Eventually

Eugene Robinson, at WaPo, contends eventually healthcare has to change:

Eventually, however, our health-care system will be restructured. It has to be. The current fee-for-service paradigm, with doctors and hospitals being paid through for-profit insurance companies, is needlessly inefficient and ruinously expensive.

When people talk about out-of-control government spending, they’re really talking about rising medical costs that far outpace any conceivable rate of economic growth. The conservative solution — shift those costs to the consumer — is no solution at all.

Our only choice is to try to hold the costs down. President Obama tried to make a start with a modest approach that works through the current system. If this doesn’t pass constitutional muster, the obvious alternative is to emulate other industrialized nations that deliver equal or better health-care outcomes for half the cost.

I’m talking about a single-payer health-care system. If the Supreme Court strikes down Obamacare, a single-payer system will go from being politically impossible to being, in the long run, fiscally inevitable.

 

About Scot McKnight

Scot McKnight is a recognized authority on the New Testament, early Christianity, and the historical Jesus. McKnight, author of more than forty books, is the Professor of New Testament at Northern Seminary in Lombard, IL.

  • David Himes

    Well, I am mildly amused that there is anything I agree with Eugene Robinson about … but it is only that there will be changes in our health care system. A single payer system is not fiscally inevitable. And a government-run solution does not solve the fiscal problems of the system.

    I spoke last weekend with a friend who is EVP of a medium-sized health care system in New Hampshire. He reports there are many changes already underway in health care … without any additional government involvement. For example, 60% of MDs are now salaried employees, up from 10% in the 1990s. And there is increasing pressure from within the health care community to counsel the families of patients, regarding end-of-life care, which is a bigger burden on the system than the uninsured.

    My friends views were echoed in a story today, also in the Washington Post, which interviewed the CEO of the Cleveland Clinic.

    Ultimately, market forces will do a better job of fixing the health care system than the government. Everything the government does causes the cost of care or the cost of insurance, or both, to increase. The less the government is involved, the more likely it is the market will develop a solution. It always has.

  • Kyle J

    @David

    Can you cite empirical evidence for those statements?

    Medicare cost growth has been below that of private health insurance.

    Every other industrialized country pays mich less for health care, with equal or better health outcomes.

    Free market ideology runs into a wall when it comes to health care. Will never be a normal consumer market due it’s inherent nature.

  • Just Sayin’

    Sooner or later your country will have to join the rest of the developed world and create a national healthcare scheme to which all citizens have access.

    Then again, with the sort of political paralysis built into your non-parliamentary political system, maybe not.

  • Fish

    I am an engineer and I stand on facts, not theory. Political theory says that the market will fix health care. The facts say single-payer is the way to go.

    You cannot show me a system anywhere in the world where the market has produced a quality health care system. I can show you country after country after country where single-payer has worked, and worked well.

    It’s simple: the output of a for-profit health care system is first and foremost profit, not health.

    We have the most profitable system in the world, true, but all that means is that I pay more for less health care than in any other developed nation.

    It’s redistribution of wealth by government, masquerading as freedom.

  • http://LostCodex.com DRT

    David Himes, I too would like something to back up what you are saying. Your thoughts do not pass any sort of sniff test.

    Now if you are to assume that you want people who make more money to get better care, then you may be right. But is that what you are thinking?

    This requires a strategic solution and our government sucks at strategic anything. That’s the problem. We cannot increment our way to better health care, we need to look at what the desired end state needs to be, and then do what is necessary to get there from here.

    Just make me dictator for a day..

  • http://restoringsoul.blogspot.com Ann F-R

    Fish, I’d quibble a bit w/ your last sentence, although I agree w/ the rest of your comment, if I read it correctly as a disagreement w/ David #1′s last paragraph which is completely unsubstantiated, as far as any info I’ve ever seen. (Given that the MD’s in my family have long been involved in trying to reform health care equitably for all, I’ve seen a LOT of info & stats!)

