13 July 2009

In Support of “Universal” Healthcare

5 Facts

  1. People with emergency medical needs get medical care, regardless of their ability to pay.
  2. The government is already involved in healthcare – individuals and families that are at a certain income level or meet other requirements are eligible for Medicaid, and people over 65 and with certain medical conditions or disabilities are eligible for Medicare – systems paid for with taxpayer money through income taxes. You cannot “opt out” of paying this tax.
  3. Health insurance coverage is not federally regulated, it’s left to the states to determine what, if any, regulation is placed on health insurance companies.
  4. Health insurance companies are private, for-profit businesses.
  5. The US government is made up of people elected by the people, for the people.

My political beliefs trend toward the constitutionalist/libertarian track. I feel government – local, state, or federal – should have an extremely limited role in my life and only focus on the matters affecting the group of people as a whole. I firmly believe that your rights end where mine begin and vice versa. Your ethics and morals should have no bearing on my ethics and morals except when it comes to affecting our collective rights. That said, I do believe one of the roles of government should be to uphold the Constitution in providing – for all citizens – the basics of life, liberty, and the pursuit of happiness. And pursuant to that right to life, medical care is essential. The Constitution of the United States makes no direct guarantees to the freedom of healthcare, but it does uphold the right to “life” as stated in Amendment 14 (bold for emphasis mine):

1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

To the point – no one can prevent someone else’s right to life. The AMA Code of Ethics also says, “A physician shall support access to medical care for all people.” From the Constitution and the AMA Code of Ethics, it is clear that the right to medical care is granted to all people – and there is no restriction or clarification regarding the ability to pay for such services. Hence, the argument for the government and physicians to provide, at a minimum, access to healthcare for all citizens is in place.

The problems develop when we try to figure out how to implement and pay for that that healthcare. Right now, the debate is between the current privately-funded insurance industry versus a government-run healthcare plan. So let’s take a peek at them side by side. Remember, though, that the US has never had a government-run plan, so that side of the equation is still based on other countrys’ models with a healthy dose of supposition.

Table 1. Stacking Up: Private vs. Government Healthcare Plans
ConcernPrivate IndustryGovernment-Funded
Decision MakersPrivate citizens who are elected board members by shareholders (also private citizens); no influence on these roles by individual patients unless patients happen to be shareholders.Public officials, elected by the voting public or appointed by elected officials elected by the voting public.
EligibilityVariable. In some states, companies that provide insurance are required to provide it for all employees regardless of their health status or ability to pay. In other states, only those who can afford it can purchase it. For individuals without access to a company plan, coverage can depend on health status despite ability to pay, etc.Everyone.
CoverageVariable. Each insurance company decides what services will be covered for which plan and which people can be covered under which plan.Fixed. The government can set the minimum services covered for all US citizens.
CostVariable. Premiums are dependent on a multitude of factors varying from company to company, plan to plan, and service to service.Fixed. The government can set a single standard price for all services for all people.
Responsibility of PaymentIndividuals with health insurance pay premiums, co-pays, and deductibles per their specific plan. Individuals who pay taxes also cover the cost of the current government-funded healthcare programs covering those who cannot pay themselves. Essentially, individuals with health insurance are paying twice – once for their own coverage and a second time for the government programs. Those who pay taxes but cannot afford health insurance are still paying for the government-funded programs – for which they might not even be eligible, thus paying for healthcare they themselves can’t even access.All taxpaying individuals will pay only once for healthcare – covering themselves and those who cannot pay. All people, however, will have access to care, period.

Am I oversimplifying? Maybe a bit, but even in trying to simplify, look at how complex the explanations are in the Private Industry column. Almost every answer can be “it depends.” Because everything is variable, there are not standards or regulations. In doing research, I found a site that lays out the pros and cons for government healthcare and it provides a good summary of the “con” arguments. Go read 15 reasons to NOT support government healthcare. But read them carefully. Then, go back and re-read the list and ask yourself this, “Is this already happening within the private healthcare insurance industry?”

Argument against (and this one is so good I’m quoting directly): “Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness.” Seriously? With the oft-reported “soaring costs of healthcare” people are going to argue that the current system leads to “greater cost control?” And where, exactly, is the competition when people need emergency healthcare? Or in fact, when their choices are limited based on their “network?” I can’t believe this argument even makes the list.

Argument against: “Government” will decide what is elective and what is necessary; or restrict drug access. Private insurance companies already do this. Ask women who have need breast reduction for health reasons – some get it, others don’t. Or IVF, some companies cover it, some don’t. There’s even a push to legislate that all companies be required to provide IVF coverage. If we’re trying to legislate that already, why not just legislate it all? As for drug access or availability, maybe you should look closer at your insurance materials. I’m certain you will find a “formulary” – a list of what drugs are covered by your insurance and which ones aren’t.

Argument against: Government runs slowly, it could take months to get anything done. How long does it take for the average health insurance reimbursement? How long does it take to go through the red tape with your insurance provider to have a procedure approved? Health insurance companies often delay processing claims and requests on purpose, hoping you’ll forget about it or get fed up and give up fighting so they can save money. And don’t forget that some insurance companies – even after approving a procedure – can change their mind and force you to pay after all.

Argument against: Slippery slope – the government will implement “sin” taxes or limit our personal freedoms. Health insurance companies already do this. People can be denied coverage for smoking or for being obese. And the government has already instituted taxes on cigarettes and alcohol. The thing is, if it’s legislature, citizens have the right to voice their concerns and vote against such measures – and elect officials who will vote no on those measures. If your health insurance company tells you that if you gain more than 10 pounds in a year they’ll drop your coverage, you don’t get to vote “no” on that.

