Scenes from the US healthcare debate

Hands across the Herring Pond - a reply to Hoosierboy

If you read my earlier piece, from November 03rd, on US Senator Orrin Hatch (Rep. Utah)'s nonsensical claims that any introduction of healthcare reforms  there would lead to the inevitable downfall of the two-party system of democracy in America, then you'll know that in the comments in response to it, one of the replies came from Hoosierboy; someone with whom I've exchanged on a number of blogs (including his own) in the past.

To recap, 'Hoose' was good enough to offer the following points below (those in courier font) - and I promised him a fuller reply in the form of its own piece: so here goes; everyone please feel free to comment, for or against!

Hoose, if it's OK with you, I'll quote each of your points in order before replying to them.

I challenge you to find one person who is denied health care in this country. If you are poor and cannot afford treatment it will be provided free in any public hospital.

A challenge, eh? Well OK, if you insist. 

In reality, millions of people are denied healthcare every year in the US, when their HMOs & Insurers refuse, for whatever reason, to authorise/sanction/pay for the medical treatment they need, as this Reuters article makes crystal clear California's Insurers Deny 21% of Claims - here's the rub: 

"From 2002 through June 30, 2009, the six largest insurers operating in California rejected 31.2 million claims for care - 21 percent of all claims."

I think you'll agree that this Reuters piece makes for some pretty grim reading - and yet that's just California - so if we, as we must, extrapolate that across the entire US, then you can see just how many Americans are "denied health care..."

And further to your assertion that "If you are poor and cannot afford treatment it will be provided free in any public hospital. " - I think it's fare to say that for the US to be basing its national healthcare policy upon mere charity is just a tad too Dickensian for the 21st century. What d'ya reckon?

Lastly on your point about how "poor people" are treated under the current system, another thing I found pretty unsettling is this recent Harvard Study, reported on the AP wires within the last 24 hours, which illustrates that uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance. 

With respect, Hoose, the "no one gets refused healthcare" line is just a popular myth in the US; and one, if we're being honest, usually punted by those on the more conservative Right (i.e. Republican) side of the political spectrum, and a myth which insists that everyone in the US, regardless of salary, can have free healthcare, simply by turning up at any hospital and asking for it. But what those punting this line choose to ignore (or omit) is the simple truth that not being able to afford healthcare insurance, or, worse, being declined its cover on the grounds of some "previous condition", is precisely the same as being "denied healthcare".

Whilst opinions on the exact number of uninsured in the US may differ - and by that I mean uninsured through either being unable to afford it, or being refused cover, for whatever reason -   we're still talking in the region of between 40 and 45 million people in the US either without or denied medical insurance cover. And that figure is nothing short of a national disgrace for the US: doubly so when we consider that any discrepancy in these figures is down to nothing more substantial than political partisanship, ideology and a desire to suit their respective prejudices.

So, where US medical healthcare (prior to any reform) is concerned, the message is clear: you cannot have what you can't afford - and if you can't afford (or are refused) it, then tough! And that's not a national healthcare system: instead, it's merely a pay-to-lay lottery.

And there is one other aspect which you've not addressed in your reply; but I think it's worth raising, for completeness, if nothing else; and it involves that other rote-learned deflection, err... sorry, 'caveat': that there is a federal mandate in the US which states that "no one can be refused treatment in a hospital..."

Sounds perfect, doesn't it? Even all-inclusive. But it fails in one chief criterion: its accuracy - in that it gives both an incomplete and (usually deliberately) misleading picture. 

Yes, no one can be refused medical treatment in the US, but, conversely, they will also receive a bill for any treatment they do receive, whether they can afford to pay it or not; and then have the privilege of being continually harangued and harassed by HMOs and Insurers when they can't pay it - just adding to their overall stress - and as if adding insult to injury (no pun intended) weren't bad enough, that's when hospitals aren't checking patients' personal credit ratings, to boot. When insurers and HMOs are placed in charge of saying ye or nay to whether a patient may receive medical treatment or not, instead of doctors, then it's not a system of national healthcare: it's a country held hostage to finance companies and one which puts profits before people.

And of course it's perhaps worth noting that, as this Harvard study shows, the paying of medical bills is behind over 60 percent of all U.S. personal bankruptcies. So you don't need me to tell you that the US has the most expensive healthcare - i.e. expensive to the end-user, the patient who needs it - in the Western industrialised world; and yet you still can't ensure that everyone - no questions asked - can receive the benefit of its coverage and treatment at point-of-need.

This isn't medicine as recognised or practised anywhere else in the civilised and developed  world; as in the US, the provision of healthcare is held as being, first and foremost, a business, and not a social service or societal necessity, as it is in UK/Europe and the Antipodes.

Is health care too expensive? Yes. Does it need reform? Yes. Can we get there without Universal Government provided health care? Yes.

