Sunday, January 06, 2008

Republican Debate: Healthcare

I watched the Republican Presidential debate from New Hampshire last night in anticipation of the New Hampshire primary on Tuesday. It has left me wondering which country these Republican candidates call home. The issue that most makes me wonder about these Republican candidates is health care.

I heard Massachusetts Governor Mitt Romney refer to the “47 million Americans who choose not to play…” in the game of insurance and health care as it currently exists in America. He went on to imply that those 47 million people are freeloaders who refuse to buy their own insurance just so the rest of us will pay for their health care.

I don’t know about you, but my friends who have no health insurance do not choose to live without a safety net in the richest country in the world. They work at small companies or businesses that can not afford to or qualify not to offer insurance to their employees. Or, they are self-employed and can not afford policies that would benefit them and their productivity as Americans. The rest of them can not qualify to purchase insurance because of pre-existing health issues.

Other members of the Republican panel seemed to agree in unison that the US has the best health care system in the world, with one of the candidates even referencing the belief that “[people from the rest of the world] come here for their health care”. If you want to see the reality of this statement, check out the World Health Organization’s rankings of countries throughout the world by the quality of their health care. From the source report:

The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th . Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy.

Even Morocco outranks the United States! Look at infant mortality rates around the world and life expectancy as well. You will find that many countries outrank the United States, yet our Republican leaders arrogantly state that we have the best health care system in the world.

If you are wealthy, you can, indeed, get the best health care in the world in this country. After all, we have the best health care that money can buy. If you can afford to purchase your own insurance or to pay for your own medical bills at any cost, we have the best health care system in the world. Even if you live in countries where universal health care is available and you want to pay for your own care, you still have that option. It is not an option, however, for people living at and somewhat above poverty level to finance their own health care when long-term care, disability and catastrophic illness come into play.

Governor Romney referred to his plan in Massachusetts to offer health care for all of the citizens of the Commonwealth. During the discussion, it was noted that to qualify for assistance, one must make less than 300% of the US Federal poverty level of income. Most Americans are probably not even aware that to qualify for 300% of the Federal Poverty Level of income, an individual must make an income that does not exceed $31K/year. When you factor in rent or mortgage, transportation, food and all the other things that one must have to live viably in this country, this is not a significant amount of income for most. Of course, for the homeless man on the corner, it would be heaven to live on 3 times the Federal Poverty level.

Although everyone on the panel believed that the free market will take care of the US population’s health care needs, no one mentioned the way that the insurance industry works to cut costs systematically by denying claims, by delaying payment on claims and by using preexisting conditions to deny insurance coverage to people with catastrophic health issues. Their plans would pass the cost ($180/month was a figure mentioned in the debate) of each person’s insurance coverage on to the individual citizen. How many people can take on a payment of $180/month easily to provide for their own health care?

Because of the AIDS pandemic and the extreme cost of treatment involved, it has become quite clear to me how this kind of system works for those most in need. The AIDS Drug Assistance Programs (ADAP) that exist on a state-by-state level define each state’s qualifying level of income. North Carolina just recently increased the threshold for qualifying to 250% of Federal poverty level for people living with HIV/AIDS. People in South Carolina have died due to lack of access to medications to fight AIDS. These programs have caps on enrollment and long waiting lists for those seeking assistance. In addition, states can create medication formularies (approved list of drugs) that only provide access to the drugs that they choose to make available. If your virus will not respond to any of the medications on the formulary, it is not certain that you will have access to other drugs that might help. This is not health care worthy of America.

Ron Paul, bless him, was the only one on the panel who stated that if we quit spending more than a trillion dollars on war, we could afford to care for our own. I think that he might actually get it, but the rest seem to live in a privileged world where their friends can fly across the Atlantic, the Pacific or Central America to come here and pay for their own healthcare as if they were taking a vacation.

For now, I am hoping for a change in the status quo. I am hoping that someone will have the courage to speak out for the least wealthy of us in the United States. I hope that someone will show that we need universal health care like that provided to their citizens by all the other industrialized countries. I hope that we will move away from private insurance where the bottom line is profit. I hope that we will move away from greed and the notion that only those who can afford health care should get it.

Most of us are not celebrities who can drop huge sums of money for cosmetic surgeries that make us look like plastic beings. Most of us don't even want that. At the very least, we want an affordable system that provides better health care for us than what we get now. May you never have to watch your parents' entire life savings pour into the insurance and medical establishment because they need long-term care at the end of their lives. May you never be denied care because you can not pay for it. May you never be excluded from coverage because you have a catastrophic illness. May none of us ever be so rich that we lose sight of what it means to live without a safety net.



Blogger John Médaille said...

I heard exactly what you did, and was so astounded that I was sure I mis-heard him. But I checked the transcript, and, alas, I heard correctly. This is an astounding statement. See my comments on this at

1/06/2008 06:11:00 PM  
Anonymous charlesclarknovels said...

How can any candidate fail to see that healthcare in this country is a national disaster--not only for the millions who are not covered by insurance but also for those who are paying exorbitant prices and who think they have the best available?

Healthcare reform will never happen if attention is not focused on quality issues: Medication errors, hospital acquired infections, poor control of chronic diseases.

Escalating costs of healthcare will continure unless reimbursement is denied for unnecessary procedures, unnecessary diagnostics, and denied for physician referrals to entities in which they own or have a financial interest.

The key is accountability on the part of healthcare providers.

1/06/2008 08:27:00 PM  
Blogger Quintus Arius said...

Insurance, insurance, insurance. That is all you ever hear in the health care arguments. Cover everybody. Single payer...blah, blah blah.

You see that only addresses the demand side of the equation. Can't anyone, I mean anyone take up the supply side? We are suffering a tremendous shortfall of medical professionals and institutions at every level.

Regardless of how we insure people, the demand for quality health care is increasing at exponential rates while the supply is static or worse. Cost escalation is inevitable.

It is econ 101 folks. Our legal and tort system is sand in the gears of what could be smooth, efficient machine. Somebody please pick up my spear...I'm about to fall off this horse.

1/08/2008 10:02:00 AM  
Blogger John Médaille said...

Concerning the supply side, see

And I would disagree that torts are the "sand in the gears." A world without torts is a world ruled by the powerful, with no check on the ways they can abuse you.

1/08/2008 10:42:00 AM  
Anonymous Hugh Elliot said...

There is gross overtreatment of those who are insured and equally gross undertreatment of those who are not insured.

The current model does not work - in part becuase of cherry picking by the insurance companies and adverse selection by the insured.

Doctors and Big Pharma have convinced the patient population (which is not hard to do given the level of wishful thinking) that an office visit that does not result in scheduling of more tests and a procedure or, at the least, a prescription, is a fialed visit.

1/08/2008 01:04:00 PM  

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