Argument against: Soaring costs – with one system paying for everyone’s care, my taxes will go through the roof! Maybe. Maybe not. Remember that you elect officials who decide those tax issues. Unlike with private insurance, if your rates go up, you have no recourse (you can try to change plans, of course, but you are still at the mercy of the companies). With the government system, you do have a say in the rates and who decides those rates. And yes, consider that your current taxes for Medicaid, Medicare, and your private insurance premiums would then go away and become one single healthcare payment. And because the government officials are elected by you and represent you, if that cost is excessively prohibitive, you *do* have a say in getting it changed.

And let’s not forget my favorite argument, the one I hear constantly – “I don’t want to have to pay for other people’s care. They should have to take care of it themselves.” Well, sorry to break it to you, but you already ARE paying for other people’s care. Your taxes pay for Medicaid and Medicare. Your premiums go up every time someone else in your health insurance group incurs too much cost. You are already subsidizing other people’s care, period, both through the government AND through your health insurance company. Under this argument, at least with government-controlled care, you’re only getting screwed once instead of twice.

And those are just a selected few of the arguments. Almost every single one of the 15 reasons can be refuted with “it’s already happening (either in the private industry or government already)” or “if government controls it, citizens will at least have a say.” Opponents to government-run healthcare like to assume that the government acts as a “private” industry and that they can just institute rules and make decisions in a vacuum. Even though that is exactly what the health insurance companies are doing right now. The real argument is that the healthcare industry employs thousands of people, and those people don’t want to lose money, and politicians don’t want to lose campaign contributions. I’m sorry, but my healthcare is a heck of a lot more important than an insurance company fat cat’s greed. People also don’t want to be held responsible for their own choices and become active in government to help shape those healthcare policies. It’s easier to say you “have no choice, the insurance company does things their own way” than step up and take responsibility yourself. After all, if you don’t make your voice heard and Congress acts against your wishes, you only have yourself to blame. But if you do vote and Congress still acts against your wishes, you still have recourse to keep trying to change things.

I am suffering no delusions that there is a single “magical” answer to the problem. But I also know that the current system is not working. The CDC recently published a report on the increase of people without health insurance coverage. When the current system is not meeting our needs, and in many cases is abusing our freedoms already, we have no choice but to take action. We are guaranteed life by the Constitution. And our government is set up “by the people; for the people.” I think it’s high time the people started demanding what is their right and start taking care of it ourselves.


  1. We are guaranteed life by the Constitution.

    Speaking of the Constitution, where does the Constitution authorize Federal involvement in the healthcare industry? The Constitution gives us a government of limited and specified powers. Unless I missed something, I don't see healthcare policy listed as a delegated or enumerated power.

  2. That said, I do believe one of the roles of government should be to uphold the Constitution in providing – for all citizens – the basics of life, liberty, and the pursuit of happiness.

    That's actually from the Declaration of Independence, not the Constitution. Moreover, you're seriously stretching the definition of the right to life by insisting that somehow means the government is to *provide* the means by which we live. I find that ridiculous.

    By that logic, the government must guarantee every American food, water, shelter, and anything else necessary to live. Also by that logic, having the right to free speech means that the government must subsidize all of my ink pens, computers, paper, bumper stickers, and any other materials I use to express myself.

    In addition, when the Constitution speaks of a right to life, it is specifically pertaining to *limits* on government power--in this case, prohibiting the government from executing someone without due process. That hardly justifies the creation of a gigantic socialized medicine scheme.

  3. 1. Yes, "pursuit of happiness" is in the Declaration, but life is clearly outlined in the Constitution as quoted above.

    2. This is in support of a single-payer government healthcare system, not government intervention in the health insurance industry. I have no problem with a health insurance industry as separate from the basic right to medical care for all people.

    3. Incidently, the government not providing you with pens and paper in no way curtails your right to free speech. You can stand in front of Congress and freely speak all you like pens and paper not withstanding.

    4. My point is not that the government *provide* the means by which to live but rather to not *deny* me the right to live. In a private industry, no one can force a doctor to operate or stitch a wound or provide prescriptions that are necessary for life. If government had a healthcare system, no one could deny me care based on their own arbitrary rules - everyone gets treatment.

  4. 1. You still haven't addressed my main point regarding the right-to-life, namely the fact that the 5th and 14th amendments, respectively, are placing restrictions upon the government...not imposing an entitlement system. As President Obama himself acknowledged, the Constitution is a "charter of negative liberties."

    2. Regardless, the Constitution does not authorize Federal involvement in either healthcare or health insurance. There is no constitutional support for what you're proposing. Moreover, having a government-run healthcare system would mean the death of health insurance anyway.

    3. Similarly, no one is stopping you from being able to obtain healthcare or health insurance, whichever may be the case. Having a right to something doesn't mean getting a guaranteed entitlement to it. Rights and entitlements are two separate concepts.

    4. Why should the government be forcing doctors to treat certain individuals? Again, where is the Constitution authority? There is none. Consequently, this would also lead to the Federal government forcing doctors to perform abortions and engage in other controversial procedures. This also means that government would also have the power to force doctors *not* to treat certain individuals.

    And speaking of arbitrary rules, do you honestly believe that the Federal government wouldn't impose arbitrary rules? Anyone who has ever worked for the government knows how naive your statement really is. In my own experience, the Federal government is by far the most corrupt entity I've ever seen and they impose all kinds of arbitrary rules.