Band-Aids and Prop-ups

Now that I have taken a livelier role in the debate on health care and health care reform I have learned a great deal from the arguments of those who think a business model of medicine is the best cure. Knowing the arguments of both sides of any debate helps you understand not only the weaknesses of your own position (if you are open to it) but also the strengths and weaknesses of those who stand firmly in opposition.

It seems to me that one of the major arguments for pro-business medicine has been the constant finger pointing at government programs with all its bureaucracy, wasteful spending and the unintended consequences associated with such. These are good points, where the government has stepped in for health care; reimbursements are low, covered services are nonsensical, red tape is at the maximum, requirements are unbelievable and potential for abuse and waste is……well, more than potential but reality.

Upon pondering these points and reviewing the spirit of all the government health care programs that I know, the obvious and hardly mentioned point hit me. All government health care programs, right from the beginning and to date have been formulated for the sole purpose of patching holes in the business model! This is no example of government run health care, this is the government supporting in a rather covert way, business run health care. Medicare was formed because non of the insurance companies wanted to cover the elderly, they are a significant profit risk, Medicaid was for the poor that the insurance companies wouldn’t cover, EMTALA is for emergencies that the private hospitals otherwise wouldn’t provide care for, critical access hospitals are for the areas of the country where hospitals wouldn’t be profitable thus would not be built, HIPPA, COBRA, it goes on and on. Really what we are talking about is prop-ups and band-aides designed to fill the voids and gaps where a business model would have left a much greater portion of the American population “out in the cold” when it comes to health care.

I propose that if the government had not stepped in with band-aids and props the public would have revolted long ago for a more palatable health care system. In fact, despite the mass tragedy of it, I think we should tear off the band-aides and props let the system collapse and allow people to see what a business model of medical care really does. OK, that is too radical; on the other hand, nothing would move us forward faster.

One other point on "free market" medicine. By all accounts that I am aware of a market is defined by a group of people who would be interested in and be able to purchase a particular product. There is no "market" that I know of that includes all people when the product is both complex and moderately expensive. So, by nature and design "free market" medicine will leave out a substantial portion of the population. Who will care for these people? I suggest anyone interested try a little exercise, go to a crowded place and decide........say.........1 in 10 people do not deserve medical care because they are not defined by the market, then you decide who they should be.

Finally, if it is not obvious at this point, I would say that the current government band-aides are no example of what a government “run” system could or would do, if you want to see that take a look at the VA system (by most accounts, quite efficient and well run). My retort then is, “government run health care that you so strongly criticize is the only thing keeping your business model of medicine afloat, which, if it needs that much help obviously isn’t working and should be scrapped, let’s sit down, your side and mine, your arguments and mine and “design” a system that we can live with and benefits us all.”