A preview of the coming national health care debate
It used to be that political advertising was mostly limited to the election season. But lately, during the 11 o'clock news, New Yorkers have been treated to a back-and-forth ad battle between liberal Democratic Gov. Eliot Spitzer and a coalition of hospitals and the big healthcare-workers union. Spitzer wants to reduce state health spending, especially Medicare payments to hospitals; he also wants to expand Medicaid coverage for the uninsured. Here's a sample of the ads. First the ad from the union and hospitals:
The New York Post is reporting today that the hospitals group has pulled out of the campaign. Here's the ad from the governor:
So... scrappy, compassionate nurses, or angelic sick kids. Which do you like better?
We're going to see more of this kind of thing all across the country, and eventually it's going to become a feature of the national debate. Whether we end up with a system of universal care, or plod along with the current "private" system in which the government pays for 45% to 60% of spending, or do something market-based, this country is going to have to figure out a way to control health care costs. If we move towards more, rather than less, government involvement in health care--and that's my prediction--voters will have to make some choices.
Should we hold down the salaries of hard-working nurses? Squeeze the incomes of expensively trained and dedicated doctors? Put pressure on the profits of the drug companies that develop all these great new treatments? Shut down hospitals in vulnerable communities? Raise taxes on Joe Citizen? Provide only spartan care to the young, the poor, and the aged? Every potential loser will have a sympathetic case to make. And every one of them will buy an ad, except for the young and the poor. Insurance companies will have a tougher time getting anyone to feel sorry for them, but they'll eat up plenty of air time to call for preserving "choice."
This is one of the most challenging debates we can have in a democracy. I'm hopeful that it will move beyond dueling 30-second ads. But they'll be a factor.
(By the way, the Albany Times-Union has been doing a better job than most at clearing through the noise in the New York debate. Click here and here for more detail on what's at stake.)
Anyone who pays attention to me knows that I'm a very strong proponent of a single-payer universal health care (with providers remaining completely in the private sector). Not that anyone pays attention to me.
However, whether we go to a single-payer system or not, we need to work with the law of supply and demand. The fastest way to increase the supply of medical care would be to legalize basic health care provision by Physician Assistants and Registered Nurses with Master's degrees. Allow those with Bachelor's degrees to work under the supervision of those with a Master's. This would instantly increase the supply of caregivers at the "general practitioner" level and drive down prices. What's more, the ability to go into medical care with a Master's degree rather than the extensive M.D. program would encourage young people to go into the field, increasing the supply even more. M.D.'s can be the specialists that the new "first tier" refer patients to when necessary. However, such issues as colds, flues, and minor injuries could easily be handled by a degreed P.A. or R.N.
The AMA fights this and will create scare tactics about the ability of P.A.'s and R.N.'s to provide this care. However, anyone who has worked inside health care knows better. The AMA and insurance cartel need to be demolished; and we can do it with a change of the law, and simple supply and demand.
Let's get back to one of the basic facts with regard to banks, mortgage companies and other financial institutions (insurance companies come to mind) who in certain cases are "forced" by regulators and laws on the books to enter into bad business practices (see discriminatory lending practices). Each credit risk should be treated as an individual case and "risk adjusted returns" should be the norm for loans, credit card interest rates, and also insurance premiums (assigned risk pools). Unfortunately, when businesses charge variable rates based on risk (it only seems fair that the higher the degree of risk for loan default, the higher the interest rate return to the loaning institution should be) they are seen as charging "onerous and excessive" rates, often deemed to be discriminatory and illegal. Many of these loans, and credit cards as well, should never have been issued. That's one of the basic risks the originating credit issuer takes (defaults) and also a risk that parties accepting the loans take (personal bankruptcy brought on by overzealous borrowing). If a loaning institution makes a bad loan, they should be responsible for the loss. Shareholders of that company will suffer and if the practice becomes problematic, management changes will be directed by the will of the shareholders. If the individuals entering into the loans default on the loan, they should be facing the consequences of not meeting their contractual obligation. With mortgages, foreclosure of the property and liquidating the asset should be the right of the institution issuing the loan. Every person who enters into these agreements faces the same risk. It is simply not fair and equitable to have others subsidize the losses of those who entered into "too risky" an agreement. In many cases, people have purchased too big a house, yet at the same time, did they lease an economy car, or buy a used car? Did they give up their cell phones (costly bills each month)or cancel their cable TV service??? Their is a basic law of economics, you can only consume what you produce! Unfortunately, in our country especially (see federal and state budget deficits), we all too often throw that line of thinking out the window! You know the window I'm talking about......the window we purchased on our credit card which we've only been paying minimum payments on for 8 years, for the house we purchased through an "interest only" loan 2 years ago without any background check as to our income and financial well being!! And when that "line of thinking" we threw out the window lands, it will probably land on the roof of the new car we leased for $650 a month, which the "repo man" will be searching for tonight!! GOOD GRIEF! Whatever happened to personal accountability and accepting the consequences that were clearly spelled out in an agreement we willingly signed???
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