Why Whatever Healthcare Proposal Obama Has Is Stupid (The Problem)

So, looking at the current state of our social programs and our economy, I've decided it's time to start pontificating.

President Obama's (and all of the plans for which details are actually known) plans for our healthcare systems are nightmarish. Do any of you remember when Al Gore made out with Tipper on stage back in 2000? That was a better plan. For our older readers (of which there are none... yet), you probably remember when the Nixon campaign decided it would be a great idea to break into the Watergate offices of the DNC for a strategic advantage in the election? Much better, and more effective. Remember when Bill Clinton chose, of all the aides he could find, Monica Lewinsky? Closer, but still a better plan than what President Obama has.

You see, while the charitable side of me would love nothing more than for everyone to be covered, I have realized that the government is the last entity that ought to implement such an idea (along with most other people who have half a brain that functions apart from an obsession with the Organizing for America emails, which I forwarded to flag@whitehouse.gov, by the way, but I digress). When we look at the various social programs of our government (a non-exhaustive list will be provided at the end of this post), it becomes clear that our Congress has a track record of success tantamount to that of the Washington Nationals (to be fair to the Nationals, they have won a few more games than has our government been successful with social programs). Now, what I will be writing may suprise you (I'm not Sean Hannity, so I use actual arguments instead of only insulting Democrats, and my readers... and I recognize that President Obama is infinitely more intelligent than the above referenced talker).

The premise of "health care/insurance reform"

The reason that we most often hear about the need for health care/insurance reform is that the cost is crippling, and the return on investment is horrific. It's actually a logical argument. We do, in fact, spend almost 150% as much as the nearest developed nation on healthcare, and our life expectancies are notably lower, and our population is (as a matter of statistics) generally less healthy than, let's say, the French. So far, so good, Mr. President. We also hear that we need to be like everyone else, since almost every other developed nation has some form of government sponsored healthcare for all of its citizens. Also very true, though these plans range from government mandated coverage (in foreign countries like Massachussetts) to all out single-payer (like Great Britain). The President has made clear that his current agenda doesn't include single-payer, though it does include a government option in a Medicare-for-all style (though his past statements say differently and most liberal supporters - especially those in Congress - would like to see single-payer sooner rather than later). So far, on face value, I can almost support what the President is saying. He even says that, if I like my current health insurance (which I do), I can keep it (which I'd love to do). I can even see the logic behind denying that Medicare, Medicaid, SCHIP or any other government-administered will suffer, because the logical thing to do would be to roll them all together into one big program.

So, the President is doing a pretty good job of trying to frame the debate with base language and non-specific rhetoric. He's a politician, and that's what politicians do. Good job, President Obama!

The problem arises when we start to look at the details. Let's take a look:

Cost vs. Benefit

Americans spend almost double the amount that other countries spend on their healthcare. That sucks. Staying healthy and taking advantage of all of the medical advances and life-saving (and life-enriching) technologies is expensive! And, you say, Americans are less healthy than those who spend around half of what we do to stay that way? What an outrage!!!

Here's the problem, though. Let's take Switzerland as a reference point. According to the University of Maine's study on health care (http://dll.umaine.edu/ble/U.S.%20HCweb.pdf), the U.S. spends $4,178 per capita, while the Swiss are spending $2,794 per capita (worldwide median is $1,783). Right there, you can see a disparity, and it's quite obvious. If this were all the data available, I would very quickly and strongly support a Swiss-style system in America. But, there are many factors that go into those costs, and it makes sense that we'd spend more (maybe not to the extent we do, but significantly more).

Innovation

Patients in America enjoy the greatest access to approved medical innovations of any country in the entire world. More doctors come from foreign countries to study these new innovations than those American doctors who study abroad, and our healthcare providers are the best trained, best equipped and most successful of any in the world. All of this is because of the for-profit nature of our system. You see, people are motivated by the reward they receive. So, when a for-profit medical research firm has the ability to maximize their profits, they will tend to do more (and more effective) research, leading to more (and more significant) breakthroughs. All of this is possible because of the reward they will receive for their efforts. In a system such as Canada's, where innovation is stifled by cost-caps, these innovations are almost non-existant. So, if you like your grandma's pacemaker, you can thank American for-profit companies for taking ideas and turning them into pacemakers.

