“Grant me a premise and I will construct you a world.”
This principal tenet of sophistry lies near the core of the current controversy surrounding the Health Care Reform debate. The converse of the maxim is that a false premise will yield a false construct. If the argument of the debate were based upon a fallacious premise, then the whole of the rationale used would be unfounded. Much of the opposition concerning Health care reform proceeds, intentionally or not, from false premises and assumptions. A more careful examination of the arguments reveals their flaws.
The first obvious flaw lies in the generalized description of “Health Care” as the object of discussion. In the context of delivery of medical services, it is critical to note that the components of medical services and health insurance are very different subjects. To institute real reform in the system, measures must address BOTH aspects. The experience in Massachusetts is a clear object lesson. Hailed as a “breakthrough” in reform, the Commonwealth of Massachusetts enacted legislation and a program to provide universal health insurance. Employers were obliged to cover employees, and those without employment based insurance were required to purchase coverage. However, what the program lacks is a system of limits on health care costs. As a result, the premiums for health care in Massachusetts are about the highest in the United States. The compromise struck with the Industry to obtain universal coverage was to refrain from imposing mandatory controls on health care costs. The compromise now threatens to swallow the program, as the government costs to subsidize the rising insurance premiums could bankrupt the state budget.
A second glaring flaw in the arguments raised in opposition is the presumption or premise that the current system is of sufficient quality that it is inherently worth protecting. The medical care systems that operate in the US are not the worst in the world, but they collectively are far from the best, despite being about the most expensive on a per capita basis. The reference to medical care delivery as a plurality is intentional, because there are different delivery systems for different classes of people in the country. For the wealthy, the best technology and the most skilled health professional specialists are available. They have no significant barriers to access or to the best care that their information and networking sources can identify.
A second tier of health care delivery is available to those with employer sponsored health insurance. These people have access to a broad range of primary and specialized health care services. Their options are limited by the provider networks that are established by the insurers in ways that the customer/patient is not even aware. This group pays the illusory cost of “co-pays” that creates a false impression of the true charges being assessed for their health care services. What most failed to realize, until the recent loss of 7 million jobs in the current recession, is that their protection is transitory and is not really “insurance.” It is subsidized health care coverage that can be taken away at the discretion of others, even when the employee is paying a substantial part of the cost of premiums for his or her family.
The third class of health care is for those who are poor and or unemployed. They have no health insurance to protect them from catastrophic or even moderate health incidents. The full impact of the high medical services costs are evident to this group and most simply avoid or defer medical care until the condition is severe. At this point, their deliver system is the local emergency room of the nearest hospital, if the institution will admit them even for temporary urgent care. Of the approximate US population of 300 million, there are about 50 Million in this third category, approximately 1/6 of the entire population.
Thus, on a macro view, the health care delivery system in the US provides no guaranteed support for about 17% of the population, limited and rationed services to the majority of the population and true health care insurance and coverage to less than 5%. The “outcomes” of this delivery system, the statistical measure used in medical parlance to assess the quality and effectiveness of medical services delivery, place the US in the middle of the pack of “developed” nations in quality of care. The per capita costs of the system, however, are nearly the highest. Consequently, it would be very difficult to sustain an argument that maintenance of the status quo is a critical objective.
The mentality of the US consuming public is easily misled and inclined to self delusion. The adherence to buying habits for automobiles is a prime example. When damage to the environment from excess carbon emissions from cars was evident and the cost of gasoline for energy inefficient vehicles was consuming higher and higher portions of the consumer’s take home pay, the public stubbornly refused to embrace change and resisted a shift to smaller more energy efficient cars. They preferred to stay with a broken model to accepting change and adaptation to a new model that was in their own best interest. This same problem is evident in the Health Care Reform debate, as fear mongering and disinformation seeks to turn consumers away from any reform that would alter the status quo. In their fear and stubborn “conservatism” they seek to retain and protect a seriously dysfunctional system that fails to serve the needs and best interests of the public.
To Be Continued….
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