Friday, October 05, 2007

Now we'll say it's in God's hands

I guess it's old news by now that President Bush vetoed the bill that would expand SCHIP to cover more children who currently don't have health insurance. I think almost every blog I regularly read mentioned it at least in passing; there's even a post on the ProHealth Fibromyalgia/CFS forum about it (registration required). I don't think anyone in the US would be willing to make the claim that our health care system is functional, and I wouldn't be surprised if health care was a major issue in the next election, maybe even as important as the War.

I have a hard time following the various proposals for change that have been put forward. I would like to be able to analyze the merits of Clinton's plan v. Edward's plan v. the Republican plan (do they even have one?), but every time I try to wade into the technicalities, I fall asleep after about the first paragraph. Technicalities are no longer my strong point.

However, there are a few basic ideas that I think I have a handle on. As far as theories about the appropriate government role in health care, I believe it comes down to the government either managing regulation of the industry to keep costs low or pouring money in to pay the industry for the care of poor people or some combination of the two. There are a lot of side issues, like research and development and the control of medication due to the War on Drugs, but the main issue is what government should do to make the system work.

I wish I knew the answer to this question. I guess a lot of people wish they knew the answer, because obviously no one does, or the ill would not be automatically destitute while insurance bureaucrats gorge on the last penny of the elderly and dying. I don't trust the government- I regard it with a visceral suspicion. Even if I thought it were possible for a government agency to run a really efficient and friendly and effective health care program, I wouldn't believe that's what would actually happen if the government took over the industry. But as someone who never expected to be disabled but who is almost entirely helpless now, I am even less eager to throw myself on the mercies of the market.

I can't see my way to unequivocally supporting SCHIP funding for families that make $60-80k a year. That kind of income seems like riches from where I'm sitting. I don't see how you could be poor, making that much money. And raising taxes on cigarettes seems like an especially cruel way to pay for it. If you're going to tax something that's socially unacceptable in order to make ends meet, at least be gracious enough not to tax something that's horribly addicting. Tax sugar, tax sitcoms, tax rich people's children, tax blond hair dye, whatever, don't tax something that people can't give up without medical intervention.

On the other hand, serious illness is catastrophically expensive, and all too often the expense hits right when you lose your job because you're too ill to work. Having insurance doesn't mean you're safe, and neither does Social Security. Serious illness is devastating all by itself, even without financial ruin, and it's not like the safety nets we currently have make your life easy. I regularly lurk on the ProHealth board, reading the stories of people who have fibromyalgia and aren't lucky enough to be veterans. The luckiest of people have spouses who can support them and houses to sell to pay their medical debts; the unlucky are young and alone, living in abject poverty for years in order to qualify for a measly couple of hundred dollars a month of welfare and a Medicare system that will deny them coverage for the treatments that help the most. It's heartbreaking. For all my libertarian tendencies, I believe that there should be a better system for these people. If society means anything, I think it must mean taking care of those who are unable to take care of themselves.

I guess my real opinion on the matter is that the whole system is broken, not just how we pay for medicine but how we do medicine. I would like to see a complete, from the ground up re-do of American medicine, that changes things from how strictly we control medicine to the whole concept of hospitals to how doctors are educated. In some ways, American medicine is great. Cancer treatment, for example, is one of the things that we usually do right. But so many things are wrong with it, and I don't have any expectation that changing payers will cure the deep structural problems.

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