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About health care ...

Note: The following is another in a series of columns on subjects of a philosophical or ethical nature by a Schuyler County resident who prefers to go by the nom de plume of A. Moralis -- a reference to what the writer sees as the lack of a moral compass in this country during this rapidly changing Age of the Internet.

By A. Moralis

When it comes to the subject of health care,
It certainly helps to have wealth there.
The Dems want a law
That would cover us all
'Cause they always look out for our welfare.

That slightly sarcastic verse pretty much has the elements being juggled around in Washington as the politicians try their mightiest -- which is to say in a rather haphazard, stumbling way -- to improve health care in the United States: elements such as the haves, the have nots, a controlling party with a tax-and-spend history, and an air of flibbertigibbety.

Not that health care isn't serious stuff. It's just that when such momentous issues as health reform are left in the hands of politicians ... well, look where we are today after years of rather mind-bogglingly spiraling health costs. A lot of that -- can you say direct-to-consumer advertising? -- can be placed at the feet of our permissive politicians.

Call it what you may -- and the mainstream media can't decide whether it's socialized medicine, national health care, government-run health, Universal Health Care, or Health Care Reform -- it sits now before the U.S. Senate. That's a hundred duly-elected representatives looking out for your welfare -- and in marked disagreement on some key points with the 435 duly elected representatives who passed a health reform bill not long ago that was acclaimed as historic ... before the media realized it was just a bill that was running into a Senate brick wall.

(The Senate, at this writing, has come up with its own 2,047-page proposal, which would -- early reports indicate -- require most Americans to carry health insurance, and prohibit insurance companies from denying coverage due to pre-existing medical conditions, among many other things. But Senate Republicans are staunchly opposed, and House-Senate negotiators still have to figure out an acceptable compromise.)

Whatever you call it -- and the hodgepodge of names itself would seem to signal its inherent ideological confusion -- welcome to the ongoing saga of health care reform, a lightning rod for debate, and unlikely to be passed any time soon.

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Will there ultimately be a health reform law? President Obama would have us believe there will -- that Congress will settle on a suitable bill that he will sign. But the guess here is that he will hold that signing option open in case the final version approved by Congress -- assuming one is -- doesn't meet with his prescribed criteria.

In any event, he has steadfastly maintained that everyone has the right to health care.

Which begs the question: Just when did health care become a right?

But right or privilege aside: Why does the subject instill such tangible fear in some people? Such anger?

We’ve seen it on TV and in person -- at town hall meetings, on the floor of Congress, and at rallies. Folks have been showing up in force to express their displeasure.

Some things never change -- thank God. A basic strength of this country has always been our contrariness and our independence. Without either, we wouldn't have had the Revolutionary War or the Alamo, and we wouldn't have battled the raw elements and the natives to spread our wings west..

And we generally, on balance, have an innate streak of fairness. Without it, we might not have had the Emancipation Proclamation, women's suffrage and the Civil Rights Act.

The politicians like to play to all of those traits: appeal to our contrariness (get us debating so much sometimes that we lose sight of what they're up to), our independence and our sense of fairness.

It's only fair, they say, that everyone have health care. And rather than give us a handout, they're playing to our independent side in maintaining that everyone should pay in to whatever system is devised. And knowing that the class system is an inherent part of the debate, they are letting our contrariness -- fueled by class divisions -- run their natural course.

Many of the speakers at the town hall meetings and rallies feel that government should stay out of the health care business, while others feel the system will be a burden to the middle class (a class already stressed and plagued by income taxes, property taxes, school taxes, local taxes, and state taxes).

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In truth, there are already various forms of government-run health care -- Public Health Agencies, Medicare, Medicaid, and the Veterans Administration, all very expensive to administer and which basically serve the poor (with the exception of Medicare, which is intended for all of our elderly).

Institutions that bill Medicare (hospitals, clinics, doctors’ offices and prisons – yes, prisons!!) must subscribe to an accrediting, surveying body (in New York State it’s The Joint Commission, or TJC) and pass inspections in order to bill Medicare. This has been mandated by the U.S. government and also supported by the World Health Organization (WHO).

WHO mandated that in order to be a member of its organization, American health institutions must subscribe to an accrediting body. It costs the institutions thousands of dollars a year to belong to one, and can financially stress them. The accrediting body can also impose punishments if an inspection is not passed, which may prevent the institution from billing Medicare -- another financial stressor, which adds to the cost of doing business.

This type of oversight is also spilling over into the secondary insurance arena (AETNA, Blue Cross/Blue Shield, etc.), which drives the cost up. This is significant because the rates to belong to TJC can range from $20,000 a year (for smaller institutions) up to $100,000 a year for larger medical centers. Do the math, and you realize that this alone generates millions of dollars annually for accreditation bodies.

Tort laws, malpractice, etc. also add to health care cost. Pharmaceutical companies need to be included in any reform, too. With the exception of New Zealand, the U.S. is the only country in the world that advertises its drugs direct to consumers -- utilizing newspapers, magazines, television, etc. And, naturally, that cost is passed along to us. And let’s not forget about the huge salaries and bonuses that are paid to pharmaceutical company CEOs. That also adds to the cost.

So ... are systems in other countries better than ours? Residents in those countries might say so, but they’re used to whatever they have. Familiarity might breed contempt, but it might also breed nationalism.

What makes health care great in any country is the ability of patients to have a relationship with a health-care provider -- the ability to speak with that provider honestly and openly, and not be rushed or time-mandated due to an insurance productivity mandate or by an accreditation standard.

Perhaps a solution to the high cost of Health Care lies outside of a government-influenced (or, as some fear, a government-run) health plan -- can be found in containing billing practices, abolishing government mandated memberships to accrediting bodies, reforming the legal system’s tendency toward frivolous malpractice suits, and finding a way to force the private insurance companies to offer varying and flexible policies affordable to all. Can that be done? It seems idealistic, but time would tell.

But first, there is the health care plan being debated. Among its proposed elements is an aspect that has triggered those fears of government control: the Public Option.

That option -- where government could in effect enter the fray as a competitor of the insurance firms --would, Obama has suggested, "keep them honest." It has a lot of support in various Washington circles, but also some fear-stricken opponents, and perhaps not enough backing in the Senate. It could, in fact, be a large stumbling block to a deal being completed.

If Congress does get its act together and sends the President a bill he can in good conscience sign -- if a national health care plan is put in place -- then it might be logical to assume that some politicians will urge movement toward even larger and more controversial plans: the abolition of Medicare, Medicaid and the Veterans Administration in a strategy aimed at equality in the health care arena.

But considering the entrenched nature of all of those programs, it seems doubtful that a majority of Congress would seriously entertain such measures any time soon -- although the President wants to connect a redistribution of Medicare payments to a national health plan.

In the end, though, amid all the current debates and maneuverings -- and looking ahead to what might follow -- we need to remind ourselves that government is not always the answer to our problems. Many times government is the problem.

But in the face of that problem, we always have three things going for us -- great balancers, if you will..

We have a general contrariness, an independence, and a sense of fairness that have long served us well ... and which continue to make anything seem at least possible.

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Previous A. Moralis columns:

The first one is here.
The second one is here.
The third one is here.