So often I hear it asked, Can we really afford to pay for health care in this country?
Perhaps the question ought to be: Can we really afford not to?
Greetings, you lucky devil, you! You're just in time. The moment everyone's been waiting for has finally arrived. Reporting live from the studios of Merriam-Webster et al. I now bring you the next exciting edition of . . . .(drum roll, please). . . . K's Word of the Day!
Perhaps you noticed something unusual there at the end. I noticed that too, but let’s be real here—who am I to question THE Merriam-Webster? Before we delve any deeper, I should perhaps also clarify number (3) from above with a follow-up definition, just in case any of my Jersey-Shore-watching friends happen to be reading along with us today and are in need of a “refresher”:
Unusual again, you say? Odd, everything looks right to me… Fine, fine, I confess. I have taken the liberty (liberty!) of making a few minor adjustments. It’s true, the Merriam-Webster original didn’t say exactly every word as stated above; however, they would’ve been fully justified in doing so, as we will soon see. Let me explain . . . .
As I’m sure you are all well aware, there has been much media fuss of late and certainly no short supply of heated headlines concerning Gov. Rick Perry’s controversial decision to reject all federal funds being offered to the states for expansion of Medicaid and a handful of other services as provisioned by the newly-Supreme-Court-approved PPACA legislation typically referred to, be it hatefully of affectionately, as "Obamacare."(Dun-dun-dun...)
As someone who has worked in health care for many more years than I care to admit, with experience in both the private and public sectors, and a substantial portion of that time spent in the most underfunded area of medicine, mental health, it is reasonably safe to say that, naturally, I bring to this particular debate quite a bit of “baggage.” I’ve put in my 10,000 hours fully immersed in the Good, the Bad, and the Ugly of health care. That being said, while I do feel that my experience affords me a great deal of insight into the situation, and lends credibility to whatever opinions I’ve come to hold, I am also rational and self-aware enough to understand that this might prove to be a double-edged sword, with my frame of reference potentially eliciting an emotional rather than reasoned evaluation.
So, I did what I always do when issues like this come up—an approach that is apparently unthinkable to the vast majority of the American public. Grit my teeth, grind my heels into the ground, and scream, “LOOK, PEOPLE - I KNOW WHAT’S BEST HERE BECAUSE I’M AN EXPERT, SO YOU ALL SHUTUP AND LISTEN TO ME!”…? In a word, NO. Absolutely not. That would be the American Way, but I like to think that my way is better. First, I begin actively seeking the very best arguments I can find against my position. I make a concerted effort to find any and all cases that oppose, contradict or refute my beliefs in any way; I read them, genuinely consider them, and weigh them carefully and honestly against whatever preconceived notions I might’ve held. Then—and only then—do I decide whether my original position is a valid one, worthy of defending, or if it would be wisest to instead amend or even completely abandon that view in light of new or better information. (Yo, Jersey, are you still here? You and a few others might want to back up and take notes here. You know who you are.) Anyway, in this spirit of challenging my beliefs and ongoing critical analysis, my search for conflicting views continues -- which now brings us to today’s topic.
TexasFred lost his head.
In what can only be described as a Fox News pundit’s wet dream – and a sane individual’s worst nightmare – conservative political blogger TexasFred has weighed in on the health care debate, enlightening readers everywhere with his seemingly infinite wisdom. And to your great fortune (torture?), I will now share his argument with you.
He begins with a lengthy quote from an LA Times article, republished here in a Seattle newspaper, which details Gov. Perry’s announcement that Texas will “opt out” of Medicaid expansion and the proposed state-run insurance exchange, along with a quote from Perry explaining his reasoning:
If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under Obamacare,” stated Perry, whose bid for the GOP presidential nomination fell flat this year. “I will not be party to socializing health care and bankrupting my state in direct contradiction to our constitution and our founding principles of limited government.