Is US healthcare too expensive? Yes, we're in broad agreement on that point, so no argument.

Is it also, prior to any reform, and as currently run by the HMO's and Insurance companies, outrageously inefficient and wasteful (a charge usually levelled at "Big Gov't" run bodies by US conservatives), which in turn only drives up its user costs further for everyone - to the tune of $800bn a year, as Maggie Fox, the Science and Health Editor for Reuters reported only last week. So another rote objection of the Right holed beneath the waterline.

Which just leaves us with one point which you've perhaps missed in your assertion above: "Can we get there without Universal Government provided health care? Yes" -  I think we can agree that there's a huge divergence in imperative between 'can we do so?' and 'will we do so (i.e. left to our own devices, and our reliance on, and in most cases subservience to, the stockholders of the HMOs, Big Medicine Lobbyists and the vagaries of a free-market which strains with every fibre of its being to prevent universal healthcare coverage being delivered in the US)?'

Fair?

Now, if anyone's reading this and still finding themselves in the "we can do this off our own bat with no prompting or obligation" school of quandary, let's have a quick look at where we have a  working 'would we-could we-should we?' parallel in US History.

On what grounds were Ford forced into an urgent redesign of its Pinto range of cars, which had the nasty habit of simply exploding into flames when hit by another car, due to poor design and manufacture, killing thousands of Americans in the process?

Does anyone still honestly believe that Ford made the necessary changes and redesigns off their own bat, based on nothing more than some good will initiative, or out of some desire to adhere to a moral code of "doing the right thing"? Or was it being obliged to do so, due to the repeated court battles and the gazillions of dollars in fines it had to keep paying out, to the families of its victims, in damages and lost legal cases?

The record clearly shows that it was not merely Ford's beneficence and altruism which played a part in their decision to make corrective design changes to their vehicles to prevent further people being burnt alive in their cars. Their motive was having to explain to their stockholders why their profits were being made to look sick.

So ask yourself: will the current HMO-run healthcare model self-rectify or get its house in order, if left purely to its own devices? No. It won't. Because the profit incentive is too strong to want to make any changes to the how things are today - hence the much needed, and soon to be introduced, reforms.

To your point, whether we like it or not the Founders envisioned and designed a Nation with a limited Federal Government. That is not the case in the rest of the world, and frankly if Europe jumped off a clifff we are under no obligation to follow. Didn't your Mom teach you that?

Actually, no, she didn't: but then again, neither did she need to.

However, what she did teach me is that 300+ year old, Georgian-era concepts need not be religiously and blindly adhered to, or never refreshed or updated to suit the times in which we live, in order to meet the needs of the modern era. This insistence, by some in the US, of sticking to old ways and outdated thinking is what's got America into the healthcare mess it's in today - or, put another way, allow me to quote John Maynard Keynes:

“When the facts change, I change my mind. What do you do, sir?”

Time moves on and thinking becomes more enlightened, and medical needs and practices are meant to keep-step and improve with them - and, as to your point about the US Founding Fathers, just as you now allow women and black people the vote in America (provision for neither of which appeared in either the US Constitution or The Bill of Rights; both were achieved - wait for it - by amendments!), the time has surely come to recognise that the medical and healthcare needs of all US citizens are just as important as clean drinking water and the right to laugh at Vanilla Ice.

And when all is said and done, the Founding Fathers made no provision for any number of things: the Space Shuttle, automobiles & Interstates, the portable TV, Presidents sleeping (and having children) with their plantation slaves...

Things change. Lord knows if we in the UK demanded to adhere to some of our oldest tenets and sacred cows, we'd still be allowed to kill a Welshman on sight!

Strictly speaking, Congress has no authority to force anyone to buy health insurance. If you can find otherwise in the Constitution, I will be glad to listen and learn. In fact the 9th and 10th Amendments give that authority to the States. If Massachusetts wants universal healthcare they can have it (they do). If Utah does not, so be it. The powers of Congress are few and disntly spelled out in Atricle 1, Section 8.

'Forcing' people to buy health insurance was one of Senator Hatch's lamentable ramblings, not one I suggested; but I think, for which suggested healthcare reforms make provision, if no one can be refused health insurance due to some previous condition, or be priced-out from affording it, then no one will be placed in a position where they are 'forced' into being unable to access health insurance, which can only be a good thing.

BTW, I should also point out that NO WHERE in the Constitution can you find the phrase "Seperation of Church and State".

Believe me Hoose, on this point, you are preaching to the converted (pun intended): I've been having this same debate with American friends for years: the actual wording used is so vague you can you can drive a coach and six through the gaps in it.

Anywyay, I look forward to reading your (and anyone else's) reply mate.

Take it easy and hopefully speak soon!

Bren.

Scenes from the US healthcare debate