I read an opinion piece in yesterday's Star Ledger that was sourced from the Washington Post columnist, Robert J. Samuelson. In his column, which was entitled in the Ledger, "The Great Miseducation on Health Care," he debunks a number of arguments that are often made in support of health care reform. They include:
Uninsured people use the Emergency Rooms of hospitals for their medical care, which is more expensive. Thus, the idea goes, if everyone had health care, costs would decrease since there would be fewer people accessing the ER for their primary care.
However, according to Samuelson,
"A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency-room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found. More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was 'more convenient' to go to the emergency room or they couldn't 'get [a doctor's] appointment as soon as needed.' If universal coverage makes appointments harder to get, emergency-room use may increase."
Insuring the uninsured will improve the nation's health. Again, Samuelson denies this claim, citing a number of studies showing conflicting results from previous health care improvements such as Medicare. His explanation:
"How could this be? No one knows, but possible explanations include: (a) many uninsured are fairly healthy -- about two-fifths are age 18 to 34; (b) some are too sick to be helped or have problems rooted in personal behaviors -- smoking, diet, drinking or drug abuse; and (c) the uninsured already receive 50 to 70 percent of the care of the insured from hospitals, clinics and doctors, estimates the Congressional Budget Office."
He goes on to say that the real problem is cost and uncontrolled spending, and criticizes the current bill for not addressing this issue. He concludes:
"He's telling people what they want to hear, not what they need to know. Whatever their sins, insurers are mainly intermediaries; they pass along the costs of the delivery system. In 2009, the largest 14 insurers had profits of roughly $9 billion; that approached 0.4 percent of total health spending of $2.472 trillion. This hardly explains high health costs. What people need to know is that Obama's plan evades health care's major problems and would worsen the budget outlook. It's a big new spending program when government hasn't paid for the spending programs it already has."
Of course, the fallacy of his conclusion is that "Insurers are mainly intermediaries; they pass along the costs of the delivery system." No, the main problem with the insurers is they are geared toward making a profit, and they try to get out of covering anyone who really needs the insurance, such as, say, sick people. Maybe profit isn't that large a percentage of overall health care costs, but it is certainly the motivating factor behind insurance company policies which result in sick people being unable to become insured, or if insured, not being covered for their illnesses.
The other problem with the insurance industry when there isn't universal coverage is, that people who have the insurance get a much CHEAPER rate than those who don't. So uninsured people are hit from two sides: One, they have to pay out of their own pockets for medical care, and two: their medical care is much more expensive than that of people with insurance.
If anyone can show me this is not true, I welcome it. But I've seen my bills from medical procedures. They show one, very high, price, then the "adjusted" price accepted by the doctor from my insurance, and then what my insurance pays, leaving a small amount for me to pay. I can only assume the uninsured pay the first price. If everyone were insured, there would be only the "adjusted" price. And that alone would be a vast improvement.
OK, so where does that leave us with President Obama's arguments in favor of health care? Is he really lying to us and not telling us "what we need to know"? No. He is giving the arguments that will pass muster with the portion of the population who have drunk the Kool-Aid of the right wing and think the main problem is they will lose something in this bargain. They will get screwed somehow if their uninsured neighbor manages to get the same benefits they have. They will have to pay more. They will lose something they had. It's all about them.
So to reach those people, he has to give them cost-related, "them"-related arguments. The rest know that health care for all is the right thing to do and don't care as much about those arguments.
Think I'm being unkind to those opposed to the health care legislation on the right? Check out Nick Silver's post on fivethirtyeight.com on the two sides of the health care debate. In his post he analyzes the results of a recent Gallup poll that included the verbatims (what people actually said, for those who don't know market research-speak) from the survey. The results showed that the nation is almost equally divided on the current legislation, with a slight tip against the bill, 48% to 45%.
Among those who support the legislation, 29% say it is because "people need health insurance/too many are uninsured." In addition, 12% said it is "a moral responsibility." 12% also felt it would reduce costs and 10% said it would make health insurance more affordable. Several key reasons included the word "help" as in, "help senior citizens," "help the poor," and that they or a family member lacked insurance.
Among those against the legislation, the top reason was it would increase costs of insurance (20%) and another 5% said it would cost the government too much. 15% were opposed to government involvement in health care or "big government" in general. 7% mentioned being against "socialized medicine" -- even though Obama's plan is not socialized medicine -- or the "public option," even though the public option is not currently in the bill. 6% said that health care is a privilege, not an entitlement and 4% were worried it would affect their own insurance.
To be sure, some of the pro-health care people are concerned about costs and are thinking this would be a way to reduce them, and if this isn't true, they have perhaps been misled. However, that does not seem to be the most important issue to them.
When you look at the verbatims themselves, the pattern is more noticeable. FiveThirtyEight.com provided "word clouds" showing the prevalence of certain words in the actual comments the respondents made to the survey.
Pro-Health Care respondents focused mostly on words like "People," "Need," "Everyone" "Insurance."
Anti-Health Care respondents, in contrast, focused much more on words such as "Government," "Pay," and "Cost," as well as "People" and "Insurance."
When you look at some of the actual comments, which Silver posted a link to on his site, "Pro" people said things like:
"THE HEALTHCARE SYSTEM IN OUR COUNTRY IS AN ABOMINATION. BECAUSE THE GREATEST COUNTRY IN THE WORLD HAS A DISMAL HEALTHCARE SYSTEM. HEALTHCARE IS A RIGHT, NOT A PRIVILEGE.