I realize Rick Perry shot himself in the foot during the Presidential debates recently, but I have to say, Rick Perry is a good Governor.”He then goes on to offer the following argument in support of this de— oops… Sorry, no he doesn’t. He then proceeds with the following rant:
Last month the libber Justices handed Barack Hussein Obama what many on the left consider to be a huge VICTORY. Last month, a once well respected and largely believed to be conservative Justice, John Roberts, outed himself as an Obama lackey when HE cast the deciding vote in favor of the Patient Protection and Affordable Care Act, or, as most of us call it, ObamaCare.
A while back I was listening to that jug-eared Kenyan talking about ObamaCare and he said he really liked that name. Do you know WHY? He said he likes it because ‘Obama DOES care’, and you know, I’m sure he does, but about WHAT?
Obama cares about Palestine, he cares about Islam and its practitioners, he cares about the socialization of America, he cares about GUN CONTROL and we ALL know he cares about his narcissist self, so, all things considered, yeah, Obama cares … about everything Conservatives stand against!
After continued ranting about the Supreme Court and being “stuck” with that commie turncoat Chief Justice Roberts, he does (eventually) find his way back to the topic of health care, diving right into another news snippet – quoting from the same LA Times article, might I add:
In rejecting the two pillars of the health-care law, Perry argued that adding millions of Texans to the Medicaid program would create a financial burden. According to state figures, about 2 million people would be added to Texas’ Medicaid rolls in the first two years. According to the state, the expansion would cost $27 billion over 10 years — numbers disputed by Democrats.
Of course the Democrats dispute the numbers, they are not Dem numbers. That is the hypocrisy of the Dems, no one is correct except them, and that’s that!
Most Dems are basically stupid. Most Dems believe that money really does grow on trees or can just be printed and distributed at will, and hey, the Feds are paying for this big old debacle called ObamaCare, so why should all of us EVIL Conservatives be concerned?
It’s FREE … right?
I am SO glad my folks didn’t live to see what the Democratic Party has become; they would have BOTH become HARD CORE Conservatives in less time than it takes to type this missive.
Oh. My. God. “Most Dems are basically stupid.” THIS is your argument?!?! YOU CANNOT POSSIBLY BE SERIOUS. Ashton Kutcher, come out, come out, wherever you are! The jig is up. That prankster TexasFred has clearly done it again. Good one, old man. You really had me going there for a minute…
In conclusion; Barack Hussein Obama has got to go!
Please, you’ll all have to excuse me for a moment while I collect my fury and fight the urge to, as my husband calls it, “let my Waco out” (yes, that Waco) right here for all the world to see… (Just to clarify, that phrase, as used here in jest, would refer to something along the lines of a super trashy, redneck, obscenity-ridden rant telling our boy TexasFred exactly what I think of him, and perhaps a recommendation or two as to where he might consider putting this ignorant, abhorrent, racist, appalling rhetoric… Thought I best spell that out, considering the other topics typically associated with Waco. Yikes, that could’ve sounded really creepy. Anyway.) Fight the urge, Krista. Fight the urge…
Okay, my “Waco” has officially been contained.
About his argument… or, more appropriately, TOTAL lack thereof. At least the gentleman from last week put forth an effort to sound like he was making one. There really are no words with which I can properly articulate my thoughts on this because it isn’t even coherent, much less deserving of a reply. I hate myself a tiny bit at the moment for even clicking on his site in the first place, and just a little more for any free publicity that might be generated because I have no choice but to link his post on my page.
You might be now be thinking, Okay, smooth move there. Liberal democrat chic found some fringe froot-loop conservative radical skulking about in the darkest, loneliest corners of the web to provide a ridiculously easy target whose (non-)argument could be destroyed effortlessly, thus making a mockery of the actual legitimate argument that belongs here, and making her own uber-liberal agenda all the more easily swallowed.
