I promised my two bits about health care reform... This is by no means a complete listing of all my thoughts on this matter!
1) Health care as a basic human right:
I don't know exactly where I stand on this. Among the list of human rights that come to mind (namely - freedom of speech, freedom of religion, right to a fair trial, rights of human subjects in research), I'm not certain that the "right to see whatever doctor whenever I want" really makes the cut in terms of significance and substance.
That being said, I do think people should have fairly easy access to high quality medical care at a price that will not cause bankruptcy. I know that a certain number of the residents at our area homeless mission are living there due to bankruptcy from medical costs. This is not right. Perhaps the difference lies in how we think of the right to health care: are we talking the right to a safe birth in a clean environment, immunizations readily available, preventive care, and basic treatment for illness? Or are we talking coverage of epidurals and circumcisions, convenience C-sections (as opposed to emergent), bariatric surgeries, cosmetic surgeries, free contraceptives/condoms, and cutting-edge technologies used for chronically ill elderly people who honestly would rather just have a bit of quality of life at the end? And I don't care where you stand on abortion: the taxpayer should NOT pay for abortions under any circumstances.
The other problem I have with the "right to health care" camp is the basic assertion (I'm paraphrasing someone who was being interviewed on NPR last week) that "the right to health care is something that has been developing over the past years, and now that we are aware of it, we need to do something about it". Basic human rights do not evolve. They are part of our make-up, there are innate. Just because it is currently politically correct to be an advocate for the poor doesn't mean we have to negate other human rights, such as taxation only with fair representation, the basic human right to life from conception to natural death, and of freedom of speech (agreed, it should be civil...).
2) Public options
-Fix Medicare/Medicaid first. It is absolutely absurd to develop a third, giant public plan when the other two will be bankrupt in a matter of years. It's not a "then" problem, it's "NOW" problem. Also, if all people who were eligible for Medicare and Medicaid were actually enrolled in the programs, the number of uninsured would dramatically drop (by some estimates, 10-15 million are eligible but not enrolled - that's about 25% of the pool we are trying to insure with another public option now).
-Should be LIMITED - by income level (not 250% of the poverty level as some suggest - if you are making that much money, cancel your cable subscription, stop buying new cars, and buy your own insurance), by age (if you are 35 and working, buy your own insurance - even if it's just catastrophic), length of time you can be on the plan (time trial?), and only open to US citizens. If we want to help immigrants, it should be done via migrant centers which are already a proven tool.
-Shouldn't be done at all. Any public program will eventually lead to tax increases. Fine, tax the rich a little more, but then stop whining about jobs being sent overseas and Swiss tax havens. Tax me more and I will freak out. The article about Canadian health care in our paper told how great their system is, and then mentioned in a very brief sentence that the average Canadian family is taxed 48% of their take-home pay. I refuse to work to provide the government with 50% of my wages. The part they get is too much already.
3) Better yet, a voucher program
I know this is not popular and will not get through, but I really think we should be focusing on expanding/adapting the community health center approach, rather than trying to develop an enormous, bureaucratic public program that will insure everyone. Here's how it works in my little brain:
#1 - Provide vouchers (like Massachussetts) to young, slightly poor, and otherwise healthy people who don't have insurance because they don't need it or can't afford it (but just barely) so that more people have good private insurance. Provide temporary insurance benefits along with unemployment to those who are legitimately out of work but are actively trying to get back into the job market (not those who are bumming around with an art history degree but don't want to work at Starbucks because it's not "creative").
#2 - Increase the number of nurse-run community health centers in impoverished, urban, and suburban areas. Go to where the people are who need the help. These centers will need government support - this is OK. Also, government should provide support (or perhaps incentives such as higher Medicare/Medicaid reimbursements) to agencies (hospitals, clinics) that provide free or discounted services to those who meet their requirements for charity care. A lot of agencies already DO provide these services, and they WILL NOT if they are faced with higher regulation and lower payments, which is likely if a public option plan is pushed through.
#3 - People who present with health problems that cannot be dealt with at a community health center (e.g. need for surgery, cancer treatments, higher-level diagnostics) will receive vouchers for the health care needed (not more, not less). These vouchers could be used at any agency - even the best and most expensive. This would eliminate some disparities - Harley the homeless guy could use his voucher to get radiation from Dr. Famous at Barnes-Jewish, the same as Darlene the debutante. If people know they can get quality care right down the street, they will go to the clinic for small problems instead of showing up at the ER with advanced cancer.
#4 - Continue loan paybacks, education incentives, and other perks to lure highly-skilled nurse practioners and doctors to work at these health centers. Tax breaks would be good too. Moving incentives. Anything to get the talent where it is needed most.
4) Sweeping under the rug
Probably what gets my goat most of all is that there are few if any controls in the health care bills under consideration currently. Some things need obvious fixing:
-tort reform (so the doctors stop ordering all these unneeded tests and quit looking over their shoulder every minute their pen touches the order sheet)
-health insurance portability across state lines (increases competition and allows families more options, particulary in states like ND where Blue Cross Blue Shield has something like 90% of the market share)
-PREVENTATIVE MEDICINE! We're great at saving people on the brink of death, while our children eat themselves into type 2 diabetes and our children are born too early because we smoke and get yeast infections. I could rant and rant and rant here.
-Fat people, smokers, drinkers, and those who insist of popping wheelies on their motorcycles without wearing helmets should have to pay more for their health care. Period. They are the reason health care costs so stinking much for those of us who eat healthy, don't smoke, drink 2 glasses of wine/month, and wear our seat belts. Everyone should have to take a mandatory health class that says this much.
-Health care reform SHOULD take place. The reason the situation is so bad now is because no one is willing to risk the political capital, take the brunt, etc for our messed-up system. I have personally care for people who are losing jobs, going bankrupt, and dying of advanced cancer for lack of good, affordable health care. That's why reform should be done compassionately and quickly.
