Domestic, Healthcare — May 4, 2012 at 2:11 am

Modest Proposal: Misdiagnosis

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Illustration by Allison Cohen

Paradigm shift. For most of us, the phrase is associated with scientific upheavals, but it is equally applicable to political discourse. Few modern issues have been so poorly discussed as President Obama’s flagship health care measure, the Patient Protection and Affordable Care Act (PPACA). The massive discrepancy between the debate over this bill and the facts of the American health care system is a testament to the sorry state of contemporary political discourse. Day and night, talking heads on every major news outlet have debated the entitlement culture being created and many have called upon any who will listen to “keep the government out of healthcare.”

Republican candidates for the presidency have been at the forefront of the movement to repeal PPACA. But Conservatives’ call to keep the government out of healthcare implies that it does not already play an integral role and existing statutes simply do not support this point of view. When asked about the number of people who die in America each year as a result of not having healthcare, former Senator Rick Santorum replied, “I reject that number completely, that people die in America because of lack of health insurance. People die in America because people die in America. And people make poor decisions with respect to their health and their healthcare. And they don’t go to the emergency room or they don’t go to the doctor when they need to.” Santorum recognized that emergency rooms are the de facto source of treatment for the uninsured, and this lays out the very problem that makes the PPACA necessary. So why was this line of questioning not pursued any further?

Simply put, political considerations have made honest speech infeasible. There were resounding  “Yeahs!” when Republican candidate Dr. Ron Paul implied he would allow a hypothetical 30-year-old man in a coma and without healthcare to die. The majority of the electorate, however, finds such sentiments callous. Paul replied, “I practiced medicine before Medicaid existed. …The churches took care of it. … I never turned anybody away who needed care.” Churches are charitable, but they are not insurance companies, and they have neither the means nor capacity to effectively pay for healthcare.  Doctors still will not and should not turn away anyone who needs urgent care, so it would seem that the government is the only institution left to undertake the task of insuring those without access to insurance elsewhere. The right to healthcare in America is implicitly recognized in the nation’s sacrosanct laws, its untouchable Medicare and Medicaid programs, and emergency room regulations that stipulate that no critical needs patient be turned away. Couple these commitments with the fact that hospitals are legally prohibited from serving patients with a bill exceeding 25 percent of their income, and it appears that the alternatives to providing health insurance are bankruptcy for the medical system or having taxpayers foot the bill for the uninsured. Ron Paul “the doctor” inadvertently made the same argument that Ron Paul “the presidential candidate” could not accept.

At the end of the day, election demographics pushed the candidates into such a pointless argument. Medicare is of paramount importance to the elderly, which is the GOP’s backbone. Meanwhile Democrats rely upon enticing the poor and working classes through social services and a safety net, of which Medicaid is the cornerstone. Rhetoric aside, there is absolutely no way these programs will disappear anytime soon, and neither will the implicit right to healthcare recognized within them.

The lack of universal healthcare is also philosophically problematic. From the New Deal, when FDR interpreted the Constitution’s promise to “promote the general welfare” to mean a basic level of social security, to LBJ’s Great Society, which set out to give the phrase “equal rights” true meaning, American political philosophy has come to recognize that entitlements are increasingly akin to rights. Furthermore, do we as a society really want to implicitly condone a system in which those who cannot get private insurance but are too wealthy for government aid face de facto, if not de jure, obstacles to political and societal participation? After all, how can one access their political and civil rights if they are incapacitated by illness? Would allowing those who cannot pay for treatment to be debilitated by sickness be akin to imposing a minimum income level for full participation in society? What good is freedom of press to a journalist who cannot hold a pen because of her untreated arthritis? As much as Mitt Romney was maligned for saying he did “not care about the poor – we have a safety net there,” his argument carries weight. Medicare, for all its inefficiencies, provides minimum care for those below the poverty line, but what about all those – ostensibly part of the middle class – who have to gamble on the chance that their child will not get sick this year in order to pay for school supplies?

Yet both parties must recognize that deciding who pays for healthcare is only the first step in making it affordable. According to the Pew Center, the National Health Institute, and the much-vaunted faculty known as “common sense,” having everyone insured will save taxpayer money. Emergency room services are overused and are more expensive than preventive treatment and regular check-ups can allow doctors to diagnose and treat diseases earlier, lowering costs by heading off developing ailments. Many Democrats are also guilty of poor reasoning in this debate. The individual mandate is necessary, given the nature of healthcare, yet the paltry penalty to skirt the mandate of $750 or two percent of income, whichever is greater, makes it largely irrelevant to its target population: middle-class singles in their twenties who think they are invincible. The minimum plan required under PPACA costs $3000. Those invincible young people will probably pay the penalty and skip going to the dentist for a few years.

Even Timothy Goodman, a prominent philosopher who finds the idea of a right to healthcare anathema, suggested in 2005 that the health insurance market is marked “by information gaps, monopoly suppliers, unequal bargaining power, and other deficiencies that are far less prevalent in markets for other consumer goods and services.” In other words, the average citizen is largely unaware of the intricacies that make the healthcare market incapable of governing itself in a traditional laissez-faire way. However, she still recognizes that health insurance is something that is fundamentally necessary for Americans’ financial security and peace of mind. At this point, when trying to negotiate a policy, what leverage does a person have? Thus, the government should step in to balance the negotiations, as the only entity capable of doing so. It is from a refusal to recognize this point that most misguided attacks stem.

Such attacks are not limited to philosophers; even the United States Supreme Court seems mired in a framework that treats healthcare like any other service. Although the majority of the Court’s deliberations in early April concerned the means utilized by the bill rather than its goal, the initial day of questioning betrayed this fundamental misunderstanding. Chief Justice John Roberts asked the solicitor general whether the government could “make you buy a cell phone.”  Unlike cell phone companies, insurance explicitly relies on the majority of people not utilizing it fully. If everyone with an insurance policy had regular surgery and monthly doctor’s visits, insurance companies would never turn a profit. Hence, insurance companies have an incentive to institute caps on coverage or turn away those with preexisting conditions. Having outlawed these practices, the system requires more individuals to pay into it, especially healthy individuals unlikely to need more than a check-up every year. The necessity of the individual mandate is evident: to prevent individuals from playing a constant game of Russian roulette with taxpayer money as their only protection in those cases where disease does strike suddenly.

So let us move beyond empty platitudes and tackle the true controversies. Let us question whether Medicare should be means-tested, whether one should have to work in order to receive Medicaid, and whether those who make poor lifestyle choices should be penalized for them. The health care system, as it stands now, is just as sick as the people it is tasked to protect. Treatment must come not in the form of panacea pills, but rather painstaking surgery to remove unnecessary, cancerous growth. We must recognize that money is the lifeblood of the system and must channel its flow productively. Before we can accomplish any of this, we need our leaders to debate the issue substantively, which may be the most difficult task of all.

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2 Comments

  1. Hi Lallo,
    I really enjoyed the in-depth debate in respect to health care. Ultimately, such a pivotal issue should be seriously discussed without political bias. It is embarrassing that a country like the states up-to-date failed to come up with an effective applicable and affordable plan for its low-income population. Keep up such trend of participation and contribution.
    Dad & Mom

  2. Your analysis of the ongoing healthcare debate is perhaps the most helpful one I’ve seen since Obama launched his initiative. It’s succinct yet even-handed, and it highlights the unrealistic premises and approaches of each side. I hope you write more on this and other issues. We need more opinion writing of this kind.

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