First of all, that’s certainly a fair question to ask. I admit, given the degree of quality and depth (appalling and nada, respectively) found in TexasFred's post, that does indeed appear to be the case. Buuuut, guess what? It’s trivia time! Anyone care to wager any guesses as to how many visitors this man’s blog has received? Anyone? 300? Higher. 700? Getting warmer. 4,000? Warmer still, but not even remotely close. 40,000? Negative. According to the third-party traffic-counter displayed on his page, The TexasFred Blog has had 875,578 page views... Yes, the disturbing, empty noise on his site has apparently been read by almost a million people. . . . It pains me to say this, but it would seem to be the case that maybe his type of mindset isn't very “fringe” at all. In fact, flip the channel to Fox News, for example; it might rightly be said that our new friend TexasFred has more in common with the mainstream conservative stance than one ought be comfortable with.
But in the interest of actually having a meaningful (or at least coherent) conversation about health care reform as planned, I have no choice but to improvise. I am now going to play devil’s advocate and present to you the argument(s) that TxFred could've -- and should’ve -- been making.
The Conservative Position
I think this can be sufficiently summarized rather quickly, so let me give it a go. The primary points of contention concerning Obamacare, as I understand them, are as follows:
- Projected costs of expanding coverage are in the neighborhood of $1.2 trillion between now and 2022.
- It will drastically increase the national debt.
- It will dramatically increase federal spending on health care.
- It will artificially inflate health care costs because the federal government will be interfering with the self-regulating free-market.
- Rick Perry & Co., as the LA Times article noted, argues that it will “bankrupt the states” and that “socialized medicine” goes against the wishes of our founding fathers.
- Perry also claims that about 2 million people would be added to Texas’ Medicaid rolls in the first two years.
- Expanding Medicaid and other social programs is only going to propagate dependency by the poor on the government and increase the tax burden on “the rest of us.
- Again from Perry, “We don’t need the federal government to come in and do for us what we can do just fine by ourselves. We can do it better.
- It’s going to force everyone to foot the bill for abortions.
- Lest we forget the great Death Panel scare spurned on mostly by the Tea Party.
- The true long-term costs can not be accurately or completely forecasted, and it will likely end up costing more than any of the projections show.
- We just can’t afford it.
Just The Facts
I will now address each of the above points one-by-one to be sure we’re all on the same page. Once we're done, we can then mull it over and perhaps make a more informed decision together about where we stand on the issue. Are you ready? I'm not sure you ready... Very well then, off we go.
1. Projected costs of expanding coverage are in the neighborhood of $1.2 trillion between now and 2022.
True. According to both the initial comprehensive evaluation in 2010, as well as the report released today by the Congressional Budget Office (CBO), this is roughly the correct projection; however, the point I rarely see mentioned is made here by Douglas Elmendorf, an American economist and current director of the CBO. As the AP phrased it yesterday, “The law's mix of spending cuts and tax increases would more than offset new spending to cover uninsured people, Elmendorf explained.” And keep in mind that while the CBO is, in theory, intended to be a nonpartisan entity, it is technically functioning under the leadership of a Republican majority in Congress. Elmendorf reports directly to Speaker of the House of Representatives, John Boehner, a conservative Republican from Ohio.
2. It will drastically increase the national debt.
False. Neither of the major comprehensive reports released have shown this. Not by a long shot. As a matter of fact, all reports published by the CBO have consistently shown that Obama’s health care legislation will reduce the deficit by at least $143 billion from 2010 to 2019 – and this is taking into account the delayed time-frame for which several of the cost-saving measures would gradually be put into effect.
Most interestingly, I think, is one point in particular that you will almost certainly not see making headlines over at Fox News, but that is highly relevant--crucial even--to the overall strength of the typical conservative argument. That point is this: While the CBO report does indeed project decreases in the national deficit as a direct result of Obama’s health care legislation, they do also predict a significant simultaneous increase to the deficit from a single source: Republican legislative efforts to repeal the health care laws. Legislative processes are not free; they require time, energy, paperwork, scores of legal and formal proceedings, not to mention some of the highest paid government employees in the nation to address it all.