    Regarding your last sentence, I’d say that the current system is a redistribution of wealth by the most wealthy and powerful capitalists, unchecked by the government.

    David #1, you said this: Ultimately, market forces will do a better job of fixing the health care system than the government. Everything the government does causes the cost of care or the cost of insurance, or both, to increase. The less the government is involved, the more likely it is the market will develop a solution. It always has. This is false, always has been and always will be, due to human sin and the resultant abusive wielding of power. Behavioral economics verifies the statistically observable reality that “market forces” have no moral neutrality, but in fact are easily manipulated by deep-pocketed & tech-connected insiders to their own benefit.

  • Fred

    So far it’s five against one, all demanding “empirical evidence” of some sort or another. I don’t see, though, any of the five providing any evidence themselves.

    Ann, I would agree with this statement:
    “due to human sin and the resultant abusive wielding of power.”

    But, show me any system unaffected by human sin.

  • seth c

    Market forces in general in the long term usually balance out. This is proven by financial economics. The issue for most policy makers and econmists is that the market isn’t moving fast enough sometimes and so policy is amended to speed it up in some manner.

  • http://redemptivethoughts.com John H.Guthrie

    The only reason Obama pushed the mandate instead of a single payer system is because the single payer option is not politically feasible. If the Supreme Court strikes down the mandate, liberals will push for a single payer system, which will cause opposition to government run health care to increase even more. According to the Congressional Budget Office, between 3 and 4 million workers will lose their employee insurance plans under Obama’s mandate http://cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf , which is, of course, contrary to Obama’s promise that workers will continue to choose the insurance plan that is best for them http://winteryknight.wordpress.com/2012/03/14/cbo-report-four-million-will-lose-health-care-coverage-due-to-obamacare/ . The Congressional Budget Office has also raised its estimation of the cost of Obamacare from 940 billion to 1.76 trillion. So much for Obama’s “modest approach.” Under a single payer plan, the cost will even be higher, which will cause even more opposition than has been generated by Obama’s mandate. And considering that it has now been revealed that under Obama’s plan, everyone will be required to pay $1.00 every payment for abortions, no Christian can with any conscience support it http://www.geneveith.com/2012/03/14/obamacare-will-cover-abortions-for-1-premiums/ . As a person who has a pre-existing condition who doesn’t want the public’s money paying for my health care and who doesn’t want some government bureaucrat deciding whether I am worth saving, I welcome a possible strike down of the mandate by the Court.

  • http://redemptivethoughts.com John H.Guthrie

    I neglected to provide the link to the story on Obamacare’s $1.76 trillion price tag, here it is: http://voices.yahoo.com/obamacare-estimate-rises-176-trillion-11097952.html?cat=9

  • bcmd

    @ Kyle J and others:

    The government keeps Medicare costs down by paying a fraction of what time and resources actually cost the physician, or by refusing to pay for needed services, forcing physicians and hospitals to pay for them out of their own pocket (believe me this often happens).

    The government also has the power to periodically shut off the cash flow without explanation. Physicians sometimes have to wait for weeks for Medicare payments to arrive, while they still have to pay their clinic staff and meet their other expenses.

    In fact, if it weren’t for cash payments and for-profit insurance companies, private physicians could not stay in business; those entities provide financial buffer which allows physicians to treat Medicaid and Medicare patients at the reduced rates the government offers.

    Based on my experience, I do not trust the government to administer a single-payer system. On the other hand, there are new phenomena such as interfaith or church-based sliding-scale clinics and cash-only zero-overhead micro-practices which are able to provide health care at significantly reduced rates without authoritarian government control.

    Some of you might find this interesting:
    http://www.patmosemergiclinic.com/
    (I have no affiliation with them).

  • bcmd

    @Just Sayin’

    Our non-parliamentary political system was designed to *create* paralysis, to prevent the rise of dictators who feel they could solve all the problems of our country in one day, if they only had the power.

