Socialized Medicine–Gotta Have It

Not a Constitutional Right

On the topic of universal health coverage, or, as we diehard liberals like to call it, Socialized Medicine, the Federalist Society crowd and other Neo-Cons make a big production out of trying and failing to find justification for it in the Constitution.  To the extent that we buy into that issue, we are being led astray.  The question is not whether there is a Constitutional right to health care, for there assuredly is not.  The question is whether it is good social policy to establish a program that will ensure a minimum level of access, regardless of means.

Our Conservative comrades compare food, shelter, and education to health care and ask whether those who propose universal health care also propose to provide all of the other necessities of life.  This is intended as ridicule, but the answer is yes; under certain circumstances.

On Food, Shelter & Public Services

Food is certainly a necessity of life, as is shelter.  However, few who say we need universal health care also advocate for free food for all or public housing without regard to need.  What is the difference?  Why aren’t we opening barracks for yuppies and mess halls for the middle class?  Food and shelter, for the most part, are within the financial capacity of most people; even the minimum-wage working class.
It makes sense to establish a government-run program to provide an essential service that is prohibitively expensive for individuals.  This is particularly true when it is relatively inexpensive if provided to the population at large.  It is furthermore sound public policy for the government to provide a service to individuals to protect the public health or welfare.

Almost no one questions the propriety of government programs to provide water and sewerage services to the general population.  A well and a septic system are relatively inexpensive and in most of rural America are quite satisfactory solutions to the problems of acquiring potable water and disposing of waste.  This does not work so well in more built-up areas.  When the population density reaches six or eight households per acre, it becomes both expensive and hazardous from a public health standpoint to allow individual households to remain “off the grid” as to water and sewerage.  In an environment like Manhattan, it would be preposterous.  Even the most conservative ideologues concede the necessity of public service projects to provide water and sewerage.

In a similar fashion, police and fire services are generally accepted as necessarily a governmental responsibility, although at one time property owners had to buy badges for the fronts of their houses to show that they had purchased fire services from for-profit fire brigades.  Why have nearly all communities of more than a few families formed fire departments at community expense?  Infernos like the Chicago Fire.  Your purchase of fire services is of little value if the houses around yours are unprotected.  The point is that a community must establish a fire department for all property in the community to protect itself effectively against fire.

What about the police?  I haven’t heard Limbaugh or O’Reilly calling for abolition of police departments or the FBI.  Although big companies may establish their own security force, communities must have a police department to protect people and property and enforce the law without regard to whether a given individual purchased police services or paid taxes.

Why does it make sense to establish universal health care, but not free food and shelter?  We do provide some subsidies for food and shelter, but there is no widespread lack of ability to purchase those things.  We don’t have a third of the population starving to death the way we have a third of the country starving for health care.  That does not mean it doesn’t happen, though.

The government tried to provide food and shelter in the wake of Katrina.  If there were a nationwide catastrophic failure of the food supply–say along the lines of the Irish Potato Famine–the government would be flying C-130s to other continents to buy food for public distribution.  This, of course, assumes that there is no catastrophic failure of national leadership–say along the lines of the Katrina Aftermath.

Availability, Cost & Fairness

The health care crisis in this country is not an availability, nor a cost, crisis. It is a failure to devise an effective system of pricing and distribution.  If we stopped treating the poor and uninsured in emergency rooms at the expense of those who pay for care either through insurance or out-of-pocket, the rapid escalation of insurance premiums would taper off and we would start paying the true cost of the services we are consuming.  If we require the healthy uninsured to buy into the system, the overall cost to everyone would be further reduced.  Just as we require car insurance, we should require a health care buy-in so that a healthy uninsured person who becomes catastrophically ill or injured does not become a charity case to everyone’s detriment.

Those who have health insurance cringe at the thought of “socialized medicine,” but a third of our population lack health insurance at least episodically.  I am sure they would welcome socialized medicine, as compared with what they have now. If a basic catalog of health benefits is insufficient for others, they could purchase supplemental insurance the way Medicare members purchase medigap insurance today.  It could be the best of all possible worlds for everyone. At least it would be better than what we have now.

Employer Problems

Multinational corporations will ultimately lead the charge to universal state-run health insurance.  U.S. industry is suffering a huge competitive disadvantage because of health care costs “built in” to every product.

Spiraling health costs are crippling those employers who continue to insure their employees and giving a competitive advantage to the skinflint employers who refuse to do so.  In the ‘60s and ‘70s, even low-level employees of small companies generally had health care coverage with only a small amount of employee contribution.  That is no longer true.  There are approximately 47 million  who are recognized as “uninsured” by the government.  This is nearly twice the number of those considered unemployed, so a large part of this group are the working poor.

