Terry H. Schwadron
Sept. 21, 2019
What made the recent Democratic debate version of pitting Medicare for All against improvements in the Affordable Care Act so uncomfortable was not only the endless citing of statistics but a sense that the participants have lost any perspective on what they all — what we all — want.
Put simply, this issue may require a discussion about insurance policies and taxes and provisions x, y and z, but at heart this was once again a discussion about money, and not Health.
And it’s not even that these Democrats appeared to be at one another’s throats, it’s that this debate format is the least best place to take apart and reassemble a complex instrument meant to address a sixth of the U.S. economy. So, to simply for voters, we end up throwing mottos and slogans at one another, just as Republicans do with the opposite conclusions.
Of all the statements thrown around the other night, there were only a few that matter.
Health is a human right.That’s something that Barack Obama believed, and lots of people before him, it’s what Bernie Sanders and Elizabeth Warren are braying about, and what Joe Biden says he is trying to improve. In fact, every Democrat seems to accept this notion, as do most Americans, except Republican leaders who think health is subordinate to the question of who needs to pay for it.
Okay, let’s go there. Before you can get your driver’s license, you must show proof of insurance in most if not all states. Before you take a loan, you have to show you can repay it. Before you go to the hospital, you have to sign financial responsibility statements, with or without insurance.
So we’re arguing about people who cannot afford health care, whether through employers, unions, or government programs. It’s a legit argument, but we ought to recognize that this isn’s health. This is health finance — and only the pay side of that question.
There is little discussion about the price of the most expensive programs. That might require telling companies and providers, like hospitals, how much they can charge.
Private insurance, which necessarily is out to make money, does say no too much before agreeing to cover what they said they would cover. Deductions are too much, and too variable. Health insurance is unfairly applied by private companies over rural areas, for women, among people with preexisting conditions and the like.
If you want to defend a private insurance approach, you must accept the idea that these insurers need close regulation and enforcement. If you want an employer-based insurance system, then you must closely regulate and enforce access to the full range of medical services, and not pick and choose which ones, for example, meet individual religious desires.
Elizabeth Warren was correct. No one loves his insurance company.
A lot of health care costs little but some of it is really expensive. If our politicians were serious about health outcomes rather than who pays for health access, you would have to have a lot more attention and government action like the vaping decision that came out this week. What? The government is telling private businesses that they cannot distribute e-cigarettes and vaping devices that clearly will put young people at risk? This has been considered outrageous behavior by governments.
Compared with expensive hospitalizations and surgeries, underwriting clinic visits and the support of health stations in rural, inner-city and other expensive health areas would bring down the cost of health altogether, making it easier to deal with the problem as a whole.
The debate the other night made no mentions of wellness visits, neo-natal visits, diet-conscious moves, support for better food choices for the poor or a wealth of other marketplace improvements. How do you think the audience would react if the government capped the number of McDonald’s burgers? Before you answer, look at the arguments over consumption of sugared sodas.
Looking more widely, where is the concern about clean waters in Flint, Michigan, Newark and a hundred other cities trying to deal with leaded pipes now rusting. Where is the concern about housing costs, a statistically significant factor in public health? For that matter, where is the concern about guns and violence in any real sense that connects to public health?
Go, candidates, have a ball with near-meaningless differences in legislation that at this moment is generously aspirational, but hardly the stuff that Senate Minority Leader Mitch McConnell will even put on the floor for a vote.
But don’t think that you’re getting to a real vote on health.