Contemporary World Issues

Universal v. Private Health Care Systems

In 2007, more than 45 million Americans did not have health insurance. The United States is the only industrialized nation in the world without universal health care, and the debate about changing that has become a popular topic recently. The difference between the two sides is a difference in values; those for universal health care desire to see the government help others, and those who do not, wish that private companies be allowed to continue taking advantage of the statues quo for profit.

Some argue against universal healthcare simply based on the fact that it is "socialist". But if that's a valid reason, then that would mean we would have to get rid of libraries, public parks and hospitals. And I don't hear anyone call for the privatization of fire and police departments, or the military, or even air traffic control jobs. So maybe the reason people are against a "socialist" health care system is because it might not necessarily benefit them as much as it would people who need it desperately.

The following numbered statements are arguments against the implementation of a universal healthcare system in the United States. They came from a "pro and con" article from BalancedPolitics.org (http://www.balancedpolitics.org/universal_health_care.htm). I rearranged some of them so that I could group together a few that I wished to address simultaneously. The blue text is my own writing, in response to the arguments. Have fun!!

1. There isn't a single government agency or division that runs efficiently; do we really want an organization that developed the U.S. Tax Code handling something as complex as health care? Quick, try to think of one government office that runs efficiently. Fannie Mae and Freddie Mac? The Department of Transportation? Social Security Administration? Department of Education? There isn't a single government office that squeezes efficiency out of every dollar the way the private sector can. We've all heard stories of government waste such as million-dollar cow flatulence studies or the Pentagon's 14 billion dollar Bradley design project that resulted in a transport vehicle which when struck by a mortar produced a gas that killed every man inside. How about the U.S. income tax system? When originally implemented, it collected 1 percent from the highest income citizens. Look at it today. A few years back to government published a "Tax Simplification Guide", and the guide itself was over 1,000 pages long! This is what happens when politicians mess with something that should be simple. Think about the Department of Motor Vehicles. This isn't rocket science--they have to keep track of licenses and basic database information for state residents. However, the costs to support the department are enormous, and when was the last time you went to the DMV and didn't have to stand in line? If it can't handle things this simple, how can we expect the government to handle all the complex nuances of the medical system? If any private business failed year after year to achieve its objectives and satisfy its customers, it would go out of business or be passed up by competitors.

2. Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness. Government workers have fewer incentives to do well. They have a set hourly schedule, cost-of-living raises, and few promotion opportunities. Compare this to private sector workers who can receive large raises, earn promotions, and work overtime. Government workers have iron-clad job security; private sector workers must always worry about keeping their jobs, and private businesses must always worry about cutting costs enough to survive.

Manufacturing and selling cars is not that complex. Just think about all the automobile companies that do; this is because it is a relatively easy way to earn a profit. Now take a look at the "Big Three." How are they doing right now? Just because some government agencies do not run efficiently does not mean that a private one would necessarily be any better. In fact, some government operations run better than private ones. How many private security companies have been bested by a criminal? Now compare that huge number to the number of times the military has lost a battle or been stolen from. With the government, thing may get done slowly sometimes, but at least they happen at some point. And if the government does not come through with something, it can be held accountable - that's what elections are for. What do you to if the private insurance industry doesn't do what you want it to?

3. "Free" health care isn't really free since we must pay for it with taxes; expenses for health care would have to be paid for with higher taxes or spending cuts in other areas such as defense, education, etc. There's an entitlement mentality in this country that believes the government should give us a number of benefits such as "free" health care. But the government must pay for this somehow. What good would it do to wipe out a few hundred dollars of monthly health insurance premiums if our taxes go up by that much or more? If we have to cut AIDS research or education spending, is it worth it?

4. Just because Americans are uninsured doesn't mean they can't receive health care; nonprofits and government-run hospitals provide services to those who don't have insurance, and it is illegal to refuse emergency medical service because of a lack of insurance. While uninsured Americans are a problem in regards to total system cost, it doesn't mean health care isn't available. This issue shouldn't be as emotional since there are plenty of government and private medical practices designed to help the uninsured. It is illegal to refuse emergency treatment, even if the patient is an illegal immigrant.

Number 3 expresses a fear of dramatically increased taxes as a result of increased government spending on health care. In Number 4, the argument is that there is ALREADY government spending on health care. If this is so, then the current tax rates already account for government health care spending and therefore can't increase that drastically.

5. Government-controlled health care would lead to a decrease in patient flexibility. At first glance, it would appear universal health care would increase flexibility. After all, if government paid for everything under one plan, you could in theory go to any doctor. However, some controls are going to have to be put in to keep costs from exploding. For example, would "elective" surgeries such as breast implants, wart removal, hair restoration, and lasik eye surgery be covered? Then you may say, that's easy, make patients pay for elective surgery. Although some procedures are obviously not needed, who decides what is elective and what is required? What about a breast reduction for back problems? What about a hysterectomy for fibroid problems? What about a nose job to fix a septum problem caused in an accident? Whenever you have government control of something, you have one item added to the equation that will most definitely screw things up--politics. Suddenly, every medical procedure and situation is going to come down to a political battle. The compromises that result will put in controls that limit patient options. The universal system in Canada forces patients to wait over 6 months for a routine pap smear. Canada residents will often go to the U.S. or offer additional money to get their health care needs taken care of.