Uninsured means that they had no insurance during the previous year.  However, other studies show that if you include persons who had no insurance for part of the previous year, the number is at least twice that, or 94 million who are uninsured or under-insured.

There are approximately 301 million people in the United States, of whom 38 million are 65 or older.  Since almost all of the 65-and-up cohort are covered by Medicare, 38% of those who would be in the market for health insurance are under-insured.  If you factor in all of those  already covered by Medicaid, the under-insured population under 65 is probably close to 50%.

Besides the un- and underinsured, those who have coverage are seeing a serious erosion in their benefits.  I could not be in business were my wife not employed by a major corporation.  However, the employer-paid portion of her health coverage has shrunk while the deductibles and co-pays have increased tremendously in the last ten years.  A simple trip to the emergency room for a laceration or other injury requiring radiology now costs us $2,000 or more.  A hospital admission would cost more than $5,000.  How can a family of four trying to get by on $50,000 a year afford that kind of expense, let alone the “working poor?”

One would think that the majority of us would demand universal health care, but the insurance and health care provider lobbies are very powerful and the uninsured are not.  Furthermore, “socialized medicine” has been stigmatized by its opponents.  The “liberal” press has not been much help, either.
A client became very irate when I made a remark about how this country needs universal health care.  He said, “You are talking about socialized medicine; that would be very bad; no, no, no!”

“Gary,” I replied, “you are in your forties and living with your father; you have no health insurance, at all.  How could socialized medicine be worse that what you have now?”  I explained how much it would cost him if he injured himself or became seriously ill.  He became very thoughtful after our discussion.

We Pay Too Much for Bad Coverage for the Uninsured

Another argument against universal health care is made by libertarians and Neo-Cons who say they do not want to pay for other people’s medical care.  This is ridiculous.  People who are uninsured–and that is mostly people who cannot afford health insurance, not those who decide to forgo health insurance because otherwise they would have to settle for a 525i when they want a 760Li–get medical coverage at public expense now.  However, instead of seeing a physician from time to time to catch developing problems, they go to the emergency room with a crisis.

Unless the plan is to allow hospitals to turn away critically injured or ill people if they cannot prove that they have cash for treatment or that they are insured, the uninsured will continue to be treated at the expense of those of us who have insurance or can afford to pay for care.  If the plan is, in fact, to deny the ill and injured if they cannot pay, this would mean that everyone would have to ensure that they can prove their coverage even in an emergency.

Let’s assume that your daughter is stabbed during a robbery and her purse is stolen.  She is lying on the sidewalk, bleeding to death.  The EMS are called.  Before they will try to stop the bleeding or take her to a hospital, they will demand to see proof of health insurance.

What if you have a heart attack?  If you do not have your health insurance card on you, too bad.  You don’t get helped.

Unless you are an Ayn Rand disciple and are willing to ration health care to only those with high income or assets, universal health care is the only reasonable answer.

In the first place, providing universal health care, so that everyone has a reasonable level of health maintenance, as well as hospitalization coverage, probably would not cost much more than the current hodgepodge of Medicare, Medicaid, health insurance, and indigent care–with millions simply falling through the cracks.  It would cost less in the long run because there would be more healthy, productive citizens.

Furthermore, the per capita cost can be kept low.  One of the problems with health insurance is that too many healthy people under insure or go without insurance.  This means that the insureds with the highest health care costs tend to be concentrated in certain plans that then have very high premiums due to insurer screening or by reason of better coverage.

A universal plan like Medicare that provides basic coverage at a nominal cost would be cheaper and more fair in the long run.  It would cost less than the current expenditures in taxes, health insurance premiums, lost wages, poor performance in school and on the job, and so forth.

The argument I hear all the time, which I find deeply troubling, is that with universal coverage, we will have rationing of health care.  We have rationing now.  The only difference between the way health care is rationed now and how it would be with universal coverage is who has to wait for care.

Under the current system, the poor and working poor get the short end of rationing.  With universal coverage, upper middle class Americans will have to share some of the burden of waiting or limiting care.  This is about the political power of the middle class, not the numbers of people affected, or the cost, or the efficiency or efficacy of the system; it is about an ultimately democratic system for delivering care.  It is apparently deeply un-American to suggest that the health or life of a lawyer or accountant is not more important than the health or life of a cashier or mother on welfare.

Let’s Get Fair

Consider a recent public health study citizens of the U.K.  How often do we hear the British Health Service demonized as all that is wrong with “socialized medicine?”  And yet, by virtually every measure, the British are healthier than are Americans.  They spend half as much of GDP on health care and achieve far better outcomes.  The Germans spend a quarter of what we do and have an excellent system.  It is time for us to wake up and get civilized.


John B. Payne, Attorney

Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
©2008 John B. Payne, Attorney