Thursday, February 25, 2010

Debating Health Care: Agreeing on the Problem

Debate: a formal method of arguing alternative perspectives about an agreed-upon common debate topic, or proposition.

The first thing you need to hold a debate is agreement on the topic, or the proposition to be debated. And therein lies the problem in the nation’s health care debate—there is no agreement. What do I mean?

Well, in trying to solve any problem, you first need to define and understand the problem. Here, ever since the Clinton’s abortive attempt to pass health care legislation, the warring sides (and let’s face it, our two political parties are at war) have been arguing about different things. Clinton failed in part because he never really even attempted to reach agreement on what problem he was addressing. Republicans were allowed to demagogue about “socialist” take over of the health care system before Clinton even had a plan. His plan was dead before it was an actual plan, done in by a very expensive ad campaign financed by republicans who were vigorously opposed to any new democratic health plan. Fundamentally, republicans were/are opposed to another democratic triumph, such as Medicare or Social Security.

So, what is the problem that drives this full court press by Obama?

Well, first, we have the issue of 45 million people without health care (the numbers change often, but it’s a big number anyway). Now, is that, or is that not a national problem? We are perhaps the only industrialized nation in the world that refuses to include all its citizens in its health care system. Republicans might argue that the number is false—that those 45 million in fact do access the health care system. They check into emergency rooms and thus receive care. They argue further that there is no “right” to health care, as there is in other civilized nations. One establishes a right, they might argue, when one has a job and can afford to make payments on health insurance. Beyond that, there is no right. So, maybe we should start the debate there. Is there, or should there be a “right” to health care in this country?

If that is a problem, then why does that problem exist? The problem breaks down into two sets of people. Set one is people who could afford health care insurance, but choose not to, mainly young, healthy people. They are willing to gamble. Set two is the group of people who are unemployed or underemployed in settings that refuse to provide health care insurance—employers like Wal-Mart who hire people consistently on a less than full time basis, precisely so they do not have to provide them with insurance coverage, or small emloyers who do not constitute a large enough pool to make coverage affordable by the employer. So, people who work in such settings cannot afford insurance, because the insurance system is based on large groups, and the groups mainly are employment-based. Buying insurance privately is simply unaffordable for almost anyone. So, it appears that the basic model—private insurers who focus on large employer groups—is the main cause of the problem of the uninsured. The group of healthy young people willing to gamble is a contributing factor that can be solved in one of two ways—force them to buy coverage, i.e., make it like Social Security—or ignore them and deny them coverage should they become ill.

So, if they could agree on that problem, potential solutions emerge quickly and could be debated—for example, a single payer model that eliminates the private carriers altogether. That is essentially the model of Social Security, Medicare and Medicaid. Note, the private sector is not excluded completely, since they can act as payment agents for the government. But one could also debate alternative models. For example, everyone could pay into a health care insurance system , like Medicare, and then private carriers could be used to implement the coverage system, with carriers being required to provide some comprehensive, and quite standard coverage approach, allowing carriers to compete on cost, and perhaps to add special items for coverage.

But, even here, we at least have the basis for an actual debate, once agreement is reached on what problem you are trying to resolve. Absent such agreement, and there is no possibility for an open and honest debate. You will get what we have currently—politicians dissembling.

Oh, and there are other problems extant, waiting to be debated--like the basic cost of health care insurance. But that too can be defined and examined to uncover the basic causes and potential solutions. All we lack now are politicians who are actually interested in problem-solving.
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