BECAUSE THIS COUNTRY IS TERRIBLE FOR US. THE BIGGEST COUNTRY IN THE WORLD NOT TO HAVE HEALTHCARE FOR THEIR PEOPLE. I'M SET BUT MY CHILDREN WON'T BE. THEY NEED TO GIVE IT A START.
I THINK WE ARE IN A FIRST-WORLD COUNTRY THAT SHOULD HAVE HEALTHCARE INSURANCE. I AM FORTUNATE TO HAVE INSURANCE BUT I DON'T KNOW HOW OTHER PEOPLE MAKE IT WHO DO NOT HAVE INSURANCE. MEDICARE DOESN'T COVER EVERYTHING. MEDICARE ONLY PAYS 80 PERCENT AND SOMEONE HAS TO PAY THE DIFFERENCE.
IT'S OUR BASIC DUTY TO PROVIDE HEALTHCARE FOR THE POOR AND ELDERLY.
SO PEOPLE CAN GET HELP.
BECAUSE I THINK IT'S NEEDED TO CHANGE TO SAVE MONEY FOR SOME PEOPLE THAT DON'T HAVE IT BECAUSE EVERYBODY SHOULD HAVE HEALTHCARE.
I DON'T THINK IT'S FAIR FOR PEOPLE TO BE WITHOUT HEALTHCARE COVERAGE.
BECAUSE I FEEL EVERYONE SHOULD HAVE ACCESS TO HEALTHCARE REGARDLESS OF INCOME, EMPLOYMENT, AND WHERE THEY LIVE."
Among the "Anti" respondents, comments skewed toward these:
"I BELIEVE IT'S GOING TO SCREW EVERYTHING UP WITH THE GOVERNMENT GETTING INVOLVED. YOU WON'T BE ABLE TO GET THE CARE YOU NEED. PEOPLE WILL BE TURNED AWAY.
I FEEL THAT THEY ARE TRYING TO LEAN TOWARDS WHAT EUROPEAN COUNTRIES. NONE OF IT WORKED. ALL FAILED. EVERYBODY THAT'S TRIED HAS FAILED. IT WILL HURT ME. I'M DIABETIC AND IT WOULD PUSH ME INTO SOMETHING. I HAVE A DOCTOR WHO TAKES CARE OF ME. IF THEY GO WITH THE REFORM, I CAN'T CHOOSE MY DOCTOR.
GOVERNMENT TAKEOVER AND INCREASED DEBT.
IT WILL BE SOCIALIZED MEDICINE.
THE COST TO ME, AND THAT PEOPLE WHO CHOOSE TO HAVE UNHEALTHY LIFESTYLES, LIKE DOING DRUGS AND SMOKING, I SHOULDN'T HAVE TO PAY FOR.
I DON'T THINK PEOPLE SHOULD GET THINGS FOR NOTHING.
I DON'T WANNA HAVE TO PAY FOR SOMEONE ELSE'S HEALTHCARE, THAT'S WHAT WELFARE IS FOR. I CHOSE A CAREER THAT PAYS FOR MY HEALTHCARE.
I THINK EVERYONE SHOULD WORK AND SUPPLY THEIR OWN INSURANCE.
GOVERNMENT TAKEOVER AND INCREASED DEBT.
BECAUSE I DON'T WANNA HAVE MONEY TAKEN OUT OF MY CHECK TO PAY FOR PEOPLE WHO WON'T WORK"
Yes, I cherrypicked these comments. However, let me be clear, the "Pro" people had no verbatims that talked about "I don't want to pay for someone else" or "I don't want to pay for people who won't work."
If you want to look at the entire list, please go to FiveThirtyEight.com and click on "verbatim responses" in the first paragraph.
I felt this was a very telling survey result, and an example of how looking at the verbatims can really take you behind the numbers and understand the mindset of the people responding to the survey.
It is obvious that the "Anti" respondents are highly influenced by the right-wing talking points and have a much more egocentric outlook on the subject. The "Pro" respondents, while still concerned about costs in general, appear to be much more altruistic in their outlooks and talk much more about helping others.
So is it any wonder that, in order to convince people who are not currently on the health care bandwagon to support his initiative, President Obama has to appeal to the cost side of the equation and not the altruism side?
In reality, I don't know whether expanding health care coverage to the uninsured will increase or decrease overall costs. I think it remains to be seen. But that is not the real reason we should be increasing coverage of the uninsured. It's just the right thing to do.
As for the left-wing opponents of the bill, all I can say is what one pro-health care respondent said:
"THEY GOTTA MAKE ONE STEP AND THEN ANOTHER AND THEN ADJUST IT IF YOU NEED TO, BUT YOU CAN'T SIT ON YOUR THUMBS AND DO NOTHING."
Dennis Kucinich, I love you and think you are ideologically pure. But opposing this bill will not be helpful. The result, if it fails, is that nothing at all will be done; and in addition, President Obama will have a very difficult time getting anything else accomplished. The Republicans will feel they have won and have the upper hand. And that would be a disaster. I'm not saying the bill is perfect as it is, far from it. But it will help insure more people, and will accomplish part of what needs to be done. Rome is never built in a day.