Lifestyle


American lifestyle is unlike any other country's. Americans, due to the for-profit nature of our economy, work harder to do more (goes back to innovation, eh?). Working more leads to more stress, and we all know the effects of stress on the holistic health of the individual (http://www.stress.org/Effects_of_stress.htm). So, it would be logical to conclude that Americans' health would be affected by their stress level, which is typically higher than that of a citizen of another country. Without this stress (because work=stress), most technological innovations, especially in medicine, would not be developed as quickly or widely (or at all), which would actually have negative affects on other countries' health (i.e. Canada couldn't impose their cost caps on non-existant drugs developed by profit-hungry American drug companies).

This may seem strange, or even hypocritical, coming from a big guy, but diet plays a HUGE role in overall health. This should come as no suprise; how long have we been demonizing McDonalds and Burger King for "making America fat"? (I'll give you a hint, Super-Size Me wasn't the first criticism.) Now, being the capitalist pig (and self-affirmed fat guy) that I am, I don't believe that we should regulate what people eat, so long as they're responsible for their own care (which they are, and should continue to be). But, it is wrong for the government to assume that their intervention in the cost of healthcare, without pronounced regulation on industries such as fast food, would somehow bring those costs under control. The only way they could do that without taking away Americans' freedom to eat all of that garbage (albeit tasty garbage) would be to deny care, which is another premise of Obama's "need for health insurance reform".

Americans' choices (such as those to work hard, and eat like Star Jones used to) lead to higher health care costs, but it is NOT the government's right, responsibility or privelege to regulate either one beyond reason (reason meaning establishing fair labor requirements and provision of accurate health facts for foods). Just like the market, success or failure is dictated upon the choices we make in our own health, and our own provisions and luxuries. If we make good decisions, we're successful (i.e. we can be healthy and afford healthcare), or we make poor decisions and we fail (i.e. we buy a 52" TV and a tub of bon-bons instead of enrolling in a health care program and a gym).

NOTE: Please, for the love of everything that makes sense in this world, do not listen to Sean Hannity. I almost performed an Eqyptian brain removal on myself the other day when I heard him say that our mortality rate is somehow significantly affected by the military. What a blowhard. Fortunately for me, I didn't have any wire hangers in my car.

Profit

This is America (wow, really?!). One of the reasons we are (well, used to be) the richest country in the world is because we worked our ever loving butts off to get this way. Our country has always been based on an investment=reward system. In other words, if you have a good product and are able to market it, you make lots of money. If you have a terrible product, or are unable to market a good one, you don't make money. (NOTE: if you have a terrible product and are able to market it, you can become President.) So, on this premise, our healthcare system isn't much different. If Hospital A has a success rate of 99% in a quad-bypass surgery, and Hospital B's success rate is only 93%, Hospital A not only will get more business, but will be able to charge a premium for their services. It's no different than paying a little more for a Cadillac than a Kia.

The better the service, the higher the price. It makes perfect sense, and it attracts more people to excel in their fields, because they'll enjoy a greater reward when the provide a greater product. When you remove profit from the equation, you remove the best-proven motivator of professionals from consideration. When you do this, you lose the best and brightest to either another industry or another area where they can maximize their profits. So, if you want the bar lowered in healthcare providers from the valedictorian of his/her class at Johns Hopkins to Johnny, the kid who can't remember if you wanted pickles on your Whopper (what are you doing at Burger King... it's terrible for you!), all you have to do is remove profits from the equation.

