it’s the profit motive which brought about all the great advances we’ve had in medicine over the years. If it weren’t for someone wanting to make a profit, there’d likely be no asthma medicine or treatments in the first place. They’d essentially cost nothing, because they wouldn’t exist.
When you’re tempted to look at profits as “evil” it would be wise to remember what the great economist and philosopher Adam Smith said, “It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest”.
But if you ever do find that utopia where people work for free to provide things to others just because they need them, let me know about it so I can go there and sit on the beach while everyone else tends to my need for food, shelter, health care, and education.
On a side note, I find it interesting how some people are so eager to curtail the earnings and profits of others because someone “needs” their services, but they never suggest the same thing for the industry in which they, themselves, make a living.
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Comment by leahjoyp | October 10th, 2009
I have to add to my above point that if we accept the current system of “free clinics” or low income Heath plans as a way out of addressing this issue, then we are putting a band aid on a stab wound. Those systems do not efficiently address preventative care and outside of the big cities the system is barely accessible. The system also doesn’t adequately cover the working poor and the low middle class. Using this as part of the debate, as some republicans are doing, Is like saying that Homeless Shelters will solve the problems in the housing markets “Don’t fret about all the foreclosures, these people can always go to a Shelter.”
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Comment by leahjoyp | October 12th, 2009
So according to you we should forget sending aid to third world countries. So what if people are dying of aids and malaria and poverty, just because they NEED help don’t do it unless there is a profit to be made. Fuck the victims of Katrina or any other disaster, those Samoan’s should fend for themselves. I would rather live in my Utopia than your Greedland. As for statistics it is a lovely lovely concept to live our lives by the numbers. Hey I understand, I took two statistic classes in college and got an A in one and a B in another and nothing make people feel smart and powerful like math and it’s magical absoluteness. Statistics are great unless you are the one suffering. Airlines run their business by statistics. They look at the cost of maintenance repairs compared to the cost of each person’s life if they died in a plane crash and statistically it is cheaper to let people die than fix the problem. I guess if you are that unlucky person on the plane we really shouldn’t care about you cuz Statistically you don’t count. Why do people replace compassion, moral decency and higher consciousness with corporate bottom line economics. And please with the slavery lecture, that is a silly scare tactic. I am sure we can have efficient healthcare without slavery, that is just ignorant. Keep reading your statistics and fighting on behalf of the billions of dollars that healthcare execs make because ya never know when you might be in a job where you will be making the big bucks. I mean that is the American dream is it not…..How lovely!!!!!!!!!!!!!!
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freedomminute Reply:
October 12th, 2009 at 4:19 pm
I just don’t understand why it is that whenever you explain how the economy works based on individuals making choices based on their own self interest, the response boils down to “so you don’t care about anybody else” or “you’re advocating that we shouldn’t care about anybody else”. This is patently ridiculous and is the quintessential straw-man argument.
I’m not at all advocating any of the things you suggest. I was simply responding to your wish that health care be delivered “non-profit” and pointing out that that is unworkable unless you use force to accomplish it. But please feel free to prove me wrong and lay out a workable, sustainable system that doesn’t use force. Perhaps if everyone in the world woke up tomorrow and decided to live their lives in pursuit of helping others, as a choice, then the world might be a better place. But that’s not going to happen any time soon. And that doesn’t mean it doesn’t or shouldn’t happen as part of a caring and enlightened society.
In the meantime, we have to figure out how best to live together and use our limited resources. We also have to figure out how to best reward those that work harder or contribute more to society. And then we have to figure out how you measure those things and who decides. What I’m saying here on this blog is that the best way to do that is to let people decide for themselves what they value and how much they are willing to pay for it. This is the fairest and most efficient way to allocate limited resources. In addition, such a system encourages all the forces that increase a society’s standard of living. When you have some other entity such as the government or well meaning groups deciding these things, you have to use some form of coercion in order to accomplish the objectives that they have decided are the “right” ones and it’s never the most efficient or fairest way to achieve a better life for everyone.
