Universal Health Care Issues -- and a Congress in Default

Some basic health care principles:

1. If there is a public government health-care option, assuring universal coverage, it will be cheaper than private insurance. Private companies exist to make profits so the owners can pay their food bills and rent. A government agency can exist on a permanent-losing-money basis because, no matter how much money the agency loses, the Government always picks up the tab either by taxing more or printing more money. Compare the Post Office and Fed Ex.

2. Because the Government plan will be cheaper than the private plans, private plans will be driven out of business. Private citizens will opt for the cheaper plan. Companies, knowing that a cheap public plan is available, will stop insuring their employees.

3. In short order, private insurers will be driven out of business. At that point, with a monopoly, Government insurance will become the health equivalent of the Post Office. Lines will get increasingly longer. Service will get increasingly shoddy. The best doctors will try avoiding patients on Government coverage, offering services on private bases.

4. As the demands for health care increase, resources will be strained, and the Government will need to cut back. Sit in a Post Office with six teller windows, and note that four are closed. Think back to the 4-cent stamp and contemplate the 44-cent stamp, even as the Post Office continues to lose a fortune. The reason that Britain and Canada have long lines and long delays in treatment is that the Governments lose control of costs and soon respond by cutting back in ways that make sense only to bureaucrats in Washington.

5. Now when you need an immunization, you go for immunization. Once the Government assumes full control of American health care, Government guidelines inevitably will be drawn to prioritize whether you may get an immunization before someone else. Expect guidelines that define "epidemic" to limit access to certain immunizations until a certain epidemiological number is reached. Thus, in the case of a Hepatitis A outbreak, gamma globulin immunization may be expected to be restricted until a minimum number of residents in a community have been stricken.

6. Universal care will take away from doctors an aspect of the motive to provide excellence. Private doctors vie for paying patients with reasonable health plans. By contrast, many gatekeepers on several of the HMOs take what they can get, compromise on fine points of quality care, live off capitation fees that pay them based on the number of heads they treat each day, and consequently drop all pretenses of bedside manner.

7. Under Government care, it will become profoundly difficult to see specialists, as money will be conserved by forcing patients initially to see lesser specialized "Gatekeepers" who will lose money by referring out, so will insist on personally treating symptoms that best would be treated by specialists. Instead of one visit to a dermatologist for a proper acne treatment regimen, then, a patient will need to first go through the time waste, inefficiency, and delay of being treated by a general Gatekeeper less experienced with specialized treatment.

8. Of the 47 million uninsured Americans, only 5 million actually need a fix in the current system. More than 10 million others are illegal aliens. Others can afford health care but opt, for their own reasons, to spend the insurance premiums instead on other items like cars, vacations, clothes, etc. For them it is a matter of choice, not desperation.

9. Any effort aimed at truly cutting health care costs would include, among its range of proposals, a proposal to reform Medical Malpractice Tort Litigation. Such litigation is often important, aimed at catching up with doctors who have malpracticed. However, such cases are few and far between. The vast majority are crap-shoot cases, in which an attorney takes case on contingency -- meaning that the client has nothing to lose in attorneys' fees -- and sometimes wins and sometimes loses. Often, malpractice insurers force weak cases to settle, even as their medical-doctor clients beg for a full defense at trial. These cases cost a fortune in litigation costs, even when plaintiffs lose, and doctors who are sued get penalized with huge increases in their malpractice premiums. Therefore, to avoid litigation at all costs -- literally, at all costs -- doctors tie up their patients and increase health costs exponentially by ordering ranges of unnecessary lab tests. The lab tests are costly, but they help the doctor establish for the disappointed patient that he was thorough. Moreover, costs are compounded by the tens of millions that doctors need to spend each year on malpractice premiums, costs that they shift to the consumer. There must be tort reform, and the failure to seek tort reform in the midst of a 1,017-page bill demonstrates that the Government is not seeking to save money.

