Obama Apologies, Part 1
Note: I wrote this as a Facebook note today in response to a friend's inquiry about my candidate of choice. The Iowa caucuses are closing as I write, and good Senator Obama is leading with 37% of the delegates, over Edward's 30% and Clinton's 29.6%. It's a good night.
This note is in response to the message on my Wall from Kelly who asks why I support Obama and who notes that she does not support universal health care.
First, a word or few about universal health care, a thousand and one options exist between pure free-market health care and fully socialist medical care. Neither Obama nor any other candidate is proposing Canadian- or British-style health care in which the State pays for everyone's health care with subsidies fully funded by taxation. Rather each proposes a different mix of private-sector incentives and pressures with public subsidies or mandates. We could not in one fell swoop eliminate the private sector from health care and should not, because it is profit motive that drives innovation and competitive care.
We also cannot ignore the "cost of poverty" on the entire system and every citizen. The U.S. pays much more per capita on health care than any comparable country (about $5000 per person, not taxpayer, not patient, per person), but fails to provide coverage for about 47 million citizens, including about 8 million kids. The Kaiser Foundation, among others, dispels a myth that we get substantially better health care than those in other countries with nationalized health care. In short, we're not getting a good bang for our buck.
This disparity leads me to two conclusions:
1. We pay too much for what we get.
2. We should not rest when the quality of health care (as opposed to the quality of plumbing, entertainment, etc.) depends on the ability of someone to pay for it.
The second conclusion arises from an ethical tension. For Christians, the disparity in access to health care should prompt concern over stewardship, justice, compassion and life. Regarding stewardship, companies, insurance, government and patients are not getting a sound deal for the money we expend on the services we consume. Regarding justice,the poor get substantially less access and quality to health care than others. Regarding compassion, we should not sit by in affluence while the poor suffer without care better available. Regarding life, we subject our neighbors to shorter, less fruitful lives when we neglect this plight.
A few other observations:
1. We already provide subsidized, nay socialist, health care to people over 65 regardless of wealth, to Veterans and to the very poor by way of Medicaid. These piecemeal efforts create inefficiency, caprice and strange incentives in the rest of the market.
2. Rationing is coming, if it is not already here. That is, providers and patients are already having to pick and choose services based on the ability to pay, even for insured patients. This arises from inefficient and expensive defensive medicine, as opposed to preventative care. It also arises from the costs levied on the providers who often have to foot the bill themselves for care to those without sufficient insurance.
3. We rely, perhaps unfairly, on doctors and hospitals to provide free care for the uninsured. This affects the free market as well, by forcing providers to shift the cost of indigent or uninsured care to other revenue streams, increasing the price for all.
4. For all the talk of wanting to maintain control and independence over our own care, we believe in a fiction. In the current market, we realistically receive care from options over which we have virtually no control. The question remains then, do you want health care power vested in the State or in the Insurance Company with an almighty profit motive? That's a hard call.
Obama's health care plan offers a mix of incentives and subsidies that still relies on private insurance companies, who still can profit, and on private health care providers, who still can profit. The profits might be smaller than the luxurious margins enjoyed these days, but the private sector still has incentives. Obama also would leverage the bargaining power of the government to negotiate prices with private companies, engaging the very free market that now creates remarkable innovation and care for the insured.
This note is in response to the message on my Wall from Kelly who asks why I support Obama and who notes that she does not support universal health care.
First, a word or few about universal health care, a thousand and one options exist between pure free-market health care and fully socialist medical care. Neither Obama nor any other candidate is proposing Canadian- or British-style health care in which the State pays for everyone's health care with subsidies fully funded by taxation. Rather each proposes a different mix of private-sector incentives and pressures with public subsidies or mandates. We could not in one fell swoop eliminate the private sector from health care and should not, because it is profit motive that drives innovation and competitive care.
We also cannot ignore the "cost of poverty" on the entire system and every citizen. The U.S. pays much more per capita on health care than any comparable country (about $5000 per person, not taxpayer, not patient, per person), but fails to provide coverage for about 47 million citizens, including about 8 million kids. The Kaiser Foundation, among others, dispels a myth that we get substantially better health care than those in other countries with nationalized health care. In short, we're not getting a good bang for our buck.
This disparity leads me to two conclusions:
1. We pay too much for what we get.
2. We should not rest when the quality of health care (as opposed to the quality of plumbing, entertainment, etc.) depends on the ability of someone to pay for it.
The second conclusion arises from an ethical tension. For Christians, the disparity in access to health care should prompt concern over stewardship, justice, compassion and life. Regarding stewardship, companies, insurance, government and patients are not getting a sound deal for the money we expend on the services we consume. Regarding justice,the poor get substantially less access and quality to health care than others. Regarding compassion, we should not sit by in affluence while the poor suffer without care better available. Regarding life, we subject our neighbors to shorter, less fruitful lives when we neglect this plight.
A few other observations:
1. We already provide subsidized, nay socialist, health care to people over 65 regardless of wealth, to Veterans and to the very poor by way of Medicaid. These piecemeal efforts create inefficiency, caprice and strange incentives in the rest of the market.
2. Rationing is coming, if it is not already here. That is, providers and patients are already having to pick and choose services based on the ability to pay, even for insured patients. This arises from inefficient and expensive defensive medicine, as opposed to preventative care. It also arises from the costs levied on the providers who often have to foot the bill themselves for care to those without sufficient insurance.
3. We rely, perhaps unfairly, on doctors and hospitals to provide free care for the uninsured. This affects the free market as well, by forcing providers to shift the cost of indigent or uninsured care to other revenue streams, increasing the price for all.
4. For all the talk of wanting to maintain control and independence over our own care, we believe in a fiction. In the current market, we realistically receive care from options over which we have virtually no control. The question remains then, do you want health care power vested in the State or in the Insurance Company with an almighty profit motive? That's a hard call.
Obama's health care plan offers a mix of incentives and subsidies that still relies on private insurance companies, who still can profit, and on private health care providers, who still can profit. The profits might be smaller than the luxurious margins enjoyed these days, but the private sector still has incentives. Obama also would leverage the bargaining power of the government to negotiate prices with private companies, engaging the very free market that now creates remarkable innovation and care for the insured.
posted by JRB at 8:55 PM
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