Most of the talk these days is about financial reform, ethics, and oil, but that healthcare bill is percolating through. NYT recently took a look at how Texas feels about it. In brief, they hate it because it costs too much.
Nurse: So. What gets me is that a lot of objections seem to be from “small government” types, whose general attitude is that the markets handle things in the best way on their own without interference. and when we’re talking about healthcare, there are a few problems with this– including that it’s clearly not working. costs are through the roof, outcomes aren’t improving, safety is a constant issue, and the system rewards choosing billable procedures over best practices.
Lawyer: And maybe, if people were shopping for healthcare services themselves, the market might take care of it. But they aren’t shopping for medical services — insurance companies are. And many of them aren’t shopping for insurance companies — their employers are. So the people setting the criteria are not the people using the services, and the people using the services end up having very little choice — hence, no market forces making it work.
Nurse: I seem to recall a Gawande essay in the new yorker about the town with the highest per capita health care costs being in texas? I would argue that healthcare is a basic human right and that the government should be protecting it as they do life, liberty, and property– but this is more controversial.
Lawyer: I mean, none of our great old documents say we have a right to healthcare. But how about the right to life? And how about international human rights agreements? I will quickly be out of my depth if we start talking about international law, but let me leave it at this: among developed countries, we’d be doing pretty badly even if everyone did exactly what this new law says.
Nurse: To the argument that providing insurance to all the uninsured is way too expensive, I say that’s short-sighted. Ask any health care professional: chronic diseases that are poorly controlled are both extremely common and extremely expensive. When these patients are uninsured, they are treated in crisis only, and the cost of this care is out of control when compared to ongoing primary care– which typically, people do not seek without insurance.
Lawyer: Exactly. People are looking at the price tag and comparing it to zero, not comparing it to the alternatives. It’s like having a job where you absolutely need a car to get to it, and looking at a used Honda and saying “that costs too much,” when the other choice is a brand new BMW. You have to buy one — so comparison shop. Don’t just let your jaw drop at one price in isolation.
Sure, lots of things I believe in are genuinely open to the criticism that the government shouldn’t be spending money on that. The problem is, the government is going to pay for all this stuff anyway, and they’ll pay less, and people will be healthier, if we make the outlay.
Next time someone tries to argue otherwise, I will ask them if they want to repeal EMTALA. (That’s the law that requires emergency rooms to treat anyone who shows up needing treatment.) If you’re in an accident and you don’t have (a) your checkbook or (b) your insurance card with you, would you like the hospital to just leave you bleeding in the hallway until you prove you can pay?
Otherwise, emergency rooms will treat people who need it. And without insurance for preventive care, more people will need it.
I have a feeling we’re preaching to the choir here. Can I get an amen?