Friday, September 04, 2009

The Great Health Care Debate goes to kindergarten

So I'm on Facebook, and I've noticed a number of my friends have updated their status to say the following:
[Name] believes that no one should die because they cannot afford health care, and no one should go broke because they get sick.
Another friend of mine posted this most excellent question:
[Name] understands why libs are dumbing down their message of healthcare reform, but I don't agree with it. It's not that simple.

I'll be the first to admit our health care system, as it is currently operating, is fraught with problems. I will also state that all those who opposed the administration's efforts to create a "public option" by screaming "it's socialism!" need to wake up and see that the system is already largely socialized. Medicare, Medicaid, S-Chip, etc., are government-run health care programs, and they cover a significant percentage of the population.

The problem with making the debate about emotionalism/sentimentalism, which is what the "no one should die" statement is all about, completely misses the point of why there is a debate in the first place. This form of argument is juvenile -- nobody involved in the debate would disagree with the sentiment of the statement. However, it certainly does not follow automatically that to agree with that sentiment means you are evil and bad if you don't support the health care reform efforts of the administration or congress.

For example, we can all agree that "no one should die because of domestic violence." That is an obvious truth. However, because that sentiment is an obvious truth, do we completely dismantle the criminal justice system to handle this subset of cases? Do we start giving wife-beaters life in prison? Do we change the burden of proof?

It seems to me that, if you support a public option, single payer system, complete free market approach, whatever, you should be able to back up why with something other than sentimental arguments a 5 year old could make. Take a listen to John Hunt, a doctor at UVA, who has some interesting thoughts on the matter (scroll down to the podcasts, look for John Hunt). You may disagree with him, but he at least makes sense.

So to get back to the facebook status updates, the point is that argument, when taken down to the level of sentimentality, becomes completely meaningless. "What do you mean, you don't support health care reform? That means you want people to die because they don't have health insurance! Meanie!" Think about it this many people have you heard about who have died in the last 20 years from not having insurance? Apparently, folks are arguing that something like 60 people per day are dying from not having health insurance. They apparently get this information from this article. Of course, actually reading the article would help, so I did so.
"Health insurance really matters in how people make their health care decisions," said Ron Pollack, executive director of Families USA. "We know that people without insurance often forgo checkups, screenings and other preventive care."

But one can't conclude that being uninsured alone killed people, said Kim Bailey, Families USA senior health policy analyst. Instead, not having health insurance is associated with mortality-increasing behavior. "We can't actually attribute any individual deaths," Bailey said.
After hearing several minutes of background on the patient, Dr. Nielsen eventually asked when the woman's last Pap smear was. The answer: 10 years ago. The woman had developed uterine cancer, a curable disease if caught early. She died a few months after the initial diagnosis.

"You can dance around it all you want, but people who do not have health insurance delay the kinds of preventive care that everybody acknowledges are critical," Dr. Nielsen said. "That woman had a preventable, curable disease, and as a society we failed her because we have not made affordable health care available to all Americans."

So what can we divine from studies and articles like these? That folks who are uninsured (a) engage in riskier behavior, or (b) are more likely to delay preventative care that could prolong their lives. Is there a direct link between the lack of health insurance and these behaviors? Maybe so, because the common factor in folks like this is, of course, poverty. I represent folks in this cohort in court all the time. They engage in risky behavior not because they don't have health insurance, but because that's just how they roll. I'm pretty sure most of my 19-25 year old criminal clients, which demographic makes up a sizable chunk of people, are eligible for Medicare already. They don't have insurance because they never signed up. They don't get preventative care not because they don't have insurance, but because they just don't give a shit about it. Why is that? There are hundreds of reasons, no doubt, but I'm pretty sure "because I don't have insurance" is not high on the list.


UPDATE: and astute commenter reminds me that I meant to say "Medicaid" instead of Medicare for my young clients. Sorry about the error.