Whither the Crisis? - Part 2 of a series on Health Care Reform

We are continually being told that we have a "health care crisis". According to President Obama, in his latest address to the joint session of Congress, the health care system is "at the breaking point." So, we need to ask ourselves if we really do have a crisis and, if so, what, exactly, is the crisis?

A crisis is a situation that requires immediate action in order to avoid catastrophe. We have seen the results, with this administration and the last, of a crisis-oriented administration. As President Obama's Chief-of-Staff, Rahm Emanuel, famously said, "Never let a good crisis go to waste." And this administration certainly hasn't. We have seen an $800 billion dollar "stimulus bill", rushed through Congress and passed before anyone had a chance to read it to respond to the "economic crisis." We saw the government take-over of 2/3 of our domestic auto industry in response to an auto industry crisis. The House of Representatives passed the Cap and Trade Bill before it was finished being written - a bill that, if it passes the Senate, will constitute the largest tax hike on the middle and lower classes in history, in response to the "global warming crisis." Taxes are being levied on sugary juice and sodas in response to the "obesity crisis." A crisis is a very convenient circumstance to rush a bill through Congress without giving the public watchdogs or even the Congress Critters time to analyze the fine print of the legislation and also gives convenient cover to spend a lot of money in order to avert the imminent catastrophe. President Jimmy Carter once said, ""When a president has authority to act unilaterally (as in a crisis), his leadership can be exerted. Otherwise, compromise, delay and confusion are more likely." In fact, when Carter was presented an "energy crisis", he declared fighting it, "The moral equivalent of war."

That is not to say that there are no real crises, but when the government attempts to rush a huge, expensive bill through Congress on the basis of a crisis, our antennae should go up and we need to be sure there actually is a crisis and that what we are doing is necessary to avert that crisis. We've all seen shoot-outs on Main Street in old Western movies. In the movies, the quickest draw always won. In real life, it wasn't like that. A quick draw and shoot with a pistol is wildly inaccurate. The real winner was usually the gunslinger that took time to aim and make sure he was going to hit his target. The trouble with much of our crisis legislation is that we don't take time to aim. We spray our shots wildly, thus wasting valuable ammunition and usually getting ourselves shot, anyway.

So, is the crisis in health care one of quality? You might think so, given some of the rhetoric coming out of Washington. We hear that we spend more on our health care than any other nation, but get less for it. I've debunked this notion in my previous essay, First, Do No Harm, posted on Sept. 12, 2009. We actually have the best health care system in the world and our numbers prove it. I'm not going to reiterate my arguments here, if you haven't yet, read my previous essay.

Another reason for the "crisis" that we hear is that there are a large number of people who have no access to medical care because they cannot get insurance. The original number we heard bandied around was 47 million Americans (out of approximately 304 million), or about 15% of the population. In the most recent speech to the joint session of Congress, President Obama revised that number down to 30 million, since 17 million of those in the higher number were illegal aliens. 30 million is still a substantial number of people uninsured, but is that the whole story? No. Actually, according to the US Census bureau, more than 9 million make more than $75,000/yr. and could afford at least catastrophic health care insurance, if they choose. Many of these people are young, single people who eschew health insurance because they are healthy and would rather spend the money on flat-screen TVs and iPods. Another 14 million people are fully eligible for government programs like SCHIP or Medicaid, but are not signed up. In fact, of the children who are uninsured, over 70% are eligible for SCHIP, Medicaid, or both. That leaves 7 million Americans, or approximately 2% who are chronically uninsured. Now, without a doubt, for those individuals and families, being uninsured is a crisis, but should we restructure the entire US health care system for 2% of our population, especially when 85% of Americans say that they are happy with their health care insurance? Are there other, and better, ways to cover these uninsured people? I argue that there are and I will discuss this topic in upcoming essays.

The third common reason we hear for the "crisis" is that health care costs are rising too rapidly and they have become a burden on our economy. Certainly, health care costs have risen far faster than the general economy over the last couple of decades. They've risen almost as fast as the advances in medicine have. There are a number of reasons for this and I'll address this issue in another essay. According to President Obama, the rising cost of health care depresses the economy of the country and the individual economies of our citizens. In his State of the Union address, President Obama claimed that a bankruptcy occurred every 30 seconds. That is false. There is not even a bankruptcy every 30 seconds in the US, let alone one caused by high medical care costs. In actuality, while people who go bankrupt often have unpaid medical bills, few people (<1%,>because of medical expenses. Almost all hospitals and physicians will allow patients to pay on an installment basis and will not contact credit bureaus if the patient is making regular payments. As Thomas Sowell says, “In a country where everything imaginable is bought and paid for on credit, why is it suddenly a national crisis if some people cannot pay cash up front for medical treatment?”