10. It is a fallacy that increased funding for "prevention" will save money. Prevention is important, and it is necessary medicine. Doctors do it and should do it, but the reality to face is that prevention costs more money than it saves. Although prevention saves a rare patient from a costly illness and treatment regimen - a wonderful result that justifies prevention medicine -- the reality is that the cost entailed in applying the same prevention efforts for the many hundreds others who never would have contracted that disease anyway more-than-offsets savings. Yes, prevention still is important. It is costly but a worthwhile societal cost. However, no one should claim falsely that prevention saves money.

11. It is a falsehood that a doctor would rather evade prevention -- a low-income process for the doctor -- so that he ultimately can have the opportunity to make big money by amputating a diabetic's foot or removing a child's tonsils. We have doctors, and we know that such allegations simply are demagoguery. A doctor does not receive $30,000 for amputating a foot, but less than $750. Nor do doctors, sworn to uphold the values of Hippocrates, practice such vicious medicine.

12. There are two bona fide problems with the current health-care system. First, portability: a person who leaves a job loses his coverage. This quirky phenomenon forces people to work at jobs they hate because they risk losing their health coverage. Moreover, those who do lose their jobs, as has been so prevalent during this downturn, lose their coverage. If, G-d forbid, they contract a disease during the interregnum of non-coverage, then they cannot later get insurance privately as individuals because they are barred for "pre-existing conditions." Congress needs to resolve the portability and "pre-existing conditions" issues. On the one hand, insurers would be hurt financially by being forced to insure people with "pre-existing conditions." On the other hand, large corporations with many dozens of workers, typically provide health coverage for all employees without regard to pre-existing conditions. That is because their employee health pool is sufficiently large to offset anomalies. Congress should be able to craft a system or fix that pools enough private individuals in a way that somehow addresses these two issues.

13. At least two states have attempted Obama-style universal health care: Tennessee and Massachusetts. Both programs began with great promise -- they would provide universal care, keep costs down, and prove societal boons. Instead, both have emerged as unmitigated disasters, with costs skyrocketing and the states forced into heavier debt as a result. In both states, as the programs have fizzled, predictions of cost savings have fizzled, and care has been rationed.

14. Obama may not intentionally be planning to pull the plug on Granny, but his plan ultimately will do just that. As funds disappear, public health care skyrockets in cost, resources become more scarce, demand builds, there will be efforts to find cost savings. People needing surgeries that are adjudged non-essential -- say, a person with a painful knee who wishes a meniscus operation -- will be compelled to wait longer than conceivable, offered pain killers during the extended interregnum. And octogenarians needing hip replacements will be evaluated not as people but as expenses: "Is it a worthwhile expense to replace the hip of someone with a life expectancy of X years?" That is British and Canadian, but that is not the way that America values its citizens.

15. The most disheartening aspect of the public debate on universal health care is the revelation, most artfully stated by Rep. John Dingell of Michigan, that he parcels out to others the responsibility to read the legislation on which he will vote. It is disheartening that legislators would vote on a 1,017-page bill without reading the bill and understanding every provision. They did this with a stimulus bill that they passed on a short fuse, told falsely that they needed to pass it immediately because shovel-ready projects were awaiting cash infusions to begin. So they voted to spend $780 billion -- and only ten percent of the funds have been spent, lo these six months later. Similarly, the Democrats in Congress rushed through a terribly complex and ill-advised "Cap and Trade" bill that really is a "Home Heating Tax Raise for the Middle Class." State utility companies will be compelled to reduce emissions at such staggering rates that they necessarily will need to spend fortunes on infrastructure modifications -- all of which will be passed along to the end consumers. This project, an insane initiative at a time when the country cannot afford the luxury of turning the economy upside-down on a theory of Global Warming, will force enormous increases in our electric and gas bills . . . and in bills for all other commodities that use electric or gas: food, clothes, everything. It emerges as remarkable that the Democrats of the House voted for such a massive bill, so massive an infrastructure overhaul, without reading its provisions either. They were elected to do a job, and they have proceeded with malfeasance and recklessness, voting to approve the most extraordinary expansions of the American debt burden in our history -- without even reading the bills they approve.