Say What You Mean

Hey Everyone!! :-)

As many of you probably know, there's an ongoing debate about healthcare in this country. The system we have now doesn't work but it replaced a system that worked even worse than the current one. There are lots of ideas floating around about how to make things better, but they basically boil down to two sides. One side, the Republicans, want a free-for-all where only the rich are able to afford health coverage and people who have serious illnesses or chronic conditions would simply be denied access to healthcare. The other side, Bernie Sanders and his supporters, advocates for a Medicare For All type system where everyone would be covered under a government insurance plan, which would be paid for by taxes.

The arguments against what the Republicans want should be fairly obvious. How the so-called "Christian Party" can justify wanting to deny healthcare to sick people is beyond me; I find the notion morally repugnant. However, some of the questions surrounding the Medicare For All option have, in my opinion, a bit more merit. IE: How would it be paid for? How would it be administered? What kind of infrastructure would need to be created for it? As our Idiot In Chief recently discovered, healthcare is an incredibly complicated issue with multiple arguments all around. I know, who'da thunk it? There are answers for some of these questions, but others do remain unanswered. Personally, I think there are reasonable answers for them; it will just take the political will on the part of our elected officials to implement those answers.

But I'm not going to get into the weeds on the whole debate, right now. Though I may go through all of it in a later post, I haven't decided yet. But, today, I just want to address one particularly loathsome argument against Medicare For All that I keep hearing. Namely, the "but what about the wait times?" argument. This argument refers to the idea that if healthcare becomes available for everyone, then the amount of time patients will have to wait to get a doctor's appointment will increase. The evidence used to support this argument is the supposed problems other countries that have universal healthcare systems have with this issue. So, first, I'll give you some basic facts on the assumption that some people may voice this complaint out of ignorance. And then I'll lay out exactly why I find this argument so disgusting.

Let's start with defining exactly what the Medicare For All side is proposing. The Bill that Bernie Sanders introduced is literally an expansion of the Medicare program. It would increase taxes, mainly on the rich, to pay for being able to cover every US citizen under Medicare. It is not, as some have suggested, "socialized medicine." A system like what they have in the UK is more like socialized medicine, with all health providers being employees of the government. I'm not knocking the UK's health system, it's certainly far superior to what we have now in the states, but that's not what Bernie Sanders, or anyone else in the federal government, as far as I know, is proposing.

Just like with the Medicare program right now, all health providers would remain employees in the private sector. If a doctor works for a practice, or owns their own practice, they would still work for their practice or own that practice. If a doctor works for a hospital or a health system like Kaiser Permanente, they would still work for that hospital or health system. None of that would change. Just like with Medicare right now, it would just be a matter of who pays the bills, not a matter of who provides the treatment.

Could some doctors decide not to accept patients with Medicare coverage? They could; some do that now. And maybe some of the ultra-exclusive "Beverly Hills doctors" would make that choice. But if virtually every patient available to them has Medicare, then 99.9% of doctors will choose to accept it. After all, it would certainly be easier for them not having to juggle demands from multiple insurance companies and only having to train their staff to produce billing documents the way Medicare wants them done. That right there would save most practices a lot of time and money, which could then be reflected in the prices.

Since the changes a Medicare For All system would result in would affect only the billing aspects of healthcare, and nothing would change about the practices or the conditions of employment for the providers, we aren't talking about the government dictating doctors' plans of care for their patients or prescribed treatments. Nor are we talking about the government deciding what doctors a patient may or may not see. In fact, since most doctors will accept Medicare, patients will have even more choice with regards to what doctor they see because they won't be limited to private insurance companies' "in-network providers." So there would be greater freedom for both doctors and patients when it comes to deciding on what choices are best for their particular health situation. In fact, as it stands right now, Medicare is the most popular government-run program in the United States, by far, with a greater than 77% approval rating. Try finding a private health insurance company with an approval rating that high.

Now that we've established what it is we're talking about, let's look at the "evidence" used to support the argument that other countries with universal healthcare have delays in patient care. We'll start by acknowledging that in some cases it is true. In some countries with universal healthcare some patients with non-emergency health concerns experience delays in treatment. Emergencies are treated without delay, unlike in this country where someone with an emergency health issue but no health coverage will only be "stabilized" before being turned away from further treatment.

Right now, people in the US who don't have insurance aren't able to access expensive or long-term treatments for diseases like cancer or certain chronic illnesses. If they go to an emergency room, they'll be "stabilized," but they won't be offered the ongoing treatment they need. That doesn't happen in countries with universal healthcare. A patient who needs a joint replacement might have to wait to get it, which is certainly unpleasant for them and not at all ideal, but they won't die from their condition. And, keep in mind, an uninsured person in the US wouldn't be able to get that joint replaced at all.

So, yes, sometimes there are delays in patients being able to see a doctor. It happens in other countries with universal healthcare systems, and it also happens here, right now. It's basically a matter of there not being enough doctors in certain specialties for the number of patients who need their assistance. Now, that is a problem, no question. There are ways we could tweak the system to help alleviate this problem -- expanding the roles and authority of nurse practitioners, physician assistants, pharmacists, counselors, etc, providing free public higher education for people who want to become doctors, incentivizing doctors to move to under-served areas, etc -- but as of right now it is a problem.

But here's the crux of the matter, the argument that universal healthcare systems are bad because wait times might increase is essentially saying it's better to just deny healthcare to some people so that other people won't be inconvenienced. Because, as I pointed out earlier, an expansion of the Medicare system doesn't change anything except who pays the bills. The number of doctors, nurses, pharmacists, hospitals, urgent care centers, etc. will all stay the same. The only thing that changes is who pays the bills, and so who is able to get the treatment they need.

Now, maybe you really do think it's okay to deny healthcare to millions of people just so that you won't face the possibility of maybe being inconvenienced at some point. According to one study conducted by Harvard Medical School and Cambridge Health Alliance, nearly 45,000 people die in the US every year due to a lack of health insurance, but maybe you think that's a small price to pay so that you won't possibly be asked to wait at some point. Okay, fair enough. But be honest about what it is you're arguing for. If you think it's a good idea for other people to die so that they don't take away a doctor's time from you, then say so. Acknowledge what you're saying and openly embrace the ramifications of it. In short, stop hiding behind coded language and say what you mean: you value your convenience over other people's lives.

Frankly, if that's how you feel, I think you're a despicable human being. But it's a free country and you can be despicable if you want to be. Personally, I'm willing to accept the possibility that at some point I might have to wait for a non-urgent treatment so that millions of my fellow Americans will be able to get the care that they need, but that's just me. I guess everyone will have to make that decision for themselves.

Peace!