I watched the Republican train wreck of “repeal and replace” while figuratively holding my breath. Full disclosure – I buy my health insurance on the “Obamacare” exchange, am relieved that the ACA will remain intact, and can only hope the Congress won’t commit too much sabotage in the coming months.
But I think we’re asking the wrong questions and having the wrong discussion. We shouldn’t be talking about insurance but about health care. There’s no way to agree on “how” or “to what extent” until we agree on “what.”
Do all Americans deserve health care? (I’ll leave aside the politically-laden word “entitlement.”)
- I thought we’d reached a lasting consensus on health care for those over 65, but various proposals to replace Medicare with vouchers makes me wonder.
- I thought we’d agreed children deserve health care, though not with methods as well settled as Medicare.
- There’s less agreement on health care for the disabled since suspicion of fraud seems to be a big worry, and there’s a lot of downright skepticism on health care for addiction and other mental health illnesses – at least in part because we don’t seem to believe anyone knows how to treat these illnesses. (Many professionals will disagree with that last bit, but I think a lot of people feel that way.)
- That leaves the rest of working age adults. There is some support for the idea that anyone who has a job should not have to live in poverty – and I’ve read that most Medicaid recipients in this category are working. But again the fear of fraud and anger at the notion that someone is getting away with something seems to overwhelm the issue.
Surely we’re all opposed to fraud, and there should be ways to guard against it. And evidence-based research should be able to prove which treatments work, even if they may run counter to some social tropes. May I assume those problems are solvable?
It leaves the core question: Do all Americans deserve health care?
Until we arrive at a generally accepted consensus, we’ll never figure out what to do about it.
You are spot on to question what really constitutes healthcare as opposed to healthcare coverage. The other leg of this stool is access.
If you live in the rural west there is a strong possibility that your nearest healthcare facility is at least an hour away by car. That’s a two hour ambulance trip. Finding a doctor who isn’t already overloaded can be almost impossible. Doctors are retiring faster than we are replacing them (unlike lawyers, which seem to be almost a commodity) and GPs are in critically short supply. Tort reform might help keep some in the profession a bit longer, but nothing in Obamacare or any of its proposed replacements has done anything to cure the shortage of caregivers.
Loosening the regs on who can treat whom and when would be a good starting point. Physician Assistants and Nurse Practitioners can do 98% of the GP’s patient interaction, aided by the ability to consult via the internet. And let Medicare/Medicaid negotiate drug prices, make hospitals post their prices online, disallow network restrictions so there are no coverage surprises and everyone plays on a level field. I could go on.
As George suggests, maybe the question should be “do all Americans deserve ACCESS to healthcare”, and I opine the answer is “yes” to that. Perhaps part of a solution to the shortage of healthcare providers would be to spend some of the healthcare subsidy moneys on education for the caregivers. Maybe more intelligent, capable people would pursue the healthcare profession if they weren’t to be burdened with hundreds of thousands in debt upon graduation.