    It’s not a bug, it’s a feature. ;-)

  • Diane

    What frightens me is that a humane health care system is not inevitable. A friend who lived in Kenya told about how people without money would be left to die on emergency room floors while nurses stepped over them. I would hope our country is not so inhumane as to adopt that system–but I worry that it might and do so self-righteously–after all the poor got that way through their own fault, right?

    The answer is single payer–but huge vested interests would lose huge profits–and people who are rich would have to subsidize people who are poor, both difficult in the current political climate. I hope we don’t continue to repeat the caricature that gov’t can do nothing well or efficiently.

  • bcmd

    @Fish

    Facts “say” nothing. We collect facts and spin theories to explain them. You look at the fact that there are many countries where single-payer seems to work and theorize that single-payer is therefore the inevitable solution for our country. I think your interpretation of the facts is a bit simplistic.

    I also think you are confusing the health care market with a “Health Care System,” and their respective purposes.

    The health care market was never “designed” to create a system. It was never in fact “designed” at all. It came into being when one man needed a rotten tooth pulled and paid another man to do it. The man that pulled the tooth said, “I wouldn’t mind doing this full-time,” and here we are.

    But what does the market exist for? To allow for the voluntary exchange of goods and service in order to create wealth. Wealth, in turn, leads to the development of life-saving and life-extending medications, as well as amazing new health technologies like MRI machines. It also leads to intelligent and talented people seeking lucrative careers as physicians, instead of as investment bankers.

    A “Health Care System,” on the other hand, is something a government imposes on a market, allowing the government to control the market.

    Can the government seize control of the assets created by the market and redistribute them to all mankind by force? Yes. Can they do it more efficiently via central control? Yes, if you are willing to pay the cost in liberty (if the government controls your health care, they control your health, and they ultimately control *you*).

    But can the government, even as all-knowing and all-wise as it is, engineer a system capable of creating wealth, attracting young people to the practice of medicine, and driving the production of new drugs and health technologies?

    I am skeptical.

  • bcmd

    @Diane

    We do not have single-payer now, and yet today those without the means to pay are seen all day long in clean, modern emergency rooms, often with very minor complaints.

    We do not look at their demographic sheets, note that they are “Self Pay” and kick them to the curb. We treat them the same as anybody else: full blood testing, IV drugs, CT scans, whatever is indicated.

    In fact, the “rich” are subsidizing the “poor” already. All of the above services are, in effect, purchased for the “poor” by other patients who have private insurance, Medicare and Medicaid. Basically, the “rich” pay for their own private insurance, then they turn around and pay for other people’s Medicare and Medicaid through the taxes they pay. All of these payments then cover the cost of those with no means of paying,

    So, if the “rich” are currently buying excellent health care for the “poor,” then why do we need single-payer?

    (I put “rich” and “poor” in quotes to highlight that we are talking about a spectrum of people here, not just stereotypes. Also, I understand there are other layers to this argument. I am just attempting to peek past this first, most superficial layer).

  • TJJ

    There is no real debate that we need healthcare reform. The problem with Obamacare was/is twofold: the sleezy and extremely partisian manner in which it was done, and the individual mandate, which even Obama himself opposed when he ran for president. If done in smaller, bipartisan chunks, it can get done.

  • bcmd

    @Diane

    Not picking on you here, but I did want to say a couple of words about the “poor.”

    First of all, anyone who works with the “poor” understands that — very often — the poor DID get that way through their own fault (though there are certainly exceptions), and stay there through their own continued faulty decisions.

    Now, I don’t believe that disqualifies them from assistance; not in the least! We should extend mercy to them as Christ has extended mercy to us! Nevertheless, we should avoid a sentimental and patronizing view of the poor.

    The next thing we need to understand is that the people who have made themselves poor are often the hardest people to help, because they simply don’t want to change. They want to keep on repeating the same disastrous patterns that made them poor to begin with.

    Now, I say this with great empathy, because I recognize that same perverse pattern within myself. How often do I resist my conscience and repeat the same sins repeatedly?

