Saturday, September 5, 2009

No One Should Die

A comment written on Face Book caught my attention.
"No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day."

On general principles I agree with the thought. People shouldn't be dying because of cost and neither should they go broke over health care in our 21st century North American society of obscene materialism. Although I suspect the frequency of both end results occur less than is generally thought. Also hospitals are pretty user friendly in setting up payment systems for folks who truly have no other way to pay.

However, universal health care isn't really that easy. From another paradigm I disagree with the comment as it leads to outcomes and consequences we might not desire nor be able to prevent once such a concept is brought about in society. The comment basically enshrines health care as a "right". Again, a seemingly beneficial aspect, but fraught with all kinds of issues. Lets explore a few of them:
How? How is the right implemented or ensured? To guarantee this right some one has to set up a system and it has to be paid for. The free-market system can do so by transferring the cost for those who can't pay over to those who can through their insurance premiums. For the most part this is what is happening now, but not in an organized manner. An illegal immigrant who can't get health insurance walks into an emergency room, gets treated (by law no one can be denied services), pays what they can and walks out the door. Other users who pay, eventually pick up the loss incurred by the hospital. One idea floated by a conservative is to create a "insurance pool" that all insurance companies pay into for coverage of the uninsured. Some health providers are already doing this like Walgreens. If we turn our health care over to a government run system, we who can pay will pay through our taxes AND our premiums.
Who? Who should be responsible for this right? The Bible teaches we are to be our brother's keeper, to protect the innocent (although another right guarantee kills the innocent), and to feed/care for the less fortunate. Are we, American citizens, responsible to care for someone who chooses to either abuse their health, illegally crosses the boarder, or make life style choices contrary to their physical health. One statistic generally accepted of the uninsured, is about 12 million folks earn greater than $74K a year and choose NOT to have insurance! Many in the 18 to 30 age group likewise opt out, especially if single, preferring to spend their money on other luxury items. So should the other 300 million of us foot the bill for others to have their cake and eat it too? Where does individual responsibility come into play in this right?
Why? Why this right? I've alluded to why in the last point, but in this point lets consider why this right over other possible rights? Try these: No one should die because they can't afford a house; No one should die because they can't afford a car; No one should go broke because they don't have a car; No one should go broke because they don't have cable TV; No one should go broke because their taxes are too high; Do you see where this is leading? If you grant one type of life style right then why not others. Our constitution mentions nothing about these kinds of 'rights' because the founders believed in setting general principles, and at that time, trusted the people to responsibly provide for themselves.
Reality? The sad fact of life: life is not fair. The comment implies all should be fair in the life we live. Life is not fair, in fact it can be down right brutal, especially if we make wrong choices. Most of the world lives in a day to day struggle for survival, where even the hope of health care is but an out of reach dream. If you live in North America, you have a number of safety nets that will help in times of need, but in the other 98% of the world that isn't the case.

These are but a few aspects of the implied 'right' to health care. There are consequences to enabling this as an universal right in our nation.
Loss of Freedom I: Others will choose for you. As suggested, a universal health care right paid for by the government, will ultimately involve loss of individual freedom to choose your health care direction. Oh, at first you'll be able to keep your current doctor, but as time goes along, inevitably for cost control purposes you'll be shunted off to another doctor. That doctor will be strictly limited as to health services you can choose from. He'll have a guidance table that will have age across the top and symptoms down the first column and where the two aspects intersect, that will be the health care provided. Too young or too old and your choices (freedom) will be limited by cost and availability. If you appeal, some faceless government gnome with a green shade cap will access your cost-effectiveness to receive treatment. There is no other way to reign in health costs but to ration and truncate care.
Loss of Freedom II: Health Nazis You laugh. But there are already legions of health nazis who are ready and able to police your life style choices and insert that info into your national health record. Doubt me? Think of this one aspect: Labor day pic-nic - You go to local grocery story, place on the checkout conveyor the following items: a bag of chips, 80% hamburger, 12 pack of hot dogs, sour cream dip, white buns, two cartons of cola, pack of marshmallows, graham crackers, and chocolate bars, and for dad a six-pack of beer. You then hand the clerk your "FOOD CLUB" card registered in your name! How hard do you think it would be for a nationalized health care system to require that data transferred into a "health risk factor system" and placed into your national health record. Then when you need a triple by-pass, all those data points will be summarized in a model formula and bingo: DENIAL OF TREATMENT! (And think on this: Will you go broke seeking private treatment in another country offering better care?)
Quality Vs Quantity: Mediocre care A national health care system will ultimately result in mediocre care. Take a look at Veteran's medical care. Overall it's pretty crappy. I should know I've used it for my military service related disability. Long lines, long waiting, examined by a PA rather than a Dr., weeks to get service or appointments, paperwork out the wazoo, and rude treatment by the sizable army of clerks. Remember, you get what you pay for. If it is free, then it cost you nothing and that's the kind of service you can expect. We will be herded in mass to local doctors who will be under-paid and over worked. If you need something routine, you'll probably get seen in a few weeks and handed your pills. But God forbid should you need any other kind of special treatment. You just might die before the system can meet your need. Also this will impact research and development of new techniques or medications. For what incentive will there be for those who work in this arena to go that extra mile if the rewards are not there? Mediocrity will become the standard mode of operation.

My last point goes to the end of the previous concept. Motivation. Why will individuals take care of themselves if they know they have no responsibility to do so? Where is the motive to move people to become doctors and surgeons if they know in the end they'll be part of giant industrial-medical system that dictates who, where, and how they will treat patients? The lessons of attempted socialism is rife with failure. One of the best examples on record is that of Jamestown of 1607. When the colony was first formed, it was done under the idea of 'communal' sharing of work as well as the benefits derived from that work. All would work together and all would share in the resulting bounty. Except human nature came into play. Those who were lazy, greedy, and/or thought of them selves as higher class didn't work. They expected to receive their share none-the-less. As the colony began to decline in output, people died from starvation. It was obvious the socialized effort wasn't working so Governor Dale canned the communal system, assigned 3 acre plots to colonists and told them "plant or die". Amazingly, the colony began to grow and thrive. Harsh? Indeed. Yet necessary for civilization to become civilized.

No, people shouldn't die or go broke from a lack of health care. But they do, and would continue to do so even if made a 'right' via a government system. That said, we need to exercise caution in assigning life-style rights for the consequences can be what we never intended, and may be far worse than what we have now.

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