I haven't even touched on the med-tech and pharmaceutical companies' profit-driven success. The biggest argument I've heard from my more liberal friends is, "[whiny voice] yeah, but I can get my [insert drug name here] a lot cheaper if I were Canadian!" This is very true. And it sucks. The reality is, though, Canada puts caps on what drugs cost. This is why almost no major medical innovation (or mass distribution of said innovations) has pretty much ever originated in Canada. While there are plenty of superfluous (or just unnecessary) drugs developed, produced and distributed in America (and they probably drive up the cost of others), the fact is that profit drives these companies to do what they do. One of the most dangerous things to do would be to impose a Canadian-style cap on drug costs, as it would again remove the profit motivator from the drug companies, slowing development and innovation. Not only would Americans suffer if this happened, but so would the rest of the world (because most of the world uses drugs and technologies developed and distributed in and from America). So, France would probably be pissed if Glaxo decided to cut production and exporting because of lower profits. Man, that would suck.

Why it doesn't add up

So, I've shown how the premise doesn't quite add up to the details when it comes to the Cost vs. Benefit debate. Yes, costs are higher in America. Yes, it seems unfair when you speak in generic platitudes and not actual details. Yes, it is largely our own fault that costs are so high. But no, there isn't really anything the government can do to fix it without screwing up a lot of other things.

The cost of innovation is high. Profit motivates medical innovation, as it does in all other industries. When profit is removed from the equation, production and distribution (and, not to mention, research) will necessarily decrease. Even if there were somewhere else in the world for these companies to go and make similar profits (there isn't), that would destroy our economy faster than Obama has destroyed his hopes of a second term (according to current poll numbers... I know, things can change, and he's all about change). I mean, seriously, I think Mickey Mouse could actually beat him if the election were held today, and I'm not even sure if Mickey Mouse is a real person!

The more we stop at the drive-thru, the more we're going to pay at the doctor's office (or hospital, as the case may dictate). If we go to a government-run system (whether single-payer or a simple government option), you can take the same equation and replace the second "we're" with "we're" (because we're still paying for it, it's just that the government takes our money forcibly in order to pay for it for someone else, too). There are too many factors that affect the relative health of Americans to the rest of the world, and almost none of them can be solved by the government without causing significant damage to other aspects of our country. So, the only difference would be that the relative responsibility for these outrageous healthcare costs would be shifted from the individual (cost directly correlates to healthcare needs) to the collective (cost spread across all people indiscriminately... you know, except that 10% of the population would pay 90% of the healthcare costs).

"If your friend jumped off a bridge and told you that you suck if you didn't jump too, even though he broke his leg and has to wait 10 months for a cast, would you jump?"

I swear, if I hear that argument (in different words, of course) one more time, I might push someone off a bridge (not really, in case the White House comes across this blog). Loud mouths from across the pond yell from their crooked-toothed mouths all the time that we suck because we haven't done the same thing that they've done. It's a terrible pity that we haven't sunk our economy even further into debt with universal (or compulsive) health insurance "reform". But hey, we have dental care!

Seriously, though, when people say that we should be like France, Germany, Great Britain, and a host of other countries whose health care systems have been shown to be sub-par on a good day, it makes me want to scream. There are those who would argue that waiting 4 weeks to 3 months for major (non-emergency) surgery is just dandy, as long as everybody is waiting that long (another logical fallacy which I'll address in a minute). There are those who say that a slightly lower success rate in surgeries and other treatments is ok, as long as everyone has access to these services (same logical fallacy... hold on). And then, there are those who claim that a universal (or compulsive) system in America wouldn't even cause those problems (using any word where the root is "logic" would be entirely inappropriate for these people). First of all, lowering the bar for some in order to cover all doesn't work, because when sub-par is the new par, everybody suffers. In other words, making everything equal doesn't make it better for everyone, instead it makes it worse for most. The simple fact is, just because it sorta-kinda works for another country (sorta-kinda, and most of these other countries don't have the same issues - especially not on the same level - discussed above in the Lifestyle analysis) doesn't mean it'll work for us. I hate to be the guy clamoring about money all of the time, but the simple fact is that a lot of it comes back to money. There is no such thing as a free lunch, and there's also no such thing as free insulin. Costs would necessarily go up, which means that our taxes would necessarily go up (well, at least the taxes of the 40% of Americans whose taxes outweigh the spending from which they benefit: http://www.taxfoundation.org/research/show/2286.html).

