June brought two good reasons to rethink basic points about healthcare reform. One was, of course, the U.S. Supreme Court’s decision upholding key parts of the Affordable Care Act. That kicked the issue back into the political arena, where it belongs, instead of in court.
The second was strictly personal: For the first time since birth, I was admitted for treatment in a hospital. That changed nothing in the wide world, but it was important to me, and it gave me a little time to think about all of this.
So let’s recapitulate some basic points:
1. The current healthcare system is broken. The United States has the most expensive healthcare system in the world – double or more the cost of healthcare in other developed countries. Yet healthcare results, in terms of actual health, are mediocre at best in our country, and we leave tens millions of people with no coverage at all.
2. This isn’t a choice between free markets and socialism. About half of all healthcare dollars in this country already are paid by the government in one fashion or another. That ship has sailed.
3. The free market isn’t going to solve this problem. The cost of my four days in the hospital quickly ran into five figures. Never have I run up such high costs with less comparison shopping.
That’s not just because I knew insurance would pay most of the cost. It’s because I had the cold shivers and a temperature of 104 degrees. If the doctor had asked me to sign over my house and baseball card collection, I probably would have done it in a shaky scrawl without a second thought. I needed help, and I needed it right now. I did as I was told, took every test they advised and lay quietly in bed.
Even if I had felt better, it wouldn’t have mattered. I had no way of knowing, and no quick way to find out, whether they ran all those expensive tests because they were afraid I might sue or because they were afraid I might die. In a battle of wits with doctors, I am an unarmed man.
4. Repealing Obamacare isn’t going to help. If Mitt Romney is elected president, he will be able to do a great deal to undermine the healthcare bill, even if Democrats in the Senate filibuster repeal attempts.
But Mr. Romney can’t make the problems go away. And he still stands by the solution he tried as governor of Massachusetts – a solution that more closely resembles Obamacare than anything else on the planet.
5. If Obamacare goes away, nothing will replace it. Even U.S. Sen. John Barrasso, R-Wyo., who has some credibility on this issue because of his background as an orthopedic surgeon, has proposed reforms that essentially amount to this: allowing the sale of medical insurance across state lines, tort reform, lower rates for healthy people and allowing small businesses to join together to offer health insurance. U.S. Rep. Denny Rehberg, R-Mont., opposes Obamacare but has even fewer alternatives in mind.
Some of these proposals are of dubious merit, and some would violate principles of state sovereignty that Republicans are sworn to uphold. Most are consistent with the bill that already is in place. If Republicans really wanted to fix the problem, plenty of ground for improvement exists. That ground will evaporate if the bill is repealed.
Look, it’s safe to say that no human being exists who wanted to pass Obamacare exactly as it is today. And critics of the bill are understandably skeptical about large, complex reforms whose full consequences are inherently unknowable.
But if the current bill goes away, neither Republicans nor Democrats will have the political will to take on the issue in any serious way anytime soon. We will be stuck with a system that nobody thinks works.
6. We got into this pickle for reasons that have little to do with free markets. Health insurance became an employee benefit in the 1940s as a way of getting around wage controls designed to get us through World War II. Now insurance has become a collar around the neck of every business, large or small. It restricts employee mobility, holds down wages and distorts costs.
Worst of all, tying health insurance to employment leaves ordinary Americans without healthcare protection when they most need it: when they have lost their jobs. And the system encourages healthy people to avoid insurance even if they can afford it.
Some of those healthy people are going to get sick no matter what. And since few of us are willing to just let fellow Americans die because they can’t afford the care they need, hospitals are forced to provide – and write off – billions of dollars of care every year.
Part of my big hospital bill went to pay for that care. Part of it went to pay for keeping those hospitals running with highly trained staff on duty 24 hours a day whether I needed them or not.
I don’t mind; I lived the first 60 years of my life in such relentlessly good health that if the medical profession had depended on patients like me, we wouldn’t need Medicaid for patients. We would need it for doctors because they would be living in poverty.
I would much rather have my healthcare premiums used to treat somebody else rather than me. But odds are that I will use quite a bit more of that precious insurance before Medicare comes along to see me through what’s left of my life.
That, I believe, will be a good deal. It’s time we provided a similar deal to everybody.