The CBO put the expected costs incurred by the Republican push for repeal of Obamacare to add at least $109 billion to the national deficit over the next 8 years.
Contrast this with Obama’s deficit reduction of ~$143 billion. And Obama’s efforts are made in the interest of (a) reducing costs, and (b) giving millions more Americans access to basic health care services.
Meanwhile, Republican efforts torepeal will be costing us nearly every dollar that Obamacare is set to save. And for what? To have their way? If you think that they are doing it purely out of concern for Republican “conservative” values of diminishing frivolous spending, I ask you: Viewed in this light, which side of this debate sounds more reasonable and conservative to you?
3. It will dramatically increase federal spending on health care.
This was largely addressed above, but I’ll add one thing. In the words of the Associated Press:
Democrats hailed Tuesday's estimates as vindication for the president. "This confirms what we've been saying all along: the Affordable Care Act saves lots of money," said Senate Majority Leader Harry Reid, D-Nev.I think it is of the utmost importance, particularly in this conversation, that we keep in mind one very simple but often forgotten fact: virtually every statistic we ever come across has the potential to be grossly misinterpreted, and perhaps more ominously, an even greater potential to be willfully misrepresented by those who have an agenda. And unless you are the scientist, economist, or mathematician collecting and running those numbers yourself, one ought put little to no faith in random stats without a GIANT dose of skepticism and inquiry to go along.
Actually, the government will spend more. It just won't go onto the national credit card because the health care law will be paid for with a combination of spending cuts and tax increases.
Take spending for example. Granted, this is a very silly example, but I think it will adequately illustrate my point. Let's say I have this friend, whom for the past 3 years or so has been spending ~$3600/mo. But then, for the next three years that follow, he's suddenly dropping anywhere from $6 to $18k/mo. What's your instinctual reaction to that sharp change in spending at a glance? What would be your long-term projections for my friend in terms of his financial stability? It shouldn’t be at all promising. But what if that friend’s change in spending came as a result of his little garage-based jumpstart business taking off, well on its way to becoming the next Microsoft or Apple? It changes the meaning of those stats quite considerably, don’t you think?
I am not saying the government should be the next Bill Gates in terms of revenues. All I am saying is that context matters. Particularly when we are talking about government spending, we absolutely cannot take into account only the value spent. Our deficit is not a product of spending in and of itself; it is a product of our spending in relation to the amount coming in.
4. It will artificially inflate health care costs because the federal government will be interfering with the self-regulating free-market.
One cannot say definitively true or false, but this is highly unlikely. Countless examples throughout history and throughout the world have repeatedly demonstrated the opposite to be true. Contrary to popular belief, the free market is not self-regulating in all cases, and it is most certainly not self-regulating in a linear, even, across-the-board sort of way. Financial and consumer markets, much like everything else in life, exist along a spectrum. Yes, it is true that many avenues of the “consumer-driven marketplace” provide a circumstance in which the consumer has power relatively equal to that of those offering goods or services. To put it bluntly, UrbanDictionary-style, if the product or service sucks, people won’t buy it, thus exerting a great deal of influence on the makers/providers to hit the drawing board and modify in some way so that they may again appeal to and please the customer.
*Please note: This free-market model, however, does not apply to the class of goods or services that cannot readily or reasonably be dropped altogether at a moment's notice. We live in a modern, technologically advanced, civilized society. If energy providers in our area are collectively charging exorbitant rates and raking in obscene profits, can we as consumers simply decide to due without their services in order to induce better prices? Realistically, no. Of course not. This is why the energy industry has been regulated for decades. The same is true for all other utilities, oil and fuel, telephone services, the banking industry, and virtually every other product or service that fits into this category. History has shown it to be the case more often than not that some degree of government regulation improves the overall stability and fairness of standard business practices.
5. Rick Perry & Co., as the LA Times article noted, argues that it will “bankrupt the states” and that “socialized medicine” goes against the wishes of our founding fathers.
First of all, bankrupt the states is not a legitimate claim. Perry is actually turning down approximately $13 billion dollars offered by the federal government to fully fund the entire Medicaid expansion. This isn’t about fiscal or social responsibility, and it is clearly not about what is truly in the best interest of Texas citizens. What is it about then? I wish I knew. My best guess would be to keep his image consistent with one he’s been presenting to the public for years and years, an image that is apparently in line with the majority of the Texas voting population since we keep reelecting him over and over and over again. Maybe he thinks it’s what most of us want. And perhaps it is. But why is it what we want? Because we’ve carefully evaluated the situation from all angles? Or is because we tend to go along with whatever our chosen party endorses as best because we naively think that our values align across the board with those representatives and that they have our best interests at heart?
As for his branding of “socialized medicine” as a dirty, nasty, evil little word, let the record also show that Perry both VOTED FOR and PARTICIPATES IN a federal program through which he obtains own health insurance through exactly the kind of insurance exchange that he has rebuked and rejected repeatedly in the media. He wasn’t quite so opposed to the idea when it was his own health and well-being at stake…
6. Perry also claims that about 2 million people would be added to Texas’ Medicaid rolls in the first two years.
Granted, numbers-wise, this seems like a reasonableestimate. I have not seen these specific data that Perry cites every other day in the media, but I would indeed expect that in comparison to other states, Texas would have drastically higher number of initial enrollment in an expansion of Medicaid for one simple reason: We are very near the bottom of the list when measuring (a) the percent of residents at or below the poverty line, (b) the number of presently uninsured Texans per capita, and (c) the ease of access to assistance such as programs like Medicaid to its poorest citizens. All things considered, it makes perfect sense that we would have a seemingly massive swell of initial enrollment; because there are so very many of us currently struggling to survive without it.
7. Expanding Medicaid and other social programs is only going to propagate dependency by the poor on the government and increase the tax burden on “the rest of us.”
8. Again from Perry, “We don’t need the federal government to come in and do for us what we can do just fine by ourselves. We can do it better.”
If that were true we wouldn’t rank 50th out of 50 states in terms of citizens with health insurance. And as is abundantly clear in this Fox News interview, Perry has absolutely NO alternative plan to improve the current situation. He gets to enjoy his fully-funded socialized health care package, so to Hell with the rest of us.
9. It’s going to force everyone to foot the bill for abortions.
This is simply just not true. Great pains have actually been taken by the Obama administration to implement a very complex additional system here that safeguards against the possibility that ANY federal or tax payer monies will potentially go toward funding an abortion, unless and until said tax payer has given their express consent by opting into an entirely separate exchange for an additional monthly cost, in which only the addition fee designated specifically for this elective coverage of women’s health services is never pooled with or funded by general public funds.<
10. Lest we forget the great Death Panel scare spurned on by the Tea Party?
I lied. I am not going to address every single point. As a healthcare provider myself, I refuse to even dignify this idiotic statement with a response.
11. The true long-term costs cannot be accurately or completely forecasted, and it will likely end up costing more than any of the projections show.
Finally, a perfectly valid point and reasonable point. Because of a multitude of factors, we cannot, under any circumstances, claim to predict the future, and it is undoubtedly the case that when our estimations are off, we are more likely to be over-budget than under. Case in point: Medicare. This has proven to be substantially and increasingly more expensive than any early projections had anticipated. There are undoubtedly a multitude of reasons for this, but among the most suspect of reasons, one might argue, had/has much to do with previously unforeseen skyrocketing of healthcare costs in this country. Which brings us to our last, and in my view most important point.
