Thursday, September 20, 2007

Raising the Stakes

She's back.

To be strictly accurate, she never left--in fact, Hillary likes to say, these days, that she has experience at both ends of Pennsylvania Avenue. (Why this phrase reminds me of something a gastroenterologist might say is better not discussed.)

For those of us who don't live in New York, though, the reappearance of Hillary carries with it all the shuddering horror of watching Dracula re-emerge from a coffin, long after you thought he'd been successfully dispatched with cross, garlic and stake. What's even worse, though, is that she's waving around triumphantly the very thing that, were this not such a decadent age, would have finished her off long ago. (And it's not Bill.)

Her health care plan.

Whether you like it or you don't is so far divided on fairly partisan lines. Proponents seem to be saying that in the thirteen years since Ms. Clinton tried to sell us this particular snake oil she's refined the product, removing many of the more obviously unpalatable ingredients; opponents seem to be insisting that the plan will be extremely costly, will raise taxes, will lead to health care rationing, will require a huge and inefficient bureaucracy, and will mandate that every single person in America purchase health insurance (but hey, at least she's not making us all go to the doctor, right?).

What neither side is saying is the obvious: the federal government of the United States of America has no business whatsoever interfering in health care.

The whole reason that it's so darned expensive to go to the doctor is because the government got involved. Once upon a time, the doctor lived in the same communities with his patients, and made house calls when you were sick. If you could pay him his full bill, you did; if you needed time to pay, he worked that out with you; if you couldn't pay at all he might forget the whole thing, or to spare your dignity he might accept a dozen jars of freshly-canned fruit or homemade preserves as payment.

Then a little national tragedy called the 16th Amendment to the Constitution happened.

Income tax forever changed the freedom of Americans to decide for themselves how to conduct their own businesses. The doctor could no longer accept those jars of preserves as payment; how was he supposed to give the federal government a percentage of Mrs. Smith's apple jam? Moreover, a myriad of new laws dealing with income made it impossible for him to charge one person more than another, or to give someone time to pay him back, because the government wouldn't wait for its share of the doctor's labor. Oh, this didn't happen all at once: most people in 1913 believed that the income tax would never even apply to them, but only to the "rich." Having opened this particular floodgate, though, the federal government was quick to pursue the advantage, and soon was taxing everybody who worked for a living.

This meant trouble for the doctor's poorer patients; it also made trouble for the doctor, who often couldn't afford to remain in practice alone. Fewer doctors lived in the same community with their patients, and house calls slowly became a distant memory.

And only sixteen years after the passing of the sixteenth amendment, the first modern group health insurance plan was formed by a group of teachers in Dallas, Texas. Throughout the 1930s and '40s employers expanded the idea, and by the years after World War II employers had realized that offering such plans to their employees not only made it possible to keep wages low, but also gave the employer himself some needed tax breaks.

Unfortunately, the proliferation of private insurance plans meant that those who didn't have access to such plans found their doctor visits increasingly expensive, since one effect health insurance programs have is to create incentives for doctors and hospitals to shift costs from a health plan's members to someone else. Soon, that "someone else" would be the federal government. In 1965, an amendment to the Social Security act created the Medicare and Medicaid programs. Additionally conceived as emergency health insurance coverage for only those most in need, these programs now cost nearly 400 billion dollars a year; these costs will only increase in the years to come, even without a Hillary Clinton-style health care plan.

Buried among all of these overlapping payers and negotiators for health insurance is the answer to one simple question: what does it actually cost to go to the doctor?

$100? $200? $500? We don't really know, do we--all we know is what our "co-pay" is, which seems reasonable and affordable until you check your pay stub and see how much money per year is being taken out for your health insurance. And that amount is just the amount you (or your husband) is paying. The company is also paying part of the cost, not out of the goodness of their hearts, but to be competitive and to get the advantage of the tax breaks they get for paying for their portion.

Once the government takes a bigger role in running America's health care, we can bet that the actual cost of health care will skyrocket. People who want to keep their private insurance will find themselves unable to do so, as employers dump expensive private plans in favor of "free" government plans. The health care industry will continue its practice of making some things affordable by charging a fortune for other things, or to other people. Layers of inefficiency will spread like an ugly mold over the whole enterprise.

Whenever the federal government gets involved in something it has absolutely no right to be involved in, three things happen:

1. What the federal government "owns," the federal government "controls." Want to be charged extra for your "government-funded" labor and delivery because you won't have your tubes tied afterward? Wait and see.

2. What the federal government "owns," the federal government "grows." Remember when the Department of Education was a small advisory board? Neither do I; it was before most of us were born.

3. What the federal government "owns," the federal government "exploits." Remember when Social Security was supposed to be a safety net for retirees, and the number was never, ever, ever going to be used as a de facto national identification card? Remember when the Dept. of Homeland Security said no one but they would ever see your library list? Just imagine: with national health care, the flight attendant on your business trip won't just see your Social Security number and know what books you read last week; she'll be privy to the fact that your last doctor visit ended up being for your chronic constipation problem.

Real health care reform would deal with the root causes of our dysfunctional system: income taxes and government involvement in health care. Only a vampire would think that the way to solve a problem involving government bloodsucking is to increase and subsidize government bloodsucking; we have to make it clear to our representatives in the coming months that we don't want to trade even more of our freedom for a handful of pills and "free" doctor visits. The stakes are already high; but we're going to have to raise them a bit more if we're going to turn this nightmarish plan into dust.


Alexandra said...

You are scaring me. I will have nightmares now. ;0

If I have to go to a government doctor, I'll consider moving to another country!

Susan said...

There are no other countries for you to move to, Alexandra (unless you want NO healthcare). Red is scary because she's right. And she knows she's right because it's happening everywhere else.

It's going to start sounding like I live in the promised land (but, ironically, I live in DC where all these problems start) but I'll try to blog this week about our awesome family doctor. I'll let you know . . .

Hélène said...

The first year we were married we had a great health insurance plan. The my husband started grad school and I got pregnant. No one would insure us because I was already pregnant and his school only offered insurance for the undergrads. We looked into keeping our old insurance under COBRA, but it would have cost nearly double our rent each month!

Three years later our family still doesn't have insurance. I used a midwife for my babies and only took them to the doctor for their newborn exam. I don't know how we would pay if an emergency happened or if they got sick, but I do know that government controlled medicine is not what I want.

I think another way to cut insurance costs besides your suggestions would be to put some sort of cap or regulations on malpractice claims, because malpractice insurance drives up doctors expenses, which drive up their fees which in turn drive up health insurance costs.

Ladybug Mommy Maria said...

Have you thought of submitting this to Catholic Exchange?

Very well written.

~cactus mouse~ said...

I love reading your blog, and I love your outspoken and blunt style. I agree with so much of what you write...except....

We were the young family, where we worked fulltime but there wasn't enough money after the paychecks to afford the Health Insurance Premiums...well, maybe if we didn't have electricity or food, there would have been. And then we had a sick child. A very sick child. If it wasn't for a state-funded medical program, we would have been burying our child.

And while your arguments come close to be much more convincing than any others I have read, I am still not completely convinced.

What you say makes some sense - but what about the child who is sick and needs medical care right now?

Now we have great private health plan - I wouldn't want to lose it, or be forced to lose it, that's for sure!! But if the "government funded" plan hadn't been available, when it is needed, then what?

Most states have a program for children - but employers aren't stopping people from adding kids to their private plans.

I just don't know....