This "problem" is no problem at all. The government wouldn't decide which procedures are medically necessary and which ones are not. (In fact, who said it would in the first place????) Doctors would be responsible for determining this, the same way doctors currently decide if their patients need a procedure in the first place. How hard was this to figure out?

6. Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now. Co-pays and deductibles were put in place because there are medical problems that are more minor annoyances than anything else. Sure, it would be nice if we had the medical staff and resources to treat every ache and pain experienced by an American, but we don't. For example, what if a patient is having trouble sleeping? What if a patient has a minor cold, flu, or headache? There are scores of problems that we wouldn't go to a doctor to solve if we had to pay for it; however, if everything is free, why not go? The result is that doctors must spend more time on non-critical care, and the patients that really need immediate help must wait. In fact, for a number of problems, it's better if no medical care is given whatsoever. The body's immune system is designed to fight off infections and other illnesses. It becomes stronger when it can fight things off on its own. Treating the symptoms can prolong the underlying problem, in addition to the societal side effects such as the growing antibiotic resistance of certain infections.

Two things. People don't go to the doctor for every little problem not just because it costs money to see the doctor but because it uses gas (a whole other subject) and most importantly time. The second thing wrong with this argument is that like the last one, it does not take into account doctors. If someone does happen to go to a doctor for something that does not require one, then the doctor won't need to treat the patient. If no medical care is necessary, why would some be given? Doctors do what they believe to be the best for their patients. If treatment would somehow manage to "prolong the underlying problem," then the doctor won't....


7. Government-mandated procedures will likely reduce doctor flexibility and lead to poor patient care. When government controls things, politics always seep into the decision-making. Steps will have to be taken to keep costs under control. Rules will be put in place as to when doctors can perform certain expensive tests or when drugs can be given. Insurance companies are already tying the hands of doctors somewhat. Government influence will only make things worse, leading to decreased doctor flexibility and poor patient care.

Unfortunately, people already face this problem. There is no reason to assume that it would get worse. If someone cannot afford an procedure or test or operation, then they will not get with the current system. With a universal plan, it might take longer to be approved or funded, but better late than never. The only potential change would be for the better.


8. Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, etc. Universal health care means the costs will be spread to all Americans, regardless of your health or your need for medical care, which is fundamentally unfair. Your health is greatly determined by your lifestyle. Those who exercise, eat right, don't smoke, don't drink, etc. have far fewer health problems than the smoking couch potatoes. Some healthy people don't even feel the need for health insurance since they never go to the doctor. Why should we punish those that live a healthy lifestyle and reward the ones who don't?

Just because you live a healthy lifestyle does not mean you will not require serious medical care. Some people will get something like cancer, which can cost a lot to treat. This happens to people whose family has a history of it. If we wanted to not "punish" healthy people for paying for unhealthy people, then should families with a bad medical history be prevented from reproducing, knowing that they have a high chance of burdening tax payers? This is extreme, but it's essentially what this argument would say is alright. 


9. A long, painful transition will have to take place involving lost insurance industry jobs, business closures, and new patient record creation. A universal health plan means the entire health insurance industry would be unnecessary. All companies in that area would have to go out of business, meaning all people employed in the industry would be out of work. A number of hospital record clerks that dealt with insurance would also be out of work. A number of these unemployed would be able to get jobs in the new government bureaucracy, but it would still be a long, painful transition. We'd also have to once again go through a whole new round of patient record creation and database construction, which would cost huge amounts of both time and money.

The transition period would be long, yes, but that makes the loss of jobs easier to cope with. People suffer when they suddnely lose their jobs; the protracted transition process means that those currently employed in the healthcare industry have much time to prepare - which includes finding a new job (possibly with "the new government bureaucracy").  And the "huge amounts of both time and money" referred to here are actually JOBS.



10. Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession. Government jobs currently have statute-mandated salaries and civil service tests required for getting hired. There isn't a lot of flexibility built in to reward the best performing workers. Imagine how this would limit the options of medical professionals. Doctors who attract scores of patients and do the best work would likely be paid the same as those that perform poorly and drive patients away. The private practice options and flexibility of specialties is one of things that attracts students to the profession. If you take that away, you may discourage would-be students from putting themselves through the torture of medical school and residency.

