Health care: My response to Carter’s response

…In response to the previous email, I just sent my Congressman the following email. It built on the research I’ve conducted so far (and required a couple hours’ additional reading) but I’m relatively proud of it.

Congressman Carter,

Thank you for your thoughtful reply to my email, in which I expressed my support for health-care reform proposals currently being discussed. I hope you don’t mind if I offer a point-by-point response.

First, you stated that “America has the highest quality health care in the world.” In support of this assertion, you quoted some impressive-sounding statistics about cancer survival rates in this country versus some in Europe. However, cancer mortality is actually almost identical across most developed countries; a much more aggressive push for cancer screening leads to a much higher diagnosis of cancer in the US population, even though the number of deaths is not sizably different. For more context, I encourage you to read this insightful New York Times article that discusses the issue in detail; or, if I could be so bold, I discussed the same topic in this blog post.

Setting aside this topic, though, I should mention that cancer is almost the only metric in which American health-care results compare favorably to other developed nations. In other important measures like average life span and infant mortality, I’m sure you’re aware that the United States ranks extremely low, and the disparity is even greater when you consider our exaggerated health-care spending. And this is not to mention the fact that 14 percent of US citizens are without health-care coverage.

Second, you agreed with me that health care costs too much; “Lawsuit abuse, government regulations, and abuse of our programs by illegal aliens have caused health care costs to spiral out of control,” you said, “and these costs increased the financial burden on American families.”

Of course health care in our country costs too much—15 percent of our GDP—but the factors you cite are not major contributors to this problem. I too am in favor of malpractice tort reform, but the CBO estimates that it caps on damages will reduce health-care spending by less than half a percent (cite). The same is true for abuse of health-care programs by illegal aliens; though I wasn’t able to find recent data for Texas, the costs of illegal immigrants to California in 2004 amounted to $1.4 billion, less than one percent of its total—and even that percentage appears to be relatively high (cite).

What are contributing to the spiraling costs of health care much more significantly are, primarily, increases in Medicare and Medicaid spending. This CBO report from June of this year outlines the problem quite clearly; as it says, if we can simply cut the rate of spending growth by one percent per year, it would be more than enough to pay for a public-option health-care plan (or any number of other health care overhauls). The CBO believes this is patently achievable, since even establishing equitable Medicare treatment across different regions could cut its spending by up to thirty percent.

Your third point is that you are opposed to any form of government-run health-care plan, such as the public option which I support. You cite two reasons for doing so:

—Cost: the Democratic proposals do indeed amount to about $900 billion, which represents an increase of almost 10 percent per year over current spending. I share your concerns that such a plan might not be deficit-neutral, but the CBO’s estimate of a $239 billion deficit increase over 10 years would amount to less than one percent of the estimated gross debt for 2019. I consider a potential one-percent increase in total debt to be an acceptable risk, if the benefit is a better and lower-cost insurance option for uninsured (or underinsured) Americans. Perhaps you feel differently.

—Competition: It is certain that many small businesses and individuals would switch from private insurance to a public plan, and it’s just as certain that the public option would put pressure on private companies to lower costs. Indeed, this is its intent. Whether it would have the eventual effect of driving private insurance completely out of business is quite debatable—different experts have reached different conclusions. But the numbers you quote are very questionable.

The so-called “independent” Lewin Group, which predicted 114 million Americans would be “forced” out of their current coverage, is fully owned by United Healthcare Group, which obviously has a vested interest in the debate. This number is almost certainly inflated. Meanwhile, the CBO report that estimated 23 million Americans would lose their current plans made no mention of the fact that those same Americans would simply be transitioning to different coverage, like that offered by the insurance exchange or the public option. It’s a misrepresentation to suggest that this number represents uninsured Americans.

Fourth, you spoke against the proposed insurance exchange, because it would “mandate what procedures are covered and how much physicians are reimbursed.” (Here you repeat another inflated claim, that 120 million Americans could lose their coverage.) I can only agree with you, since that’s exactly what the exchange is for—to standardize insurance benefits and ensure basic coverage. I view this as a good thing for insurance shoppers, and I’d refer you to the list of benefits described by the Ways and Means committee here.

Fifth, you express concern over health-care rationing. Rationing is a scary word that brings to mind “death panels” and other government nightmares, but of course it is necessary to any functioning health-care system, and is employed daily by profit-motivated insurance companies in the form of refusing coverage for any number of questionable reasons. Rationing would of course be a part of a government-run plan as well; it could not be otherwise. I encourage you to read this New York Times Magazine article for a perspective on why rationing should not be a dirty word. In short, if one supports a public option, then one supports rationing—and I do. I fail to see why the specter of “government bureaucrats” is a scarier proposition than insurance corporations that (by their very nature) care more about profit margins than peoples’ health. I welcome your further comments.

There are many more topics to discuss that you brought up—I thank you again for your lengthy email. But my response has already grown long and I should come around to a conclusion. My conclusion is this: of course the health-care issue is complex and lacking in perfectly clear answers. But some of your concerns about the current proposals are inflated; some are unfounded; and about some, we simply disagree.

We do, however, agree that dramatic action is required to improve the health-care situation in this country. I hope you’ll look into bold proposals, including those brought by the Democrats, and above all focus on facts and accurate data—not talking points and the party line—when making your decisions.

Thanks one final time, and have a great weekend.

-Kevin