Seeing it from Both Sides

As the debate over health care reform waxes on, both sides have turned up the rhetoric, and moderate or reasonable voices on either side are being shouted down and lambasted.

On the Pro-Reform side,  there is this recent commentary from Don Wycliff in the Chicago Tribune:

http://www.chicagotribune.com/news/opinion/chi-oped0903wycliffsep03,0,2484870.story

He astutely points out that the federal government is already deeply engaged in providing or facilitating health care for millions of US citizens. His list includes the following entities, all of which would have to be eliminated to get the federal government ‘out’ of health care.

    - Medicare

    - Medicaid

    - VA health care

    - Military Health care

    - Indian Health service

    - the Surgeon General

    - the CDC and the NIH.

 A few observations:

- I’ve already written a substantial amount about the failures of the VA system, and how remarkably disinterested anyone appears to be in fixing them.  The current movement is no exception: there is no discussion of fixing the problems that everyone admits plague the VA system.  Veterans with the means to do so obtain their care elsewhere.  If the VA is a barometer of how the feds will deliver health care, then the results are cause for concern, not optimism. Also concerning is that there is little discussion from either side about fixing the VA. We owe it to our veterans to do vastly better, regardless of how the current debate goes.

- Medicaid is not entirely a federally run program ,it is administered locally by the states, and has generated a patchwork quilt of coverage that verges on ridiculous.  The hospital where I work is located near the Indiana border, and is the closest tertiary care center for the hundreds of thousands of people who live in nearby Indiana.  We can care for their insured, but not for their Medicaid.

- Medicare is a big bite, too big for this post.  Let’s just say that as Medicare demands more and pays less, care for medicare patients is going to be increasingly difficult to obtain.

- The Indian Health Service is worthy of its own post, but I am unlikely to ever get around to generating it.  The spectrum of people who provide care for the IHS includes some of the very best doctors I have ever met, to doctors who cannot obtain any other employment.

 - The NIH provides little care, and the CDC almost none at all.  Both represent enormous public good, and very worthwhile outlays of federal tax dollars.  While libertarians represent that the free market would create both entities if the feds did not; the fact that nothing resembling either one exists in any other country makes me certain that this contention is absolutely wrong.

On the other side of the debate is this break down of the numbers by Dennis Byrne, also published as a commentary in the Chicago Tribune:

http://www.chicagotribune.com/news/opinion/chi-oped0825byrneaug25,0,7272374.story

First, the commentary on this one, which is posted below the article itself, is fairly typical of the partisan bomb-throwing that has been going on.  The president may have wanted honest discussion, but this topic has provoked both sides to talk at each other, not to each other.

Byrne’s numbers:

- 46 million uninsured, of them:

    - 9.5 million illegals

    - 12 million eligible for some sort of government program, but have not bothered to sign up.  Given the nature of government bureaucracy, this is unsurprising.

    - 9.1 million people who are between jobs and temporarily uninsured.

    - 7.3 million families with an income greater than $84,000/yr

    - and finally, about 8 million working poor, without insurance.

First, if we’re not going to cover the illegals, we shouldn’t include them in the count.

Second, the 7.3 million families with an income of 84k or higher are either living as a free people should be allowed to, or a group of free riders who should be made to pay or play.

Third, the temporarily uninsured are truly uninsured. For almost everyone who is unemployed, the cost of continuing their employer sponsored health plan would consume their unemployment benefit.  If they want to eat, they cannot continue their health insurance.

Fourth, make it easier for those eligible to sign up for the government programs that already exist.  Be warned: doing this will increase the expense of these programs.  Interestingly, if this number is correct, Obama could generate health care for most of these people with a minimal investment in supporting and expediting their enrollment.  This would not require an overhaul in the system, but would require the money to care for an additional 12 million people.

Fifth, understand that the real issue here are the 8 million working poor and the 9.1 million between jobs.

Finally, there are ways of controlling health care costs that have not yet been incorporated into the language of any of the bills under consideration:

http://townhall.com/columnists/HughHewitt/2009/09/04/without_tort_reform,_it_isnt_health_care_reform_--its_a_plaintiffs_lawyers_protection_act?page=1

 Mr Hewitt is correct and very clever to have thought of this.