And regardless of you blanket criticism of the use of statistics to make a point, you haven’t directly acknowledged that insurance company profits are only about 3.4%. If that is correct, then eliminating their profits (or the high pay of their executives) won’t solve the problems you wish to solve. It might make you feel better, but it’s not going help people very much. I wish also to point out that some insurance company practices are improper and need to be prevented, such as retroactively dropping a patient’s insurance when they find some pre-existing condition that wasn’t listed on the application and has no bearing on the claims being submitted. I’ll be talking about these types of problems in the next health care post.
Finally, I want to make sure you understand that I’m not saying we shouldn’t help other people. I’m saying we shouldn’t be forced to do it. Americans, with all their self interest intact, are some of the most generous people in the world. As individuals, we give huge amounts to help victims of disasters like Katrina or those suffering in other parts of the world. And private charity does it better and more efficiently than government ever could. Again, I’ll point to Katrina. So I’ll posit this question to you: If you had ten thousand dollars that you want to give away to help others in need, would you give it to a private charity of your choice or would you give it to the government?
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Comment by leahjoyp | October 12th, 2009
I guess I don’t understand where you are coming from. There are plenty of unnecessary things that people can make billions of dollars of profit from why does healthcare have to be one of them. Insurance companies are middlemen that do nothing to increase the effectiveness of the final product. I feel that taking the profit motive out of it is just a first step so that there is no longer a vested interest in people’s illnesses. We seem to feel strongly about that in education, military service, police force and fire fighters and none of these people are slaves working for free. Most of these people go into these careers because they view it as a public service. Some things in life should be looked at from the point of view of public service because it is the right thing to do. Whether a person works hard or not shouldn’t dictate whether they deserve to healed, or educated or rescued from a fire or a robbery. We can leave the corporate ladder climbing to things like whether or not a person gets cable tv or a cell phone or other nonsense things that don’t matter in life. As far as your question about giving money it doesn’t matter because there are plenty of fraudulent private charities out there that are stealing peoples money there is no inherent dysfunction of government just a broken system at the moment mostly due to corporate interest. I would give to whichever organization is putting at least 90% of the money towards the cause and STATISTICALLY non-profit organizations do just that. To answer your question directly, my dad recently donated to a VA program which is run by the government, so if I had ten thousand dollars I would give them money. For the record I believe Healthcare is a right for all people no matter what their income level is or how well the match up in the eyes of American Social Status. I believe that as a country we all can pool our money collectively through taxes to assure that every citizen has healthcare, education and safety at the very least. I value those three things more than war and expensive political campaigns and corporate contracts which cost us the most. I also believe in democracy and “65%” of the country wants at the very least a public option and it is not happening because the people with the most money seem to have the strongest voice. I also believe this is an extension of racism. The people who are deemed as not working hard enough or well off enough to afford healthcare or smart enough to work in a company that offers healthcare are predominately minority. This whole issue is looked at through a lens of the haves being hard working white folks from suburbia and the have nots as lazy stupid immigrants or “urban folks” (people don’t like to come out and say black so they conveniently use these euphemisms.) I pose a question to you. What if you continue to pay the same amount you are now for your health coverage and that money goes into a government program that offers universal care to all people and their is absolutely no change in the quality of your care would you be against it?
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freedomminute Reply:
October 13th, 2009 at 6:45 am
You bring up a lot of good questions, and I’ll try to answer them point by point.
There are plenty of unnecessary things that people can make billions of dollars of profit from why does healthcare have to be one of them… I feel that taking the profit motive out of it is just a first step so that there is no longer a vested interest in people’s illnesses.
I’m not exactly sure what your complaint is. I thought your original comment was that there shouldn’t be any profit in providing health care, but here you seem to be concerned with “too much” profit. I’m going to take a shot at this though and you can let me know if I’ve correctly interpreted what you’re saying. Healthcare has to be one of the things that people make a profit in because the people who provide these products and services have to feed and clothe and provide health care to their own families. And they’d like to go out to dinner every once in a while, and go on vacation, and send their kids to good colleges, etc. All the things that you probably wish for for yourself and your family. This is what I mean when I talk about a profit motive and self interest. If there were no profit, no one would do it. If there were no profit in being an obstetrician, there’d be no one to deliver babies, if there were no profit in making an asthma drug, no one would spend the almost $900 million on average that it takes in research and development to bring a new drug to the market. Perhaps they would like to provide those things out of the goodness of their hearts, they just can’t. They have to get paid for their work. And all these people have “a vested interest in people’s illnesses”. They have a vested interest in providing a product or service that makes people well.
Of course there’s nothing stopping anyone from creating a non-profit entity for providing medical services and indeed there are many in existence. We have non-profit groups like Planned Parenthood and non-profit hospitals and providers such as the Mayo Clinic. Although they are called non-profit, this does not mean they don’t make a profit. The profit is simply called a “surplus” and it doesn’t get distributed to owners or shareholders, but is instead retained to provide additional services. In most cases they must still charge for their services and often those fees are in line with what is charged by for-profit entities. They pay their staff well and are still beholden to the “bottom line” or they would be out of business. Their business model is not all that different than for-profit businesses and except for cases of charity care or services provided from voluntary private donations, their services are far from free. And again, there’s nothing stopping people from creating more of these and putting the for-profit providers out of business.
Insurance companies are middlemen that do nothing to increase the effectiveness of the final product.
I think our insurance system is highly dysfunctional and there are many changes that I’d support. I’m not going to get into all of that here, because that’s what I’m covering in my next post. Let’s talk about this after I make that post.
We seem to feel strongly about that in education, military service, police force and fire fighters and none of these people are slaves working for free.
This is my point. They don’t work for free. Many are paid handsomely for their services. The fact that we don’t pay them out of our pockets doesn’t mean it doesn’t cost us anything and these are not non-profit entities, they are government paid for entities, paid for with our tax dollars. For each of these, however, we have a different rationale for why we do that. In the case of police, they provide for the general protection and act as a deterrent. And since they are given the “police power” and can use force against the citizenry, it would be virtually impossible to provide this as a fee-for-service. As for fire fighters, it would be theoretically possible to provide this as a private service, but the problems involved in providing this service in that manner make it unlikely to occur. As far as teachers are concerned, this is one area where some amount of privatization or at least the introduction of competition would probably do a lot of good.
Most of these people go into these careers because they view it as a public service.
Perhaps they do, but I assure you they wouldn’t do it if they couldn’t make a good living at it. In some cases, such as the military, people who take on this profession do so because the have few other economic options and they see it as an entrée into a middle class lifestyle. The bottom line is that people in these professions are often not doing it solely out of a sense of service although in some cases it may play a role in their career choice.
Some things in life should be looked at from the point of view of public service because it is the right thing to do.
Who gets to decide which things should be “public service” and what is the “right thing to do”?
Whether a person works hard or not shouldn’t dictate whether they deserve to healed, or educated or rescued from a fire or a robbery.
I’ll agree with you to a point in the case of fire or crime. These are things which we traditionally see as emergency services that we agree to make the responsibility of government. Things beyond the emergency, we expect individuals to take care of for themselves; things like insuring your home and valuables to make you whole again after a loss. And we do provide free emergency services to those that truly can’t afford it. I’m thinking of paramedics and stabilizing emergency room care. In the case of education, we should expect parents to pay for the education of their own children if they can afford it. Then our limited tax revenues would go further for the children of those that can’t afford to pay. Realistically though, society can’t provide unlimited medical care to everyone who gets sick or unlimited schooling to everyone who wants to be educated for as long as they wish to remain in school. So we put a limit on that because as a society, we have limited resources. And there has to be some personal responsibility for taking care of yourself and your family and bettering your situation so you can provide these things for yourself.
