Son: All republicans seem to do is say "No!" Some democrats are at least trying to provide universal healthcare, and all republicans do is block their efforts. Bush even vetoes covering more children's healthcare! How can you support a party that won't support the millions out there who don't have coverage?
Dad: Some not covered are non-citizens. Half are between jobs and will be out of care for less than four months. A third of them have household incomes over $50,000 and could pay for some coverage. Some can't find or afford care; they deserve the government programs that are available. The magic word is "universal." There's a big difference between helping people in poverty and extending benefits to people who could pay themselves.
Son: We spend more on healthcare than any other country. They have universal care in Canada and parts of Europe, and they spend less.
Dad: You've been reading. Single-payer systems have different costs-long lines for service, months-long delays for important, necessary procedures and operations, and the rationing that inevitably occurs when government's takeover healthcare. Many of those same countries are now finding that they can't afford their plans. They're also finding it's hard to take back what they've already promised. Their citizens complain about their systems. You don't read about it here, but in the UK, they're facing the prospect of adding income taxes to pay for healthcare. Some in the Labor party are even talking about privatization. Many end up coming here for life-saving surgery and pay for it themselves. Look, saying "no" isn't popular with teens or citizens!
Son: But our system isn't working!
Dad: Yes, healthcare has its problems, but the solutions that expand the scope and cost of government will just make it worse. Our governor says he's a Republican, but it's getting harder and harder to prove it. Most rank-and-file Republicans want smaller government, not more entitlements. Unfortunately, he may get the votes he needs, but Californians will end up the losers. We'll be saddled with another entitlement we can't afford, and more businesses will be chased out of the state.
Son: It won't cost that much.
Dad: Programs never cost what the politicians promise. Over time you learn that every election is an advance auction sale of stolen goods; the politicians' promises today are the higher taxes of tomorrow! People want it all, but they want someone else to pay for it. They don't just want healthcare insurance; they want quality healthcare for next to nothing! Before you vote, realize that these politicians just keep borrowing on your generation's credit card. You're the ones who will get the brunt of the bill.
Son: How'd this happen?
Dad: Usually, insurance is meant for extraordinary circumstances, the big problems. You don't use car insurance to pay for oil changes or gasoline; it's there to protect you if you have an accident or your car is stolen. You don't use homeowners' insurance to pay your electricity and water bills; you have it as protection in case of fire or other catastrophes. So you shop for the best deal you can get on insurance with the deductible you can handle, and then you take care of paying for the other costs yourself. It makes you shop for the best deals you can get, because it's your money you're spending!
Son: Healthcare is different.
Dad: They've made it different. People have been spoiled by politicians and corporations that have over-promised and now can't afford it. People have come to demand the best care, and they rebel at paying even a small deductible or co-payment. Obviously, any insurance policy that promises to cover every small, ordinary expense makes everything more expensive.
Son: Why?
Dad: The biggest reason is simple supply and demand. By reducing the patient's out-of-pocket costs and making treatment less costly to the patients, it just increases the demand for doctors and hospitals. When there aren't enough doctors to meet the demand, the costs go up. Then those paying-the corporations and government-want more accountability to control costs. Soon doctors and other medical personnel are spending more time handling paperwork and complying with regulations. That just makes the costs rise higher. Oh, then you start suing people because care isn't perfect; that adds litigation and judgment costs as well as unnecessary tests and procedures to protect the butts of those providing care.
Son: Access to good care is what counts!
Dad: Good care is what it should be about. But with the single-payer, public service model, the doctor's contractual commitment isn't with his patient; it's with the state. When doctors are independent contractors offering their services directly to patients, their livelihood is dependent on the quality and availability of care they provide. We've almost destroyed that relationship.
Son: If you are so smart, what would you do?
Dad: That's a conversation for tomorrow. I've got to get to work to pay for the standard of living you've come to expect.
Byline: Dr. Terry Paulson is a psychologist, speaker, author and host to the PoliticalTalk Blog. This column first appeared in the Ventura County Star, November 26, 2007, B-6.
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