The New York Times demonstrates the importance of health care as a political issue by noting that “Sixteen months before Election Day, presidential candidates in both parties are promising to overhaul the system and cover more — if not all — of the 44.8 million people without insurance.” They provide brief overviews of the positions of several of the candidates.
To the degree that 1) health care is an important issue and 2) we have a real debate as opposed to a campaign won by the distortions and hysteria which will inevitably be created by the right wing noise machine, the Republicans can be in serious trouble. While the article is correct that the Republican candidates are also talking about health care, they are not providing any plans which will actually make things any better. I have already discussed the faults in Giuliani’s ideas on health care, as well as his demagoguery in calling Democratic proposals, which are very similar to those enacted in states under Republican Governors, “socialized medicine.”
Even the Democrats are not immune to criticism on the issue. Hillary Clinton has the problem of having proposed an overly-complex plan in the past, making her hesitant to provide details so far in this campaign cycle. Many in the liberal blogosphere are also criticizing the Democrats for not going far enough, such as at Firedoglake today. I do not think that a Canadian-style single payer plan will be accepted here immediately, and would prefer to see this option provided on a voluntary basis to those too old to obtain private coverage at an affordable rate by expanding Medicare. There is also value in such calls for a single payer plan as this positions the Democratic proposals as less radical and may help thwart the false claims (such as those debunked by Factcheck from Giuliani) that Democrats support socialized medicine. Firedoglake‘s post follows a viewing of Sicko in which Michael Moore does an excellent job of demonstrating the problems with our current system but also overlooks the problems in other plans. I previously reviewed Sicko here.
I’m skeptical of the concept, but I’d at least appreciate it if someone asked that the ones promoting these policies pledge to never — and I mean absolutely NEVER — use government budget concerns related to health care as excuse to further regulate our personal lives. What people do to themselves is no ones concern but their own, it’s bad enough the current system has people under a microscope for the slightest “bad” habit, I don’t want the government doing that.
This has limited relevance to the current health care debates as private insurers have long considered bad habits when insuring individuals. Some impact on personal lives is an inevitable part of health care coverage, regardless of whether it comes from government or private insurers. Habits such as tobacco use greatly increase health care expenses, and smoking has resulted in higher insurance premiums for years. At present many private plans do have policies which promote changing bad habits. The plan we have at my office includes wellness programs, but these are voluntary. However, my one employee who refuses to particpate in the programs does have a slightly higher premium.
This isn’t a government issue. So far government programs have lagged behind private plans in such programs. However, should we have a universal government program, it is likley that it would adopt such measures to attempt to lower costs.
The questions are not whether there are programs to affect such behavior, but how heavy handed they are and whether current privacy regulations protect those who still wish to engage in such habits.
The idea that “What people do to themselves is no ones concern but their own” is generally true, but those paying for health care do have a legitimate concern as to whether people smoke cigarettes.
And that is exactly my issue with the direction we’re going. If A is paying for B’s health care, and A objects to how B lives their life, the just response would be to either allow B to opt out of coverage, or allow A to refuse to pay for B, either way eliminating the argument for interference entirely. IMO, creating new rules to discourage personal habits is a non-starter.
Besides, far as I can tell isn’t this kind of conduct the reason the current system is broken to begin with? The ideal client for an insurer is one who will pretty much never need the service, while the ideal insurer is one who will cover anything w/o any questions — the contradiction is clear. Maybe I’m just cynical, but it seems to me that a reform in the direction of the government playing the role of ideal insurer would make the same types barking about how people choose to live now practically drool at the possibility of tilting it back towards the status quo — except this time without people able to ignore them.
The problem with the current system comes not when private insurers promote programs such as smoking cessation (and consider this in their rates) but when people find themselves uninsurable due to preexisting conditions (or find the rates too high to be practical). That’s one reason why I’d like more to have the opiton to buy into Medicare and like to eliminate the one year waiting period before the disabled qualify for Medicare.
Otherwise, community ratings would better enable more people to get coverage. I fear that as genetic testing improves, we will reach the point where an increasing number of people are not sold insurance under the present system as the insurance companies will be able to weed out not only those with chronic diseases but those who are prone to developing them.
It certainly is possible that a government run program could wind up being more controlling in terms of life styles, but at present it is the private companies and not the government which still practices this. Still, that is a definate concern about a single government program. Once such a program is in existence there is no saying what it will evolve into, and there will no longer be options. Even though there are economic arguments favoring single payer, this is a reason why I still prefer a hybrid system which provides private alternatives.