12. We just can’t afford it.
If you’re still with me this far, I applaud you for both your patience and dedication, if absolutely nothing else. I apologize for the incredible length, which I suddenly find exhaustive myself, so I can only imagine where you’re at right about now… (Watching Jersey Shore perhaps, long gone from my seemingly endless rant? I kid.) But in all seriousness, it’s almost over, I swear. Bear with me here just a few moments longer and I’ll attempt to explain what I view as among the most important points worthy of consideration. They are also among the talking points that I hear mentioned least in the media, which just seems crazy to me because they are serious potential game-changers in the tone and direction of the health care debate.
First and foremost, regardless of what you might think of the Obama administration, and regardless of whether you oppose or support the new health care legislation, the fact remains and it cannot be denied that we already have “socialized medicine” -- and this is NOT a new development! Believe it or not, we’ve been doing it for years--decades even; I submit that the only truly new element in all this seems to be the rebranding of the term "social-" anything as the most evil, awful thing on Earth.
It doesn’t matter if you have a dime to your name; if you walk into an emergency room with an injury or illness that is clearly in need of medical attention, there is not a hospital in the country that will turn you away. You are treated first and billed later, and this is a simple fact that no one can deny. And what do you suppose happens to all of those outrageously expensive emergency room visits for which many patients can never hope to afford to pay? Is it written off as charity by the hospital? If it were, we wouldn’t have a hospital left in the country because if they weren’t already bankrupt, they soon would be. One ABC News report recently detailed a single non-profit hospital in Midland, Texas, that had over $14 million in unpaid ER visit bills – in 2008 alone. Can you imagine the staggering value that must exist on a state-wide basis? And an estimated 75% of these bills consisted of non-emergent care that would ordinarily be delivered by a Primary Care Provider (PCP); however, the uninsured among us rely overwhelmingly on the ER to serve this function.
So how do they recover these costs? Well, fewer than half of Texas’ hospitals are for-profit, privately owned organizations; the majority are non-profit, public hospitals. When a local hospital is operating with substantial consistent losses, what typically happens is that these costs become socialized throughout the entire community in the form of property taxes – which helps explain why, despite being the low-tax/no-tax haven Perry brags about, we still collectively pay among the highest property taxes in the country.
Now, if we’re going to end up all paying for it together anyway, one way or another, the question really becomes whether we choose to pay it “forward” in the form of preventative care, or whether we pay for it on the other end, where it assumes the role of “crisis management.” As noted above in the ABC article, among many other places, preventative care payed “forward” by way of regular access to a PCP not only happens for a fraction of the cost no matter how you look at it, but in all likelihood the total cost of health care services spread over a lifetime is also substantially less because of improved ongoing management of chronic and/or life-threatening diseases. For example, compare the total sum of treatment costs for an individual to see a PCP perhaps once or twice a year, and, say, 30 years worth of hypertension and/or cholesterol-lowering medications; then, compare this total with the sum of all costs if that same individual were to receive none of the comparatively cheap on-going care throughout his life, but instead racked up 7 intermittent ER visits and maybe an ambulance ride or two for chest pain, along with two emergent open-heart surgeries, one of which required a triple bypass. The average cost of an ER visit is around $2k, and a single open-heart surgery costs no less than $200k… As opposed to a $10 or $15 prescription each month. You do the math.
The truth is, like it or not, our health care costs in this country are undeniably already "socialized." When our neighbor's can't or don't pay for their own medical care, we all foot the bill, whether it be via Medicare, Medicaid, sales tax, property tax, etc. etc. etc. I'm sorry if you hadn't realized and/or find this news upsetting. But to that I say:
GET OVER IT.
The dilemma we are presented with today is not, contrary to popular belief, should we or shouldn't we socialize medicine? No, the only real dilemma concerns the way in which we choose to go about it. Now, all things considered -- particularly this last bit of rather damning evidence -- I wish someone could pleasepleaseplease explain to me how it is NOT the position of each and every intelligent and informed "conservative" in America that the absolute best move we can make as a country with respect to health care is to immediately STOP going about it in the most fiscally irresponsible way possible.
So often I hear it asked, Can we really afford to pay for health care in this country?
Perhaps the question ought to be: Can we really afford not to?