    But here is the point: the poor we will always have with us. Always. No matter how much assistance we give them, we will eventually reach a point of diminishing returns. It is great to think of “our tax dollars helping the poor,” but let me tell you, at some point of assistance, people begin to buy booze instead of baby food, and STD educational tracts are used to roll reefers.

    Helping the poor requires wisdom, as well as compassion. Some of you seem to think that single-payer is a quick fix, but there is no such thing as a “quick fix” for the health problems of the poor.

    I offer those who are interested a stimulating read about how these issues have played themselves out in England, whose excellent (I am sure) parliamentary system has given them a single-payer health care system which (I am sure) must be the envy of the nations. It directly bears upon the issues that Diane and I are discussing.

    http://www.city-journal.org/html/9_2_oh_to_be.html

    Be warned: a couple of bad words are quoted.

  • joey

    1) The majority (the MAJORITY!) of health care dollars are spent in the last six months of life. As a physician, I see this truth played out daily in my practice. But no politician is talking about this fact. Nor will they.
    2) Our government spends more money than it receives. And its single, largest expense is health care. This cannot be sustained.

  • http://www.thefaithlog.com Jeff Doles

    “due to human sin and the resultant abusive wielding of power.”

    Seems to me, that is a good argument for NOT concentrating the power for health care coverage in the hands of the government.

  • Diane

    The government has a done a wonderful job administering Social Security. When allowed to do so, our gov’t works quite efficiently–our highways run, our census is taken, etc etc. If gov’t is not working, we need to get behind it and figure out why. We are citizens–this is our country.

  • scotmcknight

    Diane, that’s such a simple clear statement. Thank you.

  • http://restoringsoul.blogspot.com Ann F-R

    Joey, 18, yes, I worked in hospice care. Too many people had had too few conversations (politically named, “death panels”) about end of life issues.

    Seth C, #8, show me the economics, please. Market forces in general in the long term usually balance out. This is proven by financial economics. The issue for most policy makers and econmists is that the market isn’t moving fast enough sometimes and so policy is amended to speed it up in some manner. I’ll answer this remarkable assertion with economics, as soon as you show economics underlying the statement.

    Fred #7, and Jeff Doles #19, the greatest concentration of power in this country resides in money, rather than in the government, per se. Money is overriding voting rights. Monied interests are working quite successfully, right now, to override what is best for the majority of people. The problem is that government regulation of health care, which does reduce prices by group negotiation of pricing, is being stymied by pharmaceutical companies (if you need to assess their money, check the # of pharma commercials in prime time TV slots vs. any other industry), insurance companies and tangential providers. As my cousin, a medical director of multiple health clinics, has put it, “why would you imagine that health care isn’t already being rationed inappropriately & inequitably by private insurance companies? You trust human greed in the profit motive more than a government we can hold accountable? Why?”

  • http://restoringsoul.blogspot.com Ann F-R

    Fred, for empirical data, cf.
    http://ndt.oxfordjournals.org/content/14/suppl_6/3.full.pdf
    http://healthcare-economist.com/2011/09/22/is-international-healthcare-spending-converging/
    http://www.pnhp.org/

    The WHO and the CIA both have databases that you can use to confirm health care spending, per capita costs, quality of care (health outcomes, etc.). The facts have revealed that we pay more per capita and have worse health outcomes than other nationally managed systems – whether single payer or mixes of private/public providers.

  • http://restoringsoul.blogspot.com Ann F-R

    YAY, Diane, #20 – if the government weren’t “we, the people” then we would be wise to be concerned. That said, we should be concerned that so much money is being spent to circumscribe & undermine the ability of many Americans to vote.

