The subject of health care is not an easy one. I made a recent post here regarding how doctors in Texas are bailing out of Medicare participation. And regular contributor Donna made a comment that highlights another aspect of the dilemma.
Medical care has a cost; a high one, at that. And those costs must be bourne. If we agree that health care is an entitlement, that everyone, regardless of earning, station, or capacity must get, then we have to come to grips with some economic realities.
Since we would be in agreement that everyone gets care, then we would have to figure out a way to increase the funding base. More people would have to “pay up” so that there would be enough funds to cover the costs. The obvious place to get this money would be from a payroll tax. A few problems with this…
- Nobody likes increased taxes
- People who paid the taxes but didn’t use health care (the healthy ones) would be angered
- People who used the services but did not pay the tax would be looked upon as freeloaders
- People would come up with novel means to avoid their “fair” taxes (dodging taxes in national health care Denmark is a national sport)
- The bureaucracy required to administer this new social security would divert funds from health care to more government employees
- Since government would be taking over the whole “insurance” scheme, what to do with all those employees in that industry, their assets and liabilities, the stockholders in those companies…
And other issues would become evident as the program grew. The first, and possibly ickiest would be “can you provide unlimited services for everyone?” And, of course, the answer is no. Actuarial tables would be developed to determine what combination of age, previous conditions, probability of survival, contribution to the system, etc. would result in the dispensing of what care. It would be highly likely that a 93 year old man with a history of health maladies would simply not qualify for that life extending kidney transplant “on the system”. And what if “the system” provided that you or your family could pay extra, privately, to obtain health care beyond what was provided? Wouldn’t that cause the same thing all over again… Care providers opting out of “the system”… So you eliminate an option B situation and condemn that man to death, even if there are ways and means to continue his life. Icky.
And what of the opposite end of the spectrum? The micro-premature? Statistically, they have very little chance of survival and if they do, they are certain to exact a tremendous health care toll. A bad risk, a poor spend. Would a national system provide a “save them at all costs” approach? Probably not. A piece of paper or a clerk in some office deciding that a life is not worth living. Not so much, I have family that is currently beating those odds. Having access to the best that health care can offer (and not the dictated mediocrity) has meant that they live. And I am thankful for this. But I know that these lives would not be here under a national plan. And that brings up another icky ethical dilemma.
Which is better? That all receive the same mediocre standard of care or that some get better care than others simply because they can buy it? Does money become the true litmus test of who lives and who dies… who suffers and who is relieved? My neighbor recently spent over $2,000 to treat his pet cat. There were IV’s and pills and feeding tubes. There were many visits to the vet. The $2,000 he spent on the cat was far more than some folks will spend on their health care in a decade. Did the cat deserve better care than an indigent simply because my neighbor could afford it? And if he is free to spend $2,000 on a cat, should he be able to kick in that same $2,000 for his own care above and beyond “the plan”… and thus starts the whole cycle again.
I have no answers. Just a lot of questions.