Saturday, September 15, 2007

About Those Without Health Insurance...

A number of presidential candidates are trying to get political traction by looking at health care.

There is plenty of sloppy thinking in this area, in my opinion, made worse by sound-bite presentations of multifaceted issues with many stakeholders.

First, we need to distinguish between health care and health insurance. In the US, hospitals are required to provide care, even to people without insurance or immediate means to pay. (You will not find this true worldwide.) So don't fall into the sucker trap of equating uninsured with "can't receive healthcare." In the US we also pour and phenomenal amount of funding into Medicaid and prescription drug programs.

Second, understand that not all of the 46 million uninsured people are in equivalent situations. This group should be segmented into sub-groups. Here's recent commentary on this from the Patriot Post:

We’ve all heard it: 47 million uninsured Americans, or nearly one in six of
us. Obviously, the only solution to such a disease is socialized medicine.

However, before making such a huge change maybe we ought to take a look
at the facts. For these purposes, we will pretend that 47 million is an accurate
number, not just an inflation-adjusted one derived from an ancient, flawed
study. Do you ever hear that, within four months, 45 percent of that 47 million
(20 million) will have insurance? What about the fact that 17 million of the
uninsured can afford insurance (i.e., they remain uninsured by choice)? Or that
more than nine million are not even citizens?

No? When you add up all the numbers, dump out the duplicates and
subtract the misinformation, fewer than nine million of our citizens go
involuntarily without insurance—a troubling number, but no reason to panic. In
health care, as in every other area of human endeavor, a freedom-based market
approach works best to produce desired services at the lowest prices (unlike
every socialized-medicine approach in history). On the other hand, if we do turn
to the market, citizens would not be beholden to Congress for more crumbs.
No, better to keep the problem big, so it is worthy of their lordships’
attention, and there is enough money and power available to bother

We also need to consider a group of people that are legitimately underinsured against catostrophic healthcare expenses. I can't point you to reasonable data on this group. Every source I look at has significant biases in their interpretations. So at best we can agree this group is non-zero in size.

The last question I think needs further consideration is the role of government (at federal, state, and community levels) has in healthcare. We can probably agree that certifications and at least some regulation is helpful and appropriate. But I would question the assumption that the government should be involved at all -- where is it in the US Constitution? And I can't find reference to it in my state constitution, either.

I find it stimulating to realize that the very large majority of hospitals were established by churches and religious groups. If a church today were to create a small hospital in some US town...well, the outcry would be long and loud. Consider the reasons why this was applauded (and expected!) in 1900, but would vilified in 2007.

No comments: