Thursday, August 13, 2009

Health Care Rant

The "debate" about health care reform (or "health insurance reform" as its now being called, presumably to make it sound less scary) is really annoying me these days. I put "debate" in quotes, because it is not a debate at all anymore- it has turned into theater. The "news" about health care reform is dominated by coverage of vocal, incoherent protests. I have no problem with people protesting policies they don't like. I don't even think it is wrong to disrupt meetings if you can't get your opinions heard any other way. But the protesters don't seem to be trying to voice their opinions or participate in any sort of discussion about what health care should look like in this country. They are just shouting and waving signs with pithy sayings that don't actually SAY anything. They shout down anyone who says anything other than what they want to hear. If my two year old behaved like that, people would expect me to take her outside until she calmed down.

The other aspect of the "debate" that is bothering me is that people seem to be free to just make things up. The ridiculous discussion of "death panels" is just one example. Either the people making these claims have incredibly poor reading comprehension or they are cynically trying to scare people so that they can get their way. I can't really see any other explanation for taking a provision that would allow Medicare to pay doctors for the time they spend consulting with their patients about end-of-life decisions and using that to claim that we're going to have panels of government bureaucrats deciding when a person is not productive enough to live. When I first heard these claims, I just laughed because they seemed so silly. Now, they have apparently led the Senate finance committee to remove all end-of-life discussion provisions from their version of the bill. This is a shame. I don't know why we wouldn't want people to talk to their doctors about these issues. Where would we rather they get information about their options?

Even before the debate got this silly, though, I was frustrated by it. The people opposed to reform seem to be able to set up strawman arguments unchallenged. And the people in favor of it seem to want to dodge reality and avoid talking about some of the difficult decisions we really do need to make.

Before the death panel nonsense, the favored scare tactic seemed to be that we were heading for rationed health care. This claim also made me laugh, because we already ration health care. When was the last time you chose to get a treatment that your health insurance doesn't cover? Have you ever switched medications because the medicine your doctor originally prescribed is not on your insurance's formulary? Why is it OK to have insurance bureaucrats making decisions about what treatments are covered but it is not OK to have government bureaucrats making those decisions? Personally, I don't care if the bureaucrats are paid by a private company or government. I only care that there is good oversight and that the decisions are made based on evidence about what works.

The difficult decision we most seem to be dodging is the decision about how much personal responsibility for insurance we should require. Why is it OK to require employers to provide insurance but not OK to require people to buy it if they can afford it? Why do we think people should be allowed to dodge this responsibility but not the one to insure their cars? It seems to me that if we aren't going to go to a single payer system supported by taxes then we need to go to a system that requires people to buy insurance if they can afford to do so. Otherwise, we'll still have a group of people relying on emergency rooms for their health care- which is the most expensive way to provide it. We all pay for emergency care, via our taxes and higher costs. I can't imagine we'd ever say that we'd deny such care to people who chose not to purchase health insurance, and I wouldn't really want to live in a country that would do that. So why can't we talk rationally about how to make sure that no one relies on emergency care as their primary care?

Why can't we talk rationally about all of this? I thought we were finally going to get something approaching universal coverage in this country. I thought we might even take this opportunity to try to craft a truly better system for all of us. I didn't expect the final system to look exactly like I would want, but I did expect a somewhat civilized debate about what that system should look like. I am incredibly disappointed to see this chance slipping away under a deluge of lies, half-truths, and theatrics.


  1. MrsHaley10:48 AM

    Well said, Cloud. I agree wholeheartedly.

  2. Can I just say ditto? Maybe copy and paste your post onto my blog? (Totally kidding about copy and pasting, but you get my point.)


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