If there was an easy answer to any of this, we would have found it by now.
As this discussion demonstrates, people tend to have one of two viewpoints: either healthcare is a "right" and we should find a way to provide it for everyone, or healthcare is a service and each person should have individual responsibility for ensuring that they have it, with some sort of a safety net for those that can't.
The people who advocate for the healthcare right tend to stress:
- That this is simply the "right" thing to do, and we shouldn't as a society watch people become ill or die because they can't afford healthcare.
- That there is a public good to providing healthcare -- preventing others from getting infectious illnesses, or preventing someone from having a seizure and crashing their car into you, etc.
- That providing healthcare to everyone is ultimately cheaper in the long run, since treating illnesses in later stages is more expensive.
Of course, none of these points is absolutely valid, as:
- If we have a functioning safety net, those who are unable to provide their own healthcare will get it. This is the way we provide food, shelter, and clothing to people in the US.
- The public good of healthcare for all is overstated. Yes, infection control is important and that should be addressed by the government. Other than communicable diseases, treating other people's health usually will not influence your own health.
- The thought that early treatment will save money is highly flawed. First, it is true that treating illnesses early is cheaper than treating them later. However, since you usually need to treat lots of people to prevent a single bad outcome, it ends up being more expensive to do so unless the "treatment" is very cheap and effective (Colonoscopies to prevent colon cancer are a good example. It seems clear that doing colonoscopies over the age of 50 prevents colon cancer. However, the cost of all of those colonoscopies is much higher than the cost of treating the cancers, since very few people actually get colon cancer). Plus, if you save someone's life from something, it actually costs the system more in the future, when they get ill from something else. Likewise, the thought that treating people will generate more $$$ in the economy from a healthier workforce is questionable.
On the other side, some people have the viewpoint that healthcare should be a service. They usually focus on:
- Making people financially responsible for their healthcare will promote better expenditure of health care dollars.
- Competing services usually drive down prices and drive up quality. The Apple / Microsoft battle is a classic example.
- The government usually screws things up, because of political pressures and special interests. Healthcare will be no different if the gov't gets more involved.
Of course, all of these arguments have flaws also:
- Given the current state of healthcare, much of it is unaffordable for most Americans.
- Competition in the health care market is largely illusionary. It's very difficult to measure "quality" in health care. Most people will not be able to compare hospitals / physicians / etc. In emergencies, people will certainly not have time to find the "best deal".
- Although gov't involvement with some processes does distort the market, when providing a valuable service to the entire population, it may be the best choice.
So what's the answer? There is no "correct" answer. We can try to continue with our current plan of private insurance for those less than 65, and public insurance for those above 65. We can try to create legislation to cover more people, like the ACA. We could move to a universal health care system. All of these result in the same outcome -- those that currently pay for their health care coverage will pay more to cover the new costs.
Or, we can try to "spend less and get more". That sounds nice, but it's much harder to do. Spending less means that someone's going to make less money, or there's going to be less jobs, or that some element of health care will be "denied" to a patient. Although people talk about wasted health care resources, other than true medicare / insurance fraud, it's hard to decide what care really isn't needed. Many of the people giving / getting "unneeded" care would argue that it was fully justified.
Regardless of which direction this country heads, health care spending is a big problem. I don't believe that a single payer system itself will really decrease costs, nor do I think that a high deductible / catastrophic policy for all with increased price competition for healthcare dollars will decrease costs either. And, whenever you start talking about decreasing costs, everyone in health care points to someone else. Docs say that hospitals / testing costs are too high. Hospitals point to insurance company profits. Insurance companies point to medmal payments, and they also blame patients for demanding everything. The honest truth is that everyone is likely to take a payment haircut somewhere in the future, and the only question is how big of a cut it's going to be, and how it's going to happen.