So, is there a crisis in our health care system? Do we really need to rush a bill through Congress in order to avert an imminent disaster, or do we have time to rationally study and discuss and debate these issues? There is no doubt that health care is expensive, though we cannot expect Mercedes health care for the price of a Yugo. But there are many free-market solutions that do not involve a government that has an unbroken history of bringing in programs at higher cost and more inefficiently than anticipated.

In actuality, there is no more of a crisis now than there was a year or two or three ago. The only crisis for those who are trying to rush this through is that the American people may get wind of what is in the bill. I addressed this in my essay, Honest Barack’s Used Car Lot (posted Aug. 25, 2009.) The situation is too important to be rushed through or relegated to government control.

In my first health care essay, I used the oft-cited medical phrase, Primum non nocere – First, do no harm. We must keep that in mind as we discuss health care reform.

Honest Barack's Used Car Lot

The first new car that Dawn and I bought in our marriage was a 1987 Toyota Minivan. After looking through minivans on a dealership lot in Kansas City, the salesman asked that magic question, "What will it take for you to drive home in this car tonight?" About 6 hours later,after a lot of brutal and mind-boggling negotiations, we drove off the lot in a new Toyota Minivan, somewhat bewildered and feeling that we had been involved in something slimy. A couple of years later, after the engine blew and we found out that the dealership never sent in the money for the extended warranty, we realized that we'd been taken, but by that time the dealership had gone out of business and there was no way to recover our loss.

Having bought a number of cars, houses, and a few other large purchases in our 27 years of marriage, Dawn and I now have a policy that we don't make a decision on a large purchase within the first 24 hrs. Now, when a salesman asks me what it will take to drive my new car off the lot tonight, I tell him "Nothing." We have found that our policy saves us much aggravation and not a few dollars. Even those offers that "will expire at 5:00 tonight" seem to be able to be extended to the next day, if necessary.

I am reminded of this with our current health care debate. Maybe the President's tenure as Car-Seller-in-Chief at General Motors has equipped him for the job because it sure seems like we are getting the "offer expires today" hard sell. Obama is telling us, "If we don't reform health care now, it will never get done." He has set a deadline of the end of July as the time when Congress must pass the legislation, though like a good used-car dealer, when it looks as if he may lose the sale, it seems the deadline is becoming a little more flexible.

Fortunately, the American public seems to be learning, as we did after our minivan debacle. Now that the "stimulus" plan that was rushed through Congress so fast that no one had time to read it, has turned out to be a very expensive failure and we are now discovering all the little noises under the hood and find that the knobs on the dash aren’t connected to anything, people are wary of the Washington used car crowd.

Take the Cap and Tax Bill, for instance, which was rammed through the House so quickly that it was passed before it was even entirely written. (Think about that. If you approached your boss and told him that you needed an enormous amount of money for a project and you needed it by tonight, but you didn't have the specifics worked out yet, do you think you'd get it? Would any responsible businessman do that?) Now that people are seeing how much it is going to cost to lower the global temperature by 1/10 of 1 degree in 100 years, there are rumbles in the heartland. "But," we are told, "the United States must set an example for the world to follow." Of course, a stake was driven right through the heart of this argument with Secretary of State Hillary Clinton's recent Great American Apology Tour trip to India. When she urged India to limit their carbon emissions ("Don't make the same mistake that America did." e.g.- creating the world's greatest economy, being the greatest producer of medicines, machines, and products in the history of the world, etc.), India's government basically said, "Do you think that we are idiots or something?" (That was a paraphrase, but a pretty accurate summation.)

So now the latest model that the salesmen are hawking is health care reform. To hear Obama speak, this is the Mercedes Benz of bills – not flashy, but incredibly reliable and high-quality. Unfortunately, Honest Barack doesn’t even know what’s under the hood. When asked whether the House’s bill will allow people to keep their own insurance, as Barack promised, he replied, “You know, I have to say that I am not familiar with the provision you are talking about.” (It doesn’t, by the way.)

And don’t expect the salesmen to drive the same models they want you to buy. In Senate committee, a Republican amendment introduced by Sen. (Dr.) Tom Coburn (R-OK) requiring Congress to participate in any nationalized health care plan they enact was stripped by the Democrats on the committee. They know that the Mercedes body is powered by a Dodge Valiant engine.

As Moliere said, “Unreasonable haste is the direct road to error.” We all know this. The essay hastily written the night before it is due, as I can personally attest, is never as good as the essay meticulously researched and written. Who would take out a mortgage before reading all the paperwork? Oops, bad example, but you know how that turned out.

Any large purchase deserves careful study and thought. For our governmental used car salesmen to try to bum rush a this package by us without allowing us to even read the paperwork, let alone think about our purchase means only one thing – they know that if we are allowed to carefully consider it, we will see it for the lemon it is.

Note: I used stereotypes in order to illustrate a point. I apologize to any slimy used car salesmen that may have been offended by being compared to politicians.