Health Care Reform: The Ethics and Morality

This series of posts features my thoughts about health care, organized into some simple categorizations. It is this data, these experiences, and these moral arguments that inform my opinion about health care reform. It is, of course, incomplete compared to everything in my head, and I welcome your questions and comments.

I care a lot about other people. It is very important to me to care for others in this world. As an atheist, I see this life as the only one that we have, and that makes it all the more important to do the best with it that we can.

But it's not just atheists who care about other people. Religious people also care about other people. Every major religion (and the minor ones, too!) compels its followers to take care of the sick and the poor.

The big question, then, is to what degree should we/are we obligated to use our money to pay for others' health care? I posit that we should form a national (or possibly regional or statewide) pool of money from which everyone draws to pay for health care. This is an option that is not only possible, but is affordable and will benefit everyone.

We live in the most prosperous country in the world, and health care is not a scarce resource. (Health care is not accessible to some people because of the costs involved, but that is the primary barrier. There are some locations where it is scarce as well, but again, this has more to do with costs than anything else -- doctors need to make a living and can't do so if none of their patients can afford to pay them.)

Currently, we spend more money per capita than any other country does, and receive suboptimal results from it. We could take that same money and apply it more intelligently, and receive much better results.

A single-payer system could be financed by a 9% payroll tax -- 2% paid by the employee and 7% paid by the employer[1 -- the question about raising taxes, but the whole thing is an interesting read]. My personal income is in the 90th percentile of American incomes, and my employer and I would be coming out ahead on this deal. Together, we pay $1250/month to insure my family -- and this rate applies to everyone they insure, not just high-income professionals.

Having a single-payer system would benefit everyone. It would benefit those who currently lack access to health care, for obvious reasons. But it would also benefit those of us who do have access to health care as well.

Something I worry about, as the primary breadwinner and person who enables my family to have access to health insurance, is what happens to my family if something happens to me. The best case scenario is if I am killed instantly -- my family collects on my life insurance policies, they can use the proceeds of that policy to pay for COBRA, their regular bills, and training for my husband to get himself back into the workforce. Hopefully he would be able to get a job with benefits that would cover his pre-existing conditions, although that could be difficult to find.

The worst case scenario is if I linger. Jeff will want to spend those last weeks or months with me, and taking care of me, when he should be getting himself back into the workforce. I'll be terminated from my job -- perhaps I'll receive long-term disability payments, but no longer an employee of my workplace, I'll have to begin paying the full health insurance premium -- and the clock will start ticking on COBRA. My care will eat up our savings, as our health insurance company finds limits in our policy that I hadn't realized were there, and I'm too weak to fight them for it.

A single-payer system, on the other hand, entirely eliminates this worry. My family's pre-existing conditions will always be covered, regardless of my employment status. My final months of life will not send my family into bankruptcy, because it's all covered by the system. But this is not the only way in which I will benefit.

If everyone has access to the health care they need, then they will be able to innovate without worry of the consequences. If I come up with a brilliant idea for a new company, I'll be able to pursue that idea without worrying about the consequences to my family's health insurance coverage. (It's a good thing I love my job, because I am basically tied to working for a large employer with health insurance coverage for pre-existing conditions, thanks to our health history as a family.)

A healthier workforce means a more productive workforce. If everyone has access to the health care they need, then there will be fewer people on disability. A person with diabetes can get the treatments they need to prevent blindness, for example. A person with a broken leg can get it set properly so that both legs are the same length and their back doesn't get strained by the imbalance.

Even the wealthy would benefit from a single-payer health insurance system. The amount of money that their businesses would have to pay to provide health insurance to their employees would decrease, lowering the bottom line. Their assets would not be at risk should they develop a costly or life-threatening illness. And they could use their influence with the government to improve the quality of health coverage, should they be unhappy with it.

A single-payer system is the right choice ethically and morally. It's a system that works well for many of our peer countries, and that could benefit the United States too.

Health Care Reform: The Math

This series of posts features my thoughts about health care, organized into some simple categorizations. It is this data, these experiences, and these moral arguments that inform my opinion about health care reform. It is, of course, incomplete compared to everything in my head, and I welcome your questions and comments.

I. Money

In the United States, we spent $2.4 trillion, or $7900 per person, on health care in 2007. This is 17% of our GDP [1]. Health insurance premiums increased by 5% last year -- twice the rate of inflation. Our neighbors to the north (Canada) spend half what we do per capita, yet have the opportunity to consult with doctors nearly 60% more than we do (an average of 6.0 visits vs 3.8 visits per year) [2].

II. Demographics

In exchange for the highest per-capita investment in health care, we end up with suboptimal health outcomes. We have the 33rd or 46th lowest infant mortality rates in the world (depending on if you use the UN or CIA factbook statistics), getting beat out by countries like Cuba and Israel [3]. We have the 30th or 38th longest life expectancy, getting beat out by Cuba, Greece, and Jordan [4]. In the WHO assessment of health care systems by country, the United States ranked 37th out of the 191 countries evaluated, behind Saudi Arabia [5]!


What are we getting for all that spending, then?

For those who have access to healthcare, we get some of the best care in the world -- the United States has a lot of resources that aren't available in places like Cuba, after all. But those who lack the access to healthcare, well, they may as well be living in a country that doesn't have any of those resources, because they won't get a chance to see them until there's such a dire emergency that the medical bills just can't be avoided any longer.

Here's the dark side of what we're getting: we're getting a whole lot of money wasted on administration -- six times the amount per capita than is spent in our peer Western European countries, all of which achieve superior health outcomes to us. We're getting CEOs rewarded with nine-figure bonuses when they merge two large health insurance companies into one mega-company. We get our insured health care decided based on profit, not on what's actually best for the patient, and all health care rationed based on people's assets rather than their needs. We get 68% of medical-bill-related bankruptcies being folks who had health insurance when their medical condition began [1].

Surely there's got to be a better way. We could spend all that money more wisely and provide better healthcare for more people.

Next: The Ethics and Morality