11. Malpractice lawsuit costs, which are already sky-high, could further explode since universal care may expose the government to legal liability, and the possibility to sue someone with deep pockets usually invites more lawsuits. When you're dealing with any business, for example a privately-funded hospital, if an employee negligently causes an injury, the employer is ultimately liable in a lawsuit. If government funds all health care, that would mean the U.S. government, an organization with enormous amounts of cash at its disposal, would be ultimately responsible for the mistakes of health care workers. Whether or not a doctor has made a mistake, he or she is always a target for frivolous lawsuits by money-hungry lawyers & clients that smell deep pockets. Even if the health care quality is the same as in a government-funded system, the level of lawsuits is likely to increase simply because attorneys know the government has the money to make settlements and massive payouts. Try to imagine potential punitive damages alone. When the government has the ability to spend several trillion dollars per year, how much will a jury be willing to give a wronged individual who is feeble, disfigured, or dying?


First of all, someone who really wanted to be a doctor would decide to do so to help other people, not because they wanted to make a lot of money. Additionally, however, there are many things that would persuade some would-be doctors to NOT shy away. Because people will always need doctors, being one for the government has the kind of job security many should envy. But there's also the issue of malpractice. Doctors can feel more assured and be less afraid of treating a patient, knowing that they would have the federal government on their side in a legal battle. Now don't fall into the trap of saying to yourself "But that means that doctors are more likely to be negligible in their practices because of a lack of accountability!" Just think: Does the government want to spend the resources to defend a doctor, even if he's innocent? Does it want to have to spend money if it loses a case? Absolutely not. Because of this, the government would have a thorough hiring process to ensure it hires safe, professional doctors - similar to how insurance companies want to insure safe and healthy people.

12. Government is more likely to pass additional restrictions or increase taxes on smoking, fast food, etc., leading to a further loss of personal freedoms. With government-paid health care, any risky or healthy lifestyle will raise the dollar cost to society. Thus, politicians will be in a strong position to pass more "sin" taxes on things like alcohol, high-fat food, smoking, etc. They could ban trans fat, limit msg, eliminate high-fructose corn syrup, and so on. For some health nuts, this may sound like a good thing. But pretty soon, people will find they no longer have the option to enjoy their favorite foods, even in moderation, or alternatively, the cost of the items will be sky high. Also, it just gives the government yet another method of controlling our lives, further eroding the very definition of America, Land of the Free. 

I fell for it too, at first. This argument plays on our fears of losing our ability to "'sin'" away with our bad habits. But if you pay attention, you can see this argument is actually MIXING two different thoughts, as well as two different categories. I need to clarfiy. Yes, there is a POSSIBILITY that there MIGHT be some sort of tax on unhealthy consumable items. But this argument sneaks in the idea of BANNING specific substances. Just because trans fat and msg are limited or eliminated does not mean that fast food will disappear or be expensive. If anything, it means the opposite. If unhealthy food can no longer be unhealthy because it's not made with unhealthy things, why would there be a tax or ban on it? And eating fast food and smoking are not comparable. Smoking can harm people around the smoker, and is bad for you both short-term and long term. The negative effects of fast food do not harm someone not eating it, and is short-term. Regulating smoking, even in the form of a ban, can help save lives.  

13. Like social security, any government benefit eventually is taken as a "right" by the public, meaning that it's politically near impossible to remove or curtail it later on when costs get out of control. Social security was originally put in place to help seniors live the last few years of their lives; however, the retirement age of 65 was set when average life spans were dramactically shorter. Now that people are regular living into their 90s or longer, costs are skyrocketing out of control, making the program unsustainable. Despite the fact that all politicians know the system is heading for bankruptcy in a couple decades, no one is rushing to fix it. When President Bush tried to re-structure it with private accounts, the Democrats ran a scare campaign about Bush's intention to "take away your social security". Even though he promised no change in benefits, the fact that he was proposing change at all was enough to kill the effort, despite the fact that Democrats offered zero alternative plan to fix it. Despite Republican control of the presidency and both houses, Bush was not even close to having the political support to fix something that has to be fixed ASAP; politicians simply didn't want to risk their re-elections. The same pattern is true with virtually all government spending programs. Do you think politicians will ever be able to cut education spending or unemployment insurance?...Only if they have a political death wish. In time, the same would be true of universal health care spending. As costs skyrocket because of government inefficiency and an aging population, politicians will never be able to re-structure the system, remove benefits, or put private practice options back in the system....that is, unless they want to give up hope of re-election. With record debt levels already in place, we can't afford to put in another "untouchable" spending program, especially one with the capacity to easily pass defense and social security in cost.

Actually, because of the failing Social Security system, we now have the foresight to prevent something like it happening with universal healthcare. The program should be designed to be flexible - to be ammendable, like the Constitution, in the future. Thanks, Argument 13, for helping us plan ahead.


America won't get anywhere if its people can't recognize how important we are to each other. Helping to take care of others is both the pragmatic and the MORAL thing to do. Let's try to catch up with the rest of the world.

Sources

"Five Basic Facts on the Uninsured". The Henry J. Kaiser Family Foundation. 10 December 2008 <http://kff.org/uninsured/7806.cfm>.

Messerli, Joe. "Should the Government Provide Free Universal Health Care for All Americans?." BalancedPolitics.org 9/25/08 3 Dec 2008 <http://www.balancedpolitics.org/universal_health_care.htm>.


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