I was listening to Fox Channel via my satellite radio on the way to work today and caught a contributor whose name I didn’t catch in the middle of her discussion as to why she favored the health care legislation. Although I’m on the other side of the issue as those of you who have been following my rants well know, she made one of the more cogent philosophical arguments for her view. She stated that those that support the wars in Iraq and Afghanistan don’t bring up cost, saying that it’s something we have to do. Her reasoning in favor of the health care reform legislation is that, yes, it will raise taxes in the short term but will help with costs long term and that it is a moral imperative that we provide health care for the uninsured. 

This argument has traction if A) we assume that we have the same moral imperative to provide universal healthcare as we do to combat bloodthirsty terrorists trying to exterminate us, and B) the health care legislation as it is currently being proposed is the way to do it. 

As I’ve stated from the outset, I have no beef with the argument that reform is imperative. Without even bringing morality into it, it is a pragmatic imperative that we deal with it as the system is going broke. It may be a moral imperative to help pay for those that are destitute, but I lose enthusiasm when we are paying for people for whom the expense of health insurance is a significant burden but affordable if the standard of living they adopt is lower. The economic crisis we’re experiencing is the consequence of a perfect storm of multiple excesses, among them exceptional corruption and greed but also a general tendency to live to a higher standard than we’ve earned. The issue also dove-tails with the argument I made last time: opting out of the expense of insurance (barring poverty) cannot be an option unless we’re committed to not accessing health care resources we can’t afford out-of-pocket. When serious illness strikes it’s the exceptional individual who will stand on principle and stay home to die because he chose not to purchase insurance. 

The bottom line is that, if we’re truly going to try to pay for everyone with the least health care rationing possible (and rationing there will be, trust me), everyone must prioritize the health insurance bill above that flat panel T.V. or smartphone when the cold, cruel reality of personal finances dictates. 

We can no longer live off our children’s and grandchildren’s economic futures.


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  1. rantsramblingsravesandothersignsofmentalillness Says:

    I am blessed enough to have a good job at a large companywhere I have access to very affordable health insurance. My parents, on the other hand, are self employed. Having seen what they went through and still go through, I took into account the cost of insurance when searching for a job out of college, but my parents could never have predicted so many years ago that insurance premiums for individuals would skyrocket the way they have. Their monthly costs about $2,000 for health insurance that still has a high deductible.

    Sure some people want a handout, but others just want a fair deal – reasonably priced insurance. I hope that this proposed price exchange for insurance policies leads to a similar mechanism that allows consumers to compare the cost of services at a variety of their local providers/medical facilities. The more information available to consumers in a user friendly format, the more Americans can be responsible healthcare consumers. If we had access to some type of quality data as well (i.e. consumer driven or government driven) we could weigh the cost and the quality of service.

    I also believe the government should limit the marketing of medications on television. I realize some people may have a condition that they didn’t realize was treatable, but I have to wonder if some people are winding up on medication they may not need… You’re a doctor please share your thoughts on this.

    • heartheaded Says:

      I agree that $2,000/month for insurance is untenable and out of reach for many people. Hence the need for meaningful reform. When I started this blog I laid out all the problems with the current system I could think of and 15 suggestions regarding approaches to dealing with them. Only a rational, comprehensive approach to the problem can blunt the rise in costs that is sure to continue. We are seeing unprecedented numbers of very elderly patients that would never have lived this long. I rounded on an 88 and an 89 year old just today, one in an ICU, and the hospitalist rounded on two nonagenarians. I think everyone deserves a “fair deal” and we need to discourage those that want handouts. People will learn in this era of the internet very quickly when they are no longer out of the loop, protected by third-party payers and are directly responsible for more of the costs of their health care. I agree that direct marketing of prescription drugs to patients has a downside; I don’t think it’s central to the problems we face. It doesn’t change my prescribing patterns. Pressure on a doctor to prescribe the prescription du jour can drive up costs only if the insurance companies or the patients are willing to pay. Most of my patients are clamoring for the cheaper generic drugs, which I try to use whenever possible.

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