Our Bodies, Ourselves
Perhaps the central touchstone of the women's movement has been the ownership and decision-making for one's own body, starting of course with the freedom to choose an abortion, but extending into a number of other health and sex-related issues.
What amazes me, though, is how quickly all this is chucked out the window when it comes to having the government take over health care. Because many of the exact same people who have campaigned for the primacy of a person's decision-making for their own body are also strong supporters of government funded universal health care. And I can't think of anything less compatible with individual decision-making for one's own body than having the government run health care.
The demands for universal health care general come from two complaints:
- Health care is too expensive and is more than I can afford
- Health care quality is low. In this category, by far the most common complaint is that "my insurance won't pay for X procedure that I want, or Y level of care, etc."
Neither is a surprising complaint, given how our health care system is currently set up, and both are highly related to one another. The key problem in the US health care system is that, unlike just about any other product or service you and I purchase, the typical individual is not presented with a cost-quality tradeoff. Since most of us have a fixed price insurance plan, we couldn't care less how much anything costs, and in fact, like an all-you-can-eat buffet, our incentive is to use as much as possible.
This puts the insurance companies in the odd position of having to make cost-quality tradeoffs for us, via their coverage and treatment rules. But when they try to cut costs by narrowing or limiting certain treatments, consumers tend to get the government involved to remove these limitations. They either do this though legislation (many states now have onerous requirements on what procedures insurance companies must pay for in that state) or through litigation (the threat of lawsuits pushing doctors into expensive defensive medicine, asking that every conceivable test be conducted). In other words, people take their dissatisfaction with #2 above to the government, who acts, pushing up costs and making problem #1 worse.
Until we find ourselves in a Strossian post-scarcity world, someone is going to have to make this cost-quality tradeoff for our health care. Even if it is never discussed, this is the most important design factor in any health care system. There are only three choices:
- Individuals make these choices for themselves, paying for their health care and making their own decisions about whether certain procedures are "worth it". - OR -
- Insurance companies make these choices for us. (I am not sure this is even a choice any more, as government micro-management seems to be pushing this de facto into the next choice). - OR -
- The government makes these choices for everyone
So, folks that are pushing for government-funded universal health care are in fact saying "I want the government to take over decision-making for my body." Yuk! Where are the feminists when we need them?
Beyond just ceding to the government decisions such as whether its really worth it for dad to get his new hip joint, there is another chilling factor, which I have written about a number of times. Government health care will act as a Trojan Horse for nanny fascism. Because, you see, if the government is paying to fix your body, then you can't be trusted to do whatever you want with your body. By paying for your health care, the government has acquired an ownership interest in your body. You want that Wendy's cheeseburger? Sorry, but the government can't allow that if it is paying for your health care. Likewise, it is not going to allow your kid to play dodge ball at all or to play soccer without a helmet -- can't afford to fix all those broken bones. And no swing sets or monkey bars either!
Already, when its only affects us as individuals, the government is poking its nose into micro-managing our lives. Just think what will happen when the government has a financial incentive, in the form of health care costs, to do so! Eek! In fact, it is already happening:
People who are grossly overweight, who smoke heavily or drink excessively could be denied surgery or drugs following a decision by a Government agency yesterday. The National Institute for Health and Clinical Excellence (Nice) which advises on the clinical and cost effectiveness of treatments for the NHS, said that in some cases the "self-inflicted" nature of an illness should be taken into account.
New York City is at the forefront of this new public health movement. In January, city health officials began requiring that medical testing labs report the results of blood sugar tests for all the city's diabetics directly to the health department. This is first time that any government has begun tracking people who have a chronic disease. The New York City Department of Health will analyze the data to identify those patients who are not adequately controlling their diabetes. They will then receive letters or phone calls urging them to be more vigilant about their medications, have more frequent checkups, or change their diet....
So what could be wrong with merely monitoring and reminding people to take better care of themselves? New York City Health Commissioner Thomas Friedan has made it clear that it won't necessarily end there. If nagging is not sufficient to reduce the health consequences of the disease, other steps will be taken. Friedan argues that "modifications of the physical environment to promote physical activity, or of the food environment to address obesity, are essential for chronic disease prevention and control." Friedan envisions regulations for chronic disease control including "local requirements on food pricing, advertising, content, and labeling; regulations to facilitate physical activity, including point-of-service reminders at elevators and safe, accessible stairwells; tobacco and alcohol taxation and advertising and sales restrictions; and regulations to ensure a minimal level of clinical preventive services."
Read that last paragraph. That's just the starting point for where the government will go when it starts paying for all our health care.
Postscript: This is a very hard topic to discuss with people, because they are so ingrained with the way the market is set up today. When I started working for myself, I told my wife that we needed a high-deductible medical plan, to protect us from a health disaster, but we would just self-pay for dental costs. "What?" She said. "You can't pay for your own dental - you need insurance. We can't go without insurance. That's all you hear on TV, the problem of not having insurance. We'll be one of those people!" I patiently explained that it was almost impossible for us to face a dental problem that would bankrupt us, and that for any conceivable level of dental care, it was cheaper to just pay the bills than get dental insurance. Eventually, she relented.
We have been paying our own dental bills for years now, and have saved thousands vs. the quotes I got for insurance. The other day we had an issue that perfectly highlights why 3rd party payer systems cause problems. My wife chipped a tooth. She was presented with two choices: To file it down for nominal cost, or to do a major repair which would cost $500. She asked me my advice on which to do, and I said "its your mouth. You know what else we might use $500. You make the tradeoff." I am not even sure what decision she made. It is simply impossible to make this kind of decision for someone else. Everyone will make it differently. A government-payer system would only have two options: 1) don't allow anyone to get the expensive fix or 2) force taxpayers to pay for everyone to get the expensive fix. Both solutions are wrong. Such is the problem with all single-payer systems.
Posted on January 15, 2007 at 12:02 AM | Permalink
I've purchased dental services with and without insurance, from the same dentist. The prices are often higher without the insurance. By that I mean the total price, not just my copay. It seems that through negotiating rates on my behalf they save me money, much like AAA to find towing or repair services. How does one find good dental rates, knowing they cannot very well ask a dentist for the price of every possible procedure? Are there any services that negotiate rates on your behalf, but otherwise don't provide insurance coverage or perhaps merely do so with a very high deductable?
Posted by: OneEyedMan | Jan 15, 2007 12:48:11 PM
Avoid the British pay-twice system. We pay once through our taxes for the remaining NHS dentists who survive somewhere in the country - but not here - and then we pay the second time for our own private dental care.
Posted by: dearieme | Jan 15, 2007 3:31:08 PM
I can live with paying dental out of pocket. I looked at the cost of 2 exams yearly for my wife and I versus my contribution from my paycheck and bingo, I get 2 dollars of return for every dollar I pay. In the waiting room, I often hear the receptionist say we'll discount it by so much because you're paying in cast. But then again it has a $1000/year max benefit, so I could afford that.
I dropped my vision because I get a 30% discount for cash on the exam and I visit a friend of a friend 20 miles outside of town that offers sturdy frames at reasonable prices.
It's the hospital costs that scare the crap out of me. I basically want something with a $7500 deductible coupled to a tax free savings account, oh wait they have those nevermind.
Posted by: Ian Random | Jan 15, 2007 11:19:58 PM
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