Health Care: A Basic Value of an Advanced Economy

As Americans ponder the health care reform initiatives now coming from Congress and the Obama Administration, I want to say a few words about what the subject means to me.

America is often touted as the richest country in the world. It is certainly a rich nation with an advanced economy. As such, certain basic services and protections should be taken for granted. What is the point of being a rich nation if basic needs are not met?

From the beginning, national defense was a clear service and protection offered to all residents. Eventually, these protections and services expanded to include education and the right to vote for all adult citizens. After the calamity that was the Great Depression, we also realized that a less porous social safety net was necessary. Unemployment insurance came into being.

Now, in the 21st century, more than 230 years after our first Independence Day, isn’t it time that access to insured basic preventive and emergency health care get added to this list?

I am not saying that all American residents must have comprehensive coverage. What I am saying is this: it is utterly deplorable that the richest nation in the world could allow millions of its own citizens and residents not to have insurance against basic health care needs. You must question the value system of a nation which allows many of its residents to be bankrupted in order to get healthy.

Let’s be honest, when costly services like education and health care are provided for through a common pot and everyone pays the same amount, some people are going to get a better deal than others. But, so what? That is the reality.

So, when you are thinking about health care reform and how to get it, you should be asking yourself why we need reform at all. To me, it has little to do with cost, little to do with who administers it, and little to do with who profits from it. Those are technical issues – vitally important to cracking this nut, but not the core issue of health care insurance.

The core of this debate has to do with basic values: Which rights and protections do Americans believe should be available to all residents of an advanced economy in the 21st century? In my view, health care insurance is one of them.

Comments

[ain't no fo...:]

"You must question the value system of a nation which allows many of its residents to be bankrupted in order to get healthy."

I totally agree with you Mr. Harrison. The fact that we allow 50 million+/- of our citizens to face uncertainty, fear and potential personal bankruptcy or death because they are not "privileged" enough to be able to afford healthcare is a disgrace.

The insurance lobby and the "I've got mine - screw you" crowd scream "socialized health care" as if it were a crime - when all they are doing is calculatingly distracting the discussion from what it should always have been about - the world's supposedly most enlightened, advanced economic powerhouse having the integrity and compassion to provide for its own, many of whom through no fault or action of their own are the most vulnerable and susceptible.

And by the way, the benefits of having a physically healthier populace will no doubt result in a healthier economy, more corporate productivity and therefore profitability, less crime, etc etc etc.

Its a disgrace that we have let it go on so long, and it starts in Congress, which is the most advantaged "I've got mine" group in the country, with the best health care plan in America. I'd like to see Congress step up for once and have the guts to walk their talk.

Jul 02 01:24 PM

[Paul in Texas:]

In the Declaration of Independence, we declare "... certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." You are willing to take away my unalienable rights for someone else's welfare. No! I will fight for my rights as did our ancestors. We need to resist every step we take toward socialism. Whether we can turn this country around or not remains to be seen, but I will not give up.

Jul 02 02:08 PM

[bigmoney:]

the theory is good, but universal healthcare in a welfare state with wide open borders makes you wonder. Furthermore, in the old days, many women married for money and status. These days, some marry for health insurance. National healthcare will just encourage ever more women that they are "independent", and prefer to be single mothers.

Jul 03 01:18 AM

[John Lounsbury:]

I think there are two components of health care insurance that should be considered. First, there is the basic health care coverage that Edward talks about. This is something that is needed by a large percentage of Americans every year. If it were results oriented (rather than procedure oriented), I believe costs would be lower.

But there is a second aspect of insurance, and that is catastrophic health care. Maybe one in 100 (or maybe 1,000?) have such an event each year. (I don't have accurate statistics, just making a guess.) Let's arbitrarily define catastrophic expense as $50,000 or more in a year, although the amount could be means tested and scaled to family income. This is a second aspect of insurance that is more amenable to the basic use of insurance: protection against a rare but catastrophic event. If the threshhold is $50,000, maybe the average is $100,000. Then than apportioned risk (for one chance in a hundred) is $1,000 per person per year. If the probability is one in 500 each year, then the apportioned risk is $200 per person per year and at 1:1,000, $100 per person per year. You can calculate the apportioned risk for any other probability you think is more appropriate.

Let's take the apportioned risk at $200 per person per year and add 20% for administration. That comes out to catastrophic coverage cost of $20 per month per person. This would be a small adder to the cost of basic coverage and would protect against the 10 or 20% probability (maybe higher?) of being forced into poverty or bankruptcy during a lifetime because of a medical catastrophe.

Edward, you have raised some good points and have gotten a good cross section of opinion in just a few comments. I hope I added something to the discussion, by moving away from social issues to focus on an insurance issue.

Jul 03 01:52 PM

[Swashbuckler:]

IMO, providing basic health care to a person in need is certainly no worse than our tax dollars being pi$$ed away on supporting some foreign government. And no worse than using the income extorted from taxpayers to provide hookers and limos to our congressmen (as per recent headlines).

Jul 03 03:18 PM

[Edward Harr...:]

As always, John, you provide an impressive amount of insight into the question. I will re-post a comment I made on my site on the same post that I think is relevant to what you are talking about because the catastrophe insurance is much to the point. I also feel that basic preventive care should also be covered because studies show that lack of preventive care leads to a greater likelihood of catastrophic medical intervention.

Here is what I wrote (with reference to a good comment bout the need for access to health care and not health care (catastrophe) insurance:

I should point out to commenters here that nowhere have I mentioned who supplies the services and protections we receive. Nor have I endorsed specific services and protections other than health care.

For what it's worth, I don't like the way social security is structured (pay as you go). I think we need to cut entitlement programs (huge unfunded liabilities). And I don't like the way unemployment insurance is administered (through the employer).

The fact that most of you who disagree with me keep pointing to the government and universal health care suggests less than an open mind. It illustrates bias. I suggest you re-read the post and you will see what I mean.

My point as nothing to do with universal health care or government funding. Again it is that health care INSURANCE for everyone is necessary in the same way car insurance for everyone is necessary. How you fund that insurance scheme is another question that I m NOT addressing here. (It could be funded privately, nationally, or by states or communities. Re-read the post and you will see this)

So, fresnodan, I have to disagree. It is not access to health care that concerns me here but insurance i.e. the protection against catastrophic financial loss both preventive and after the fact. Remember, the two big ticket material items most individuals own - cars and houses - are insured against catastrophic loss. Our health, our person needs similar insurance as healthcare is one of the largest expenses in anyone's budget and a catastrophic loss is a major cause of bankruptcy.

As to the U.S. system, I have to agree with Joel's sentiments here. I have had the opportunity to be a part of health care systems in other countries. My daughter was born on the NHS healthcare system even though at the time I had private insurance as well. And contrary to what people will tell you, the U.S. system is not undeniably better than others.

In fact, my experiences in the U.S. have been negative: which doctor can I see, how much will you cover, does insurance cover this medicine? These ridiculous questions are ones I never had to answer in other countries. I had been able to go to any doctor who could prescribe any procedure or medicine.

You may not know this but Americans pay more for drugs than Europeans, such that we are generally either subsidizing their drug purchases or helping the drug companies make more money - take your pick.


On Jul 03 01:52 PM John Lounsbury wrote:

Edward, you have raised some good points and have gotten a good cross section of opinion in just a few comments. I hope I added something to the discussion, by moving away from social issues to focus on an insurance issue.

Jul 03 03:31 PM