As far as your question about giving money it doesn’t matter because there are plenty of fraudulent private charities out there that are stealing peoples money there is no inherent dysfunction of government just a broken system at the moment mostly due to corporate interest.
Fraudulent private charities eventually get found out and go out of business. This is also true of charities that just do a lousy job of handling their contributions. The point is that private charities are beholden to those that contribute and if they are not efficient, their donations eventually dry up. Government is under no such constraints. They can keep appropriating funds in the form of taxes and continue programs whether or not they are effective or efficient. I’d submit that this is an inherent dysfunction of government and not just some temporary system that is broken. As for corporate interests co-opting government, I completely agree. Corporate, as well as other, special interests will always try to use the power of government to further their own agendas and gain an advantage. It has always been and will always be the case. The answer is to limit the power of government so the special interests have nothing to co-opt. A perfect example of this is how the health care insurers just came out with ads that are critical of the current health reform proposals. The major news outlets characterized this as the health insurance industry trying to scuttle health reform. Nothing could be further from the truth. The health insurers are upset that the bills don’t go far enough to penalize those that don’t buy the product they are selling. They want the bills to go further with a mandate so they can profit more. I don’t blame them, they are acting in their own self interest and it is perfectly predictable. Instead, I blame the government for including provisions that would force citizens to buy a particular product.
I would give to whichever organization is putting at least 90% of the money towards the cause and STATISTICALLY non-profit organizations do just that.
Again, this is my point. Private organizations do a much better job because they are beholden to their contributors and these people vote with their donations. I would, however, like to see a reference for this particular statistical claim about non-profits. And remember, non-profit doesn’t mean people don’t get paid, just that any surplus must be used for the benefit of the organization, rather than distributed to investors.
To answer your question directly, my dad recently donated to a VA program which is run by the government, so if I had ten thousand dollars I would give them money.
Did you or your dad check to see how efficient they were being with donations and whether there were any private charities that might be more efficient?
For the record I believe Healthcare is a right for all people no matter what their income level is or how well the match up in the eyes of American Social Status.
Health care cannot be a “right” in the same way we have the right to free speech, or to practice a religion without interference by the government, or to be secure in our persons and effects. If it were a right, we would then be entitled to it as a consequence of our birth as free people, but providing it requires that some one else provide us with the fruits of their labor regardless of whether we can compensate them for it or not. This impinges on the rights of others. In essence, we would have to force others to give it to us whether they want to or not. You cannot morally have any right that impinges on the basic rights of others. Therefore, anything that you cannot provide for yourself without taking away anyone else’s rights cannot be a basic right. This is the same reason that we don’t have a right to food. You certainly have the right to buy or barter for food, but you don’t have the right to force someone else to give you theirs.
I believe that as a country we all can pool our money collectively through taxes to assure that every citizen has healthcare, education and safety at the very least. I value those three things more than war and expensive political campaigns and corporate contracts which cost us the most.
Those may be the things you value most, but what about someone who does not value the same things as you. Do you have the right to force them to see it your way?
I also believe in democracy and “65%” of the country wants at the very least a public option and it is not happening because the people with the most money seem to have the strongest voice.
I’m not sure where you are getting your numbers from since you didn’t give us a reference, but the latest Rasmussen Reports poll found that “46% favor the creation of a government-sponsored non-profit health insurance option… Thirty-seven percent (37%) are opposed”. But when they “asked about the creation of a public option if it encouraged companies to drop private health insurance coverage for their workers… support for the public option falls to 29%, and opposition rises to 58%”. I’m not going to debate whose statistics are right since I’m sure you can find some poll that gives different numbers, but I will point out that the support for a public option is not as strong as you suggest. Regardless, taking the public’s temperature on something as complicated and confusing as health care reform is not the best way to create public policy.
I also believe this is an extension of racism. The people who are deemed as not working hard enough or well off enough to afford healthcare or smart enough to work in a company that offers healthcare are predominately minority. This whole issue is looked at through a lens of the haves being hard working white folks from suburbia and the have nots as lazy stupid immigrants or “urban folks” (people don’t like to come out and say black so they conveniently use these euphemisms.)