There are plenty of doctors... right?

In 2002, America had approximately 2.3 doctors per 1,000 citizens. Now, out of those 1,000 citizens, approximately 83% have health insurance, and a smaller percentage of those get regular checkups. All Americans (even those who are uninsured) are entitled to emergency services (life-saving emergency treatment), though they are not exempt from the bills that follow.

Given the above information, it is reasonable to assume that our nation’s doctors are too few. Many otherwise qualified individuals choose to go a direction other than medical school because of the costs, and the debt that often results. If, as the President proposes (one of the few things of which he’s actually taken ownership in this debate), healthcare charges are to be capped and regulated, this would lead to lower profits for hospitals and health systems (which affects affiliated doctors’ salaries) and smaller profits for independent physicians. Since education isn’t getting any less expensive, would it not stand to reason that even fewer otherwise qualified individuals would chose not to pursue a career in the medical field if the earning potential were lower but the cost of education and licensing continued to rise, or even remained steady? That would have been like asking Mike Vick to play second string to Donovan McNabb before he was caught being the slimeball that he is. To further that analogy a bit more, the resulting class of med students would consist of less qualified (or less decent) candidates, and a lower quality of healthcare. That's just like Jeffrey Laurie signing Mike Vick because no one else would, and Vick now playing second string to Donovan McNabb. Lower pay equals lower quality players (either in skills or scruples). Sounds great, right?

Do I even need to address the disparity between the number of doctors we currently have practicing (who are already stretched thin) and how many more would be required to effectively cover an additional 20-45 million patients? How many more doctors do you think we'll get with a higher cost/lower reward system for doctors, as President Obama is proposing (he would never use those terms, of course)?

Still want Obama’s health care/insurance reform?

So, figuring in the vast cultural differences between ours and other cultures around the world, the innovation that only America’s system has allowed, the economic cataclysm that would undoubtedly result, and all of the other issues that are either ignored or unaddressed by Obama’s (and the Democrats’) proposals, does it still sound like a good idea?

Never mind the “you can keep your healthcare if you like your healthcare” argument (which, ironically, is also unlikely to be true: http://factcheck.org/2009/08/keep-your-insurance-not-everyone/). I mean, everyone LOVES paying for private services despite the fact that they’re paying for similar (though not the same) services from the government, except that the government compels you to pay, while you have an option to pay your private premiums. At least that’s what I thought (sarcasm should be noted). Never mind the fact that the government has an ability to fit the law to its program while forcing private firms into the ever shrinking box of regulations (I should note that it isn’t the regulation that’s shrinking; instead, it’s the breathing room inside of that box). Your private insurance won’t be affected! The fact that your employer will pay more in taxes to pay for Obama/KennedyCare, plus a penalty if the coverage they continue to provide doesn’t meet government standards is no matter. Surely they won’t simply opt to push you out into the “market”, which will amazingly compel you into Obama/KennedyCare. Surely private insurance will still be available and affordable (not to mention reasonable). But, hey, if you’ll buy that argument, I’ve got some ocean front property in Arizona……

I’m not one who is ready to say that President Obama has some evil scheme to eradicate the free market and turn us into Cuba. I’m not prepared to say that his policies are reminiscent of the beginnings of the Nazi/Stalinist/Fascist regimes of the earlier parts of 20th century Europe. But, I do believe that President Obama is smart enough to know that these plans are not as innocent and well-intentioned as he’d like to make them seem (or at least that his intentions aren’t the same as he’s presented them recently… I think you can learn a bunch from the statements he’s made previously, as well as those of his closest advisers). The worst thing that we could do for our economy and our populace would be to create more bureaucracy (more complication and higher costs). It is important to realize that everything costs money (even in France). While the government can print an endless amount of our own currency, its value diminishes with each drop of ink from the Fed’s printing presses. I don’t know for absolute certain what Obama’s goals are, but I do know what his plans will do to us, and it’s not good.