The Missing Focus in Health Care Reform

Is Government Health Care Reform Even Constitutional?

Aug 14, 2009

The health care reform debate has generated plenty of passion. However, there is a growing number of Americans who believe the debate is missing the point.

Opponents of House Resolution 3200 such as Priests for Life’s deputy director Father Peter West are opposed to the program labeled "Obamacare" because, "Obamacare will lead to health care rationing and mandatory coverage of abortion and the loss of private insurance. Despite his insistence to the contrary, I think the provision of end of life counseling will pressure people into euthanasia."

Not everyone believes that advocates of the president’s programs are sincere. William Carl is a novelist in Texarkana, Texas and believes advocates are masking their intentions, "The current democrat trickery is for their senators like Missouri Democrat Claire McCaskill to say there are none of those odious provisions in this bill."

Mr. Carl and Father West aren't alone in their objections or suspicions. A recent Rasmussen Survey now says that 54-percent of the American public believes that passing no health care reform is better than the bill currently before Congress.

There is also a growing number of people in the United States who think the debate is over the wrong details and that the Congress is asking the wrong questions. One of those growing number is corporate executive Mr. David Goldhill who says that in his recent article in the September Atlantic Monthly .

In the article, Mr. Goldhill asserts the present health care system is responsible for his father’s death. His father died in a New York City hospital from an infection he contracted while hospitalized.

Yet, he says the responsibility for his father’s death is not with the health care professionals, nor with the insurance companies.

“My dad’s doctors weren’t incompetent... Nor is he dead because of indifferent nursing—his nurses were dedicated and compassionate. Nor from financial limitations—he was a Medicare patient, and the issue of expense was never raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.”

It's The System

“America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate insurer of value.”

In other words, Mr. Goldhill says the health care system has made Medicare, Medicaid, the HMOs and the insurance companies the consumers of American health care.

In a sense, we have a "moral hazard" with how we do health insurance. Because we’ve delegated payment for even simple procedures to the insurance companies, we’ve become spendthrifts, ‘and otherwise taking less care with our decisions, when someone else is covering the costs.’

Dr. Joseph Newhouse is a professor at Harvard’s John F. Kennedy School of Government and an expert on health care reform doesn’t dispute Mr. Goldhill, suggesting that the patient and insurers could work as a partnership, "Patients decide whether to seek care and whether to comply with a physician's prescriptions. Insurers can assist patient choice through a variety of tools, including structuring out-of-pocket payments to favor taking important medications, disease management techniques, and personal health records and other IT support."

Yet, under Goldhill’s view, the problem comes because when a patient walks through the door of a doctor’s office, it’s automatically assumed that someone else is going to paying most of the bill.

Dr. Newhouse believes that the patient not having to worry about paying the whole bill allows freedom in decision-making. "A major purpose of health insurance and other types of insurance is to protect the patient/consumer against large out-of-pocket expenditures. So it is a non-starter to not have health insurance for hospital bills, which can run into six figures."

Yet, that’s not Mr. Goldhill’s point. Mr. Goldhill’s efforts are aimed at making the health care delivery mechanism cost-effective. That would come through making the process more personal. Mr. Goldhill writes that if a detailed statement were given directly to the patient first, radical cost adjustments would take place.

He believes the first thing that will happen if the patients are the consumers is that the hospitals will reduce how much they charge for simple medications such as acetaminophen or simple procedures like x-rays. Mr. Goldhill believes that these changes alone will radically reduce the costs of health care.

Is It Constitutional?

There is still another aspect to this debate that has been completely ignored. Teacher, talk show host and former candidate for Congress Kevin Thompson lives in Beloit, Wisconsin. He says the Constitutionality of federal health care has been left out.

Thompson observes, “Article One, Section 8 of the US Constitution lays out about 18 different categories in which the Congress is allowed to spend money. Nowhere is universal healthcare mentioned. This is not a federal issue, but should be debated among our state officials.”

The talk show host says that one man with whom he talked about the issue was shocked that the Constitution should have any role in the health care debate, but later admitted, "That this may be better handled on a state-by-state basis."

Massachusetts public advocacy activist Lynne Roberts agrees with Mr. Thompson and adds that there shouldn’t be any debate on federal health care reform.

“By joining in on the 'fray' arguing about aspects of the bill, we are unwittingly agreeing to it.” She continues with an analogy, “If you tell your teenage child they absolutely cannot go out tonight, discussing how they are going to travel to their destination is a conversation that WILL NOT OCCUR. If you discuss how they are going to travel to their destination, then you have agreed that they are going!”

She says that when the public debates how the federal government can reform or reshape health care, the battle is already lost.

The copyright of the article The Missing Focus in Health Care Reform in American Affairs is owned by Michael Carl. Permission to republish The Missing Focus in Health Care Reform in print or online must be granted by the author in writing.