I’m going to call a major foul here. You are certainly entitled to this opinion, but unless you have some proof to back it up, you don’t get to make it as part of a responsible debate. As I stated in my introductory post, demagoguery is not permitted. Please refrain from these types of Ad Hominem attacks.
I pose a question to you. What if you continue to pay the same amount you are now for your health coverage and that money goes into a government program that offers universal care to all people and their is absolutely no change in the quality of your care would you be against it?
I would support it if it also:
a. was voluntary
b. reduced the costs of health care spending
c. didn’t require a tax increase either now or in the future.
d. didn’t require an increase in the deficit or debt either now or in the future.
e. didn’t require rationing of heath care services.
f. didn’t stifle innovation or advances in medical care or disincentivise high quality people from going into the medical field.
g. required something in return from those that are being subsidized.
h. didn’t subsidize those that can afford to pay for themselves.
No proposal currently being considered comes close to fulfilling even a few of these requirements. I’d also point out that none of them would even accomplish the things that you pose in your question.
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Comment by leahjoyp | October 13th, 2009
I think it does come down to us valuing different things but I stand by my convictions and will continue to voice my opinion. I will also reiterate that some things come from wisdom and understanding of humanity and not necessarily black and white mathematical proof. Many great ideas have to start with a vision before the nuts and bolt are laid down. Once the vision of healthcare for all is seen, then the particulars can be argued. The bills out right now are so crappy because there is no real collective vision that sees a better future of healthcare or get to the heart of the issue. What we have now are bandaids that try and appease every monetary interest. I will suggest you watch the Ken Burns documentary on the National Parks. It shows how people and politicians fought to preserve this land for the sake of the land even though many people thought it should be used for commercial gain. There are many other similarities that you will have to discover yourself as you watch it.
I also reiterate that the cost of war and the amount of money continually going to defense contractors like KBR (formally Haliburton), Lockhead and Blackwater has wasted more tax payer money which would have already paid for healthcare. I’m not going to site proof because this stuff is common knowledge to those paying attention and it can be easily researched. My thoughts come from a place of wisdom and insight based on the large amount of information I read, see and hear and from that I express my point of view. Nothing I am saying is made up and I learned in my Communications Research class in college that you can devise a statistical model for any topic you want. Statistics are particular to the agenda you want to set. In school we came up with a theory and then we found the formula to prove it and if it didn’t come out in your favor there where many models to try. Yes research is vital and math is important; however it is one part of the whole picture. I again refer to my Airlines example, they are right statistically to let people dies but are they right morally? I will the clear up my statement about The right to have healthcare, it is a social and moral right not a constitutional right,(although I wouldn’t mind that) I will restate it and say that Healthcare is a principle we must highly value. Healthcare and Education are on the top of my list of principles that we “Should” all value and provide for one another even if some people can’t or won’t pay for it. This is not the same as paying for people’s car or tv or computer or other superficial materialistic things. Personally I would add food and shelter to this list but I am willing to compromise on those because I know there are many people who would resist this as, your words, “Utopia”.
I can not back down from the subject of racism because it is the silent fuel to this fire around the country and no body is allowed to talk about it. You can check out Bill Moyers online at PBS and he has a few documentaries on this hidden issue. Black people are scared to bring it up because white people will get mad, or illegitimate their complaints but it is real and to think it is not a part of this issue, in my strong opinion, would be naive. Also my “proof” I present Jimmy Carter who bravely called it out and unfortunately was brushed off my mainstream society.
My comments are intended for those reading who do value Free Universal Healthcare and I am inviting and urging them to get involved with their representative because it is the only way, Historically, meaningful change has happened. Now I am off to a meditation retreat and will be peacefully away from this subject for a while. Namaste…
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Comment by leahjoyp | October 13th, 2009
Sorry about all the typos readers…..
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