  • http://restoringsoul.blogspot.com Ann F-R

    bcmd, #17, I think it was Scot who linked this article about the psychology of being poor and its affect on economic decisions (i.e., behavioral economics) in a recent Weekly Meanderings: http://www.haaretz.com/business/the-psychological-poverty-trap-1.414260 I’ve studied it alongside a recent article which explores the sociology of poverty and a philosophical observation of rich enclaves which uncomfortably resembles the behavior of poor people in their neighborhoods. Providing health care does not give money to the poor to buy drugs, alcohol or cigarettes. NOT providing access to health care for the poor perpetuates the cycle of despair, hopelessness & the looming sense that everything is outside their control or hope, in most people.

    I have no idea where you get the impression that the rich in this country are “buying excellent health care for the poor”. This is far from the statistical truth. The poor may have access to emergency rooms, but that is ridiculously wasteful and doesn’t provide primary care and preventative care needs.

  • bcmd

    @Ann F-R

    I emphatically did NOT say that providing health care gives money to the poor to buy drugs, alcohol or cigarettes. I was making a larger point. Please re-read that post.

    I emphatically DO say that free health care is NOT sufficient to break the cycle of despair, hopelessness and helplessness in many people’s lives, and the Dalrymple article I linked to illustrates this phenomenon. It’s just not that simple. The article is not pleasant to read, but it rings true to anyone who actually tries to take care of the poor on a day-to-day basis. Read it to the end.

    As for my statement about “rich” people buying excellent health care for the “poor,” this is demonstrably true, within the context I outlined. Americans with higher incomes purchase private insurance for themselves, and then their taxes purchase Medicare and Medicaid for those with lower incomes. Private insurance, Medicare and Medicaid payments allow hospitals, in turn, to thrive to such an extent that they are able to provide excellent ER and hospital care even to people who are unable to pay anything.

    Is this the best way to provide health care to those who are unable to pay? Possibly not, but I never said it was. I only wished to reassure Diane that the poor and dying are not being stepped over in our emergency departments, despite our present lack of a single-payer health care system. They are being provided for via the largesse of the rich.

    My remarks were limited to emergency room visits and hospital care, because that was the context of Diane’s post. However, since you bring it up, something similar can be said regarding clinic visits. As I stated in a previous post, higher reimbursement rates from private insurance enable clinics to accept low and slow reimbursement from Medicare and Medicaid. As it stands, many physicians have stopped accepting Medicare and many more are threatening to do so. What makes you think that the government will start paying a fair rate in a timely manner when physicians have no choice about whether to accept unfair treatment?

    Your points about the wastefulness of the current state of affairs, and the lack of primary care and preventative care is well-taken. I was thinking of those issues when I said: “I understand there are other layers to this argument.” However, do you really believe that government-run health care is the best means of eliminating waste? Google “government waste.” X-D

    Incidentally, I read the article by Schecter that you linked to (thanks!). His findings may explain some of my observations (and those of Dalrymple) but they do not negate them.

  • bcmd

    I would like to encourage anyone who feels a special burden for the health of the poor — physical or spiritual — to consider volunteering at a local Community Sponsored Clnic.

    These are private non-profit clinics that provide free- or low-cost services to uninsured or under-insured patients. They are primarily funded by philanthropic and community financial support, and are often supported by volunteer clinicians.

    Volunteer work is one of the purest expressions of love for the poor that one can offer, in my opinion. It gives you the chance to meet people who are really suffering — body, soul and spirit — and offer them direct, personalized assistance.

    This unselfish giving of your time and energy often results in a bond which allows the opportunity to offer prayer and spiritual advice, and even to share the Good News of Jesus Christ. These are things that a government program can’t provide.

  • Fred

    Thanks, Ann.

    bcmd, where can a person find one of these community sponsored clinics? How common are they?

  • Jeff

    I’m from Canada. My relatives still all live there. I have no desire whatsoever to go to a government run solution. You want facts? Get sick in Canada and have to navigate the crappy hospitals and endless waits to see a specialist – not too mention the wait for something like an MRI.

    David above got pilloried for not providing facts – none of his interlocutors did the same.

    Now, I would be at least willing to try single payer at the state level – at least if it doesn’t work it could possibly be abandoned. But at the federal level? Monstrous bureaucratic nightmare.


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