Healthcare - the debate continues

I've noticed a huge oversight here. You see, my wife has this weird fixation on having something she calls "a life" I don't really understand it, but it makes her happy, so I go along with it. As a consequence, though, I tend to take notes and comment on other people's blogs in the evening, and blog on the weekend.

As a result, sometimes I'll have pages of notes by the time the weekend comes around, and, reading back, I see that I've left out some points in favor of others, and some of them are relatively important. Thus, this entry. It may be a little more fragmented than most, but since I have some new fans, I think I should just throw it out there and let them at it.

There's a lot of weird claims out there:

The government can't even run a post office/the DMV/(insert random program here)! How can they run healthcare?
I don't hear a lot of seniors shouting that they want to give up their Medicare; in fact, recently, when Rep Anthony Weiner put forward a bill to end Medicare, not one single congresscritter voted for it. And that's government-run healthcare. Really. It is. (Those same congresscritters are also refusing to give up their own government-run healthcare plan - why is that?)

Universal healthcare will stifle innovation!
You know, funny thing there. A lot of the innovation going on in America doesn't happen at bottom-line-focused, pay-to-play corporations, but at universities around the country. Like the latest innovations in joint surgery out of UW Medical Center.

In fact, if you look through the Annals of Surgical Innovation and Research, you'll find that most advances occur in two places: American universities, and foreign countries where they have universal health care (or very often, both, working together).

The country can't afford to give everybody healthcare! We'll go bankrupt!
Well, that's been answered often enough by other people, let's let one of them handle it.

The truth: We need health care reform now in order to prevent bankruptcy—to control spiraling costs that affect individuals, families, small businesses, and the American economy. Right now, we spend more than $2 trillion dollars a year on health care. The average family premium is projected to rise to over $22,000 in the next decade—and each year, nearly a million people face bankruptcy because of medical expenses. Reform, with an affordable, high-quality public option that can spur competition, is necessary to bring down skyrocketing costs. Also, President Obama's reform plans would be fully paid for over 10 years and not add a penny to the deficit.

But let's add to that.

The Bush tax cuts for the rich didn't seem to help the economy much, now, did they? On the other hand, they helped the richest people quite a bit. To be exact, they helped the top 0.1% of the richest people in America, without doing a damned thing for the rest of us. (In fact, there are even coalitions of rich people, like "Wealth for the Common Good" and "Responsible Wealth" offering to pay their fair share.)

So, would rolling back the Bush tax cuts pay for part of the healthcare reform they're touting? Well, Paul Krugman, the Nobel Prize=winning columnist already explained that last month.

OK, so the CBO score for the 3-committee House health care plan is in: $1 trillion over the next decade for 97 percent coverage of legal residents.

That’s a bargain: the catastrophe of being ill without insurance, the fear of losing insurance, all ended — for much less than the Bush administration’s useless $1.35 trillion first tax cut, quickly followed by another $350 billion.

Or let's look at what other people have put together on the subject:

What are the costs of not achieving universal health care?
In a landmark six-part series on the uninsured, the Institute of Medicine compiled an extensive report on the "hidden" costs of uninsurance.

• Fewer years of participation in the workforce: The annual cost of diminished health and shorter life spans of Americans without insurance is $65-$130 billion. People who do not live as long do not work and contribute to the economy as long.

• Developmental losses for children: children who are uninsured are more likely to suffer delays in development because of poor health, thus affecting their future earning capacity.

• Cost to public programs: Medicare, Social Security Disability Insurance (SSDI), and the criminal justice system have higher costs than they would if there were universal coverage. For Medicare, the reason is that people who are uninsured have poorer health, and this poorer health translates into higher expenses once they become enrolled in Medicare. A similar effect exists for SSDI and the criminal justice system, although to a smaller degree because most people do not end up using these programs whereas the vast majority ultimately enroll in Medicare at age 65.

The Institute of Medicine also studied the cost of high rates of uninsurance to communities.

• Lower health care delivery capacity: Communities with high levels of uninsurance tend to have a lower health care delivery capacity, as providers burdened by the costs of uncompensated care reduce staff, relocate, or close.

• Impaired access to emergency departments: Access to ER’s is impaired for both uninsured and insured individuals in communities with high rates of uninsurance. The reason is twofold: emergency departments burdened by uncompensated care costs close down or reduce capacity, and uninsured individuals who have nowhere else to turn to for primary care overcrowd ER’s.

• Weakened local economy: A high rate of uninsurance and the corresponding burden of uncompensated care costs weakens a community’s health infrastructure (e.g. closing or downsizing of local hospitals). Since health care is an important part of a community’s economic base, communities suffer economically.

• Adverse effects on public health: Communities with high rates of uninsurance have less effective control of communicable disease (e.g. less vaccinations, less surveillance of TB) and an overall greater disease burden in general. Furthermore, public health agencies may have budgetary problems if the local government has to siphon dollars away to pay for safety net services for the uninsured.

In addition to the costs delineated by the Institute of Medicine, there are several other areas of economic inefficiency because of the lack of universal health care in America:

• Unnecessary use of the ER: the ER is an expensive place to receive care. An average visit to an emergency room costs $383, whereas the average physician’s office visit costs $60. It is estimated that 10.7% of ER visits in 2000 were for non-emergencies, costing the system billions of dollars.

• Lack of preventive care and adequate care of chronic diseases: Because the uninsured do not get the preventive and chronic disease care they need, they are more likely to develop complications and advanced stage disease, both of which are expensive to treat. The magnitude of this cost is difficult to estimate, but it is significant.

• "Job lock": Job lock refers to the idea that people stay with their jobs when they would rather work elsewhere because their current job offers health insurance. For example, many individuals opt to stay with their job instead of starting their own business because they are unsure of whether they can get health insurance on the individual market, which has higher premiums and often denies people with pre-existing conditions. Although the number of people who would be self-employed if there were universal health care is controversial, one study from 2001 put the number at 3.8 million Americans. This loss of entrepreneurship is a real economic cost in a society that is relying on start-ups to offset the loss of jobs that are moving offshore.

The above are the costs of not achieving universal health care in America by any solution. There is a specific subset of costs that would remain if the solution chosen to achieve universal health care builds on the current system of employer-based insurance (e.g. if the solution is not a comprehensive reform that moves to a centralized insurance scheme, like single payer or social insurance).

• Strain on businesses: The employer-based insurance system in America constitutes a tremendous drain on businesses, as skyrocketing health insurance premiums dig further into profit margins and undermine the ability of businesses to invest in expansion. Health insurance premiums in 2005 grew approximately 2-3 times the rate of overall inflation (3.5%) and wage increases (2.7%).

• Loss of global competitiveness: Health insurance costs are built into the prices of American products. Because businesses in other industrialized countries are not responsible for shouldering most of the costs of employee health insurance, American companies are at a competitive disadvantage globally. General Motors reports that every car it makes is $1,500 more expensive because of health care costs, far more than what Japanese and German automakers have to pay

Now, there's nothing new going on with these arguments. They've been made so many times before that it starts to get old after a while. I mean, let's be real. Everybody from the most blatant capitalist job site to the Green Party can connect these dots.

So where is the opposition to Universal Health Care coming from? Well, obviously, it comes from the healthcare industry, who don't want to lose the multi-billion dollar profits that they're making. I mean, really, this shouldn't be surprising. Corporate Healthcare still haven't been willing to answer the US Senate's question regarding how much of the premiums that their customers pay go to profits for their company, instead of healthcare.