The Health Care Debate That Hasn't Happened

Even as someone who generally prefers private solutions to problems over governmental, taxpayer-funded answers, I have to admit that the Democrats, who are largely in favor of health care reform which gives government a larger role in providing coverage to all, have well-beaten the Republicans, who largely favor less of a government role, rhetorically speaking. While support for Barack Obama's approach to health care has been dropping among the public according to some polls, I think that's more because of the economic situation the country and perhaps even more importantly the government is facing. Expecting the government to help fund a universal health care system seems a bit like relying on a homeless guy to help you pay your mortgage. The thought is lovely, but you kind of have to stop and ask yourself, "Can he really afford to do that?" I think there's a lot of skepticism about cost projections related to the various health care reform proposals floating around the Congress -- well-warranted, in my view, considering we've heard for years that Social Security and Medicare are underfunded. Still, if more people had the unlimited faith in the government's ability to fund everything through taxation and inflation that all politicians seem to have, I think the poll numbers would lean more heavily in favor of President Obama and the Democratic Party's approach to solving health care simply because people know the system is broken and want SOME solution -- even a thoroughly imperfect one -- that works for everyone.

Ideally, from my point of view, the solution wouldn't come from the government but from the private sector. Thus far, though, the private sector's solution has sucked. The health insurers have already had a shot to provide health care to all, but it hasn't worked for a couple of reasons. The first is that one's need for health care has little to nothing to do with one's ability to pay for it (or for health insurance). That makes health insurance unlike auto and home insurance right off the bat -- if you can afford to maintain a car or a home, you can likely also afford insurance so that system basically works for most people. Because of this basic fact about the costs of health care, we already have heavy government involvement via Medicaid and Medicare to essentially insure those who cannot insure themselves. Secondly, the insurers have failed the customers they do have by making it hard (if not impossible) for some to get insurance and sometimes denying coverage when it is needed. Technically, the insurers may well be justified from a business point of view for their actions (and, indeed, some might not even be able to stay in business were it not for those actions!), but these practices hurt too many people. Health care is a life and death matter; unethical business practices may always be bad, but when it comes to health insurance their consequences can utterly ruin finances and end lives. If health insurance is all the private sector can offer, then the private sector has failed insofar as health care is concerned.

However, there is another private approach to health care that gets scant attention. Free clinics have long provided free or extremely cheap care to the poor uninsured, and Shriners Hospitals provide free health care to children with specific conditions. Neither solution is universal, but the fact that both exist show the potential of health care as charity. The free clinic model basically requires the existence of a parallel health care industry because the doctors and nurses who volunteer at free clinics get paid for their work on paying customers elsewhere. Simply turning every hospital into a free clinic isn't acceptable -- doctors, nurses, and other health care professionals do some of the most important work in our society and deserve to be well paid for it. However, with a massive infusion of private money in the form of donations and endowments, it is conceivable that health care could become much more a nonprofit service. Sadly, though there are plenty of nonprofit hospitals that exist today, they tend to do very limited amounts of charity care and aren't necessarily cheaper than for-profit hospitals. Still, if enough people got on board with such an idea, health care could be changed fundamentally. Imagine, for instance, that in order to receive profits from an endowment a hospital would have to reduce the average costs per patient per procedure or treatment year over year. Slowly, costs would come down if the endowment's profits were large enough (the endowments would have to be massive and likely heavily weighted towards reasonably safe, fixed-income investments...stock market fluctuations have been the bane of even the large university endowments at institutions like Harvard lately and the Shriners' endowment has also been severely affected). As I see it, there would also need to be a move towards making other aspects of the health care industry nonprofit as well as part of keeping those overall costs down. This revolution is, alas, quite unlikely to happen now simply because health care is too big of a business, but it probably could've occurred earlier in our nation's history. I definitely feel that the private sector "dropped the ball" on health care long ago by foisting the health insurance non-solution on us all; the likely consequence of our collective decision is more government involvement in health care funded by compulsion rather than voluntarily.

Even so, I can't help but feel we haven't really explored the possibilities of private solutions to the health care crisis. For instance, I wonder why sports stadiums often bear the name of sponsors but hospitals don't. Soft drinks may not be the healthiest thing in the world for you to drink, but who wouldn't want to get treated at Pepsi Memorial if you knew your treatment was being partially subsidized by some corporate overlord intent on spreading good will? Given that we have peer-to-peer lending that lets people loan small amounts of money to regular folks through sites like Prosper (unfortunately, federal and state government regulations have really hurt sites like these), why don't we have sites for peer-to-peer health care or even health insurance funding to help those in need bear the costs of the present system? I hate that the health care debate has been reduced to private health insurance vs government interference...there could be all kinds of solutions being proposed and attempted. I wonder if part of the problem is that a lot of people feel that health care SHOULD be a government thing. Henry Ford, for instance, wanted publicly funded roads and refused to support private roadbuilding initiatives though he certainly had the dollars to make a big impact if he had wanted. Major philanthropists may be reluctant to invest in health care knowing that the poor and needy in other countries tend to be considerably worse off than in America -- there's some truth in that, but ultimately suffering needs to be addressed wherever it exists. Hopefully, any health care reform that does occur, be it a private or a public initiative, will effectively reduce suffering...that is the most important thing at the end of the day.