What KIND of health care?

September 7, 2009 | By | 4 Replies More

The raging health care debate “debate” is almost entirely devoid of facts, an issue on which I’ve previously posted.  Instead of discussing fact, then, we tend hurl vague accusations, like calling the reformers “communists” (and you’ve GOT to see this).

I “blame” Obama for this lack of specificity, but I realize that the vicious opposition mounted by huge self-interested insurance companies and health care providers might require that he not play all of his cards at this point.

Image by Devonyu at Dreamstime.com (with permission)

Image by Devonyu at Dreamstime.com (with permission)

But isn’t it odd that our politicians aren’t at least clarifying the term “health care coverage” when they refer to national health care coverage?  Defining this term would make a huge difference to the public reaction to any national plan. Here are two possibilities (though there are others):

A) The national plan will offer gold-plated coverage much like the expensive United Health Care coverage I buy for my family through my employer. For the record, the pre-tax cost of this coverage is about $20,000 per year for my family. Is the Obama proposal to provide every citizen with this kind of coverage? If so, I can see why there is massive resentment to the proposal. Many working people can barely afford health insurance coverage at all, and the coverage many people do purchase is not nearly as comprehensive as the expensive coverage I purchase.  Of course people who can can only afford to buy their own rudimentary policies will resent that the government might buy gold-plated policies for everyone else, including many highly irresponsible people.

B) The national plan will offer a rudimentary coverage only. It will cover x-rays and casts for broken arms, but not heart transplants and expensive drugs that only marginally increase one’s chances of surviving an illness. It wouldn’t keep people suffering from terminal illness on life support when there is no reasonable chance that they would ever leave the hospital.  It would cover only a small subset of the treatments covered by gold-plated policies.  It might be akin to the Oregon Plan.

I believe that there would be massive resistance to the national coverage described in A) but far less resistance to the coverage described in B).

At least Oregon’s legislators had the cajunas to specifically state what was covered under their plan and what was not (Oregon’s prioritized list is available for all to see). Oregon had the fiscal responsibility to make certain that they could afford the level of health care to which they were committing.  Oregon dealt head-on with the accusation that they were “rationing” health care; absolutely they were, just like private plans ration health care only to those who pay those high premiums.  Both responsible and irresponsible health care plans “ration” health care.  Therefore, it is not a criticism of any health care plan that it “rations” health care. Here are the guiding principles to the Oregon Plan:

In 1987, the Oregon Legislature realized that it had no method for allocating resources for health care that was both effective and accountable. Over the next two years, policy objectives were developed to guide the drafting of legislation to address this problem. These policy objectives included:

• Acknowledgment that the goal is health rather than health services or health insurance
• Commitment to a public process with structured public input
• Commitment to meet budget constraints by reducing benefits rather than cutting people
from coverage or reducing payments to levels below the cost of care
• Commitment to use available resources to fund clinically effective treatments of
conditions important to Oregonians
• Development of explicit health service priorities to guide resource allocation decisions.

Our national conversation regarding health care is so dysfunction on so many levels that it’s hard to know where to begin.  I’ll make only one more point in this post, however.  Opponents of current proposals often make accusations that there will be “death panels,” indicating that some sick people will be allowed to die.  As a nation, we need to grow up and deal with the fact that this happens every day in every hospital in the country:  we shouldn’t be allocating huge amounts of money to maintain pulses in people who have become living corpses.  There are some families who “can’t let go” no matter what (e.g., Terry Schiavo), and our national plan needs to have specific guidelines for these situations.   In fact, every private insurance plan should have guidelines for determining when further treatment is likely to be futile and a provision for ending coverage at that point.   The alternative is to make policies so horrifically expensive that many people can’t afford policies that cover tratments likely to make an immediate positive impact on their lives.

Only when we put these issues clearly on the table can we begin to have a real conversation.


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Category: American Culture, Communication, Health, Meaning of Life, Media, Politics, Psychology Cognition, Science

About the Author ()

Erich Vieth is an attorney focusing on consumer law litigation and appellate practice. He is also a working musician and a writer, having founded Dangerous Intersection in 2006. Erich lives in the Shaw Neighborhood of St. Louis, Missouri, where he lives half-time with his two extraordinary daughters.

Comments (4)

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  1. Erika Price says:

    I don't just "blame" Obama for this kerfuffle, I blame Obama. One of his most appealing promises (to me anyway) was that of transparency. He has definitely backslid on this oath, by not releasing torture documents and not posting bills online for the "five days before signage" he had promised.

    The lack of clear discussion on potential health care plans to me is an extension of this backsliding- a candidate knows not the stresses of a presidency, and the pressure and power can alter the perspective of any man, I'd guess. Obama thinks his course of action is the wisest and most practical, I'm sure. He's trying to give Congress discretion, find a workable compromise and avoid the errors of the Clintons, no doubt. But it sure stinks of old political scripts, not a new, aired-out political process we can all believe in.

    If only we had a more concrete health care plan to discuss.

  2. Erich Vieth says:

    Obama on his approach to passing health care reform:

    "I, out of an effort to give Congress the ability to do their thing and not step on their toes, probably left too much ambiguity out there, which allowed then opponents of reform to come in and to fill up the airwaves with a lot of nonsense," Obama told ABC's Robin Roberts on "Good Morning America."


  3. Scarlett L. says:

    I cannot fathom how Obama got anyone to buy into the notion that he was going to transform American politics. He ran on a campaign slogan of "Yes We Can." What the hell is that? It sounds like a toilet training philosophy. His speeches are always long and devoid of substance and details. This comes along the lines of being duped into buying a $4.85 box of Cheerios for a .15 cent toy that isn't nearly as big when you take it out of the box as it looks on the back of the box.

    Camille Paglia offered some interesting observations in a recent piece:

    "Throughout this fractious summer, I was dismayed not just at the self-defeating silence of Democrats at the gaping holes or evasions in the healthcare bills but also at the fogginess or insipidity of articles and Op-Eds about the controversy emanating from liberal mainstream media and Web sources. By a proportion of something like 10-to-1, negative articles by conservatives were vastly more detailed, specific and practical about the proposals than were supportive articles by Democrats, which often made gestures rather than arguments and brimmed with emotion and sneers. "


  4. Erich Vieth says:

    My thought today is this: What if we, as a country, can't possibly afford the health care that the average American craves?

    We are a country that currently rations health care. It is done by the big nasty insurance companies AND by our economic system that determines those who make enough to buy the insurance in the first place.

    My assumption is that if every American is covered with a meaningful health care system, that health care providers will be asked to provide a lot more health care. They'll do it for more money, of course, but do we have the money? If not, who is going to need to bear the burden? If the "government" is going to foot the bill, then what other government services will suffer?

    I don't want to keep sounding like a broken record, but I don't trust that we, as citizens, yet know 10% of what we need to know in order to make meaningful decisions on health care reform. I write this, having been a big supporter of Obama over McCain. Yet I'm constantly uneasy by this entire debate.

    Yes, we all want great quality health care for everyone, but the devil is in the details and we don't yet have nearly enough details.

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