THE PROBLEM WITH HEALTH CARE

When reading articles about various aspects of the health care issue here in the U.S., one should always keep in mind that the crux of the matter is the basic fact that health care is a service provided by people to other people for a fee. In the end, health care providers must, somehow, get paid. If they are not paid, or paid inadequately, then most will find something else to do. All the arguments boil down to that simple fact. We can pay them as government employees (as they do in Cuba as just one part of a command economy, or as they do in Great Britain as a government-run piece of a free market economy), or we can have one government-run and funded insurance company pay them (as they do in Canada), or have a patchwork of private insurance companies and government-funded institutions pay them (as we do here in the U.S.).

Here are the problems with each system.

In the government-run system in a command economy (Cuba) the problems of the health care system are inextricably linked to the overall problems of an economy without free markets. Everyone in Cuba is entitled to the best care the system can provide, which is limited by the constraints of a small and stagnant economy. Everyone is equal (except, of course, Castro and other high Communist Party officials) in getting limited help.

In the government-run system in the market economy (Great Britain) and the government-funded insurance system in the market economy (Canada) the main problem is similar to the patchwork system we have here in the United States. That problem is the fact that the people who fund the system want to pay as little as possible. Taxpayers in Britain, Canada and the U.S. resist when their elected leaders try to raise their taxes. This constrains the growth of government budgets as a whole and each government, within the constraints of its particular political system, strains to fully fund their obligations. So, here in the U.S., we read a story like this one, about doctors and their lobbying groups pushing the Congress to undo cuts in Medicare reimbursements. The doctors are quite right when they complain about how they are not getting adequately paid by Medicare for their services to its beneficiaries, which results in doctors closing their practices or refusing to take new Medicare patients. On the other hand, the politicians in Congress (mainly Senate Republicans on this issue) are right when they point out that the system is growing beyond our means to pay for it within the existing tax structure, and that the taxpayers of the country will almost certainly reject any effort by this or any future Congress to raise taxes substantially enough to fully fund the program. We also read stories like this one, about how hospitals in New Jersey are closing, especially in poor neighborhoods, because they cannot make enough money to keep the doors open. They need to get paid but, because so many of their customers are without either private or government health insurance and they are required by law to treat them anyway, they cannot make ends meet.

In Canada and Great Britain they are also limited by how much the taxpayer is willing to pay, so we periodically hear about complaints of an underfunded National Health Service in Britain, or complaints by health providers in Canada that they aren't being adequately compensated for their services.

There is no perfect system. In each case a decision has to be made. Since health care is a service provided by people to other people for a fee, like any other service, and because our resources are not unlimited (both personally and as a community), then we need to determine how health care services are rationed. If we decide to ration those services like we ration most other services in our economy, then we will do it based on one's ability to pay. But, as we have seen in Canada, Great Britain, and other advanced, industrialized nations, deep down we really don't want to ration health care the way we ration cars or wide-screen TVs. Deep down we don't think our health and well-being should be determined by how much money we have. But, because we are Americans, not Canadians or Britons, we haven't yet been able to make the leap into making health care a government-insured right for everybody (so far, we've made it a right only for the poor and the elderly). Still, we haven't been able to embrace the idea that it is not a right, rather that it is simply another aspect of life that requires each of us to pay as individuals. This is why we have such a patchwork system, and this is why we are struggling to fix the problems without addressing the main points, because we do not want to stare the truth in the face on this issue.

If health care is a right, then we must devise a system whereby every citizen can access care, and every provider will be paid adequately to provide such services.

If health care is not a right, then every individual is responsible for his or her own care, and the care of their loved ones, and should pay willing providers for such services through a fee arrangement of their own agreement.

Choose.