Sunday, August 23, 2009

So what should the Christian perspective on health care reform be? To start with it must be rational. That means it must look at the facts as they are, not as we wish them to be. It must be informed by faith, that is the center of any reform must be the inherent dignity of the individual and their right to life.
In my last entry I ran through some numbers on health care and pointed out that the "health care crisis" is in reality a money crisis. A rational look at our health care situation demands that we start by looking at what our present situation is. We have already done that. Then we must lay out the principles that we can, as Christians, accept as the goals of health care reform. Then we must face the requirements that exist which takes us from where we are to where we need to be to meet our goals.
I would propose the following principles must be applied.
Medical care must be available to all Americans. Than means from conception to natural death. Abortion is not health care, neither is euthanasia.
The quality of the medical care must be equitable.
Equitable means that care, of a quality now enjoyed by those who have good health insurance must be expanded to all, not that everyone receive less car through the practice of rationing.
Business must continue to carry their fair share of health care coverage. That means they must either continue to pay their portion or they must give that money to their employees so that they can use it to purchase health care. No windfalls by dumping employees on some government health care program. Health insurance is part of a benefit package for most employees, that is part of their compensation for doing their job. To withdraw that compensation without replacing it with cash is equivalent to a pay cut.
If those are our goals then we must face one fact. We will be spending more on health care. Not just "We the People", that is the government, but we the individual. We pay more for a car in 2009 than we did in 1965. We can not realistically expect to pay the same for health care in 2009 that we did in 1965. No one expects that in 2015 cars will cost less. Is it rational to expect that health care will be less?
We also know that as we get older we will need more health care. We should expect that our health costs later in life will be more than when we are young. Just as we plan for retirement, those of us who are fortunate enough to be able to invest and save for retirement must expect that some of this money will go to increased health care costs.
We must also face that there are those who either don't or are not financial fortunate enough to be able to save for this period. We must accept the fact that we will have to pay for them. Either through private Christian charity or government mandate. If we refuse to do it through the former method we should not be surprised if we are force to do it through the latter.
We must also face some other facts. We do not have enough doctors to give equitable care to everyone. This is one of the reasons care is rationed in Canada and Great Britain. The other is investment of too much of their health care dollar(pound) in bureaucracy instead of health. That is the natural result of a single payer system.
So how to get there from here?
Continuance of health savings plans is one way. This is set for the ax under the House's Health care bill. Health savings plans encourage individuals to save for their health care needs. They should be allowed to carry over from year to year amounts that are not spent. At the present time any amount not spent goes to the administrator of the plan.
13% of Medicare is lost to fraud. The way to stop that is not more rules and tighter constraints but more investigators, prosecutors and jail sentences.
Not all of the uninsured are equal. There is a difference between a family which truly cannot buy food, shelter and clothing and afford health insurance and one which chooses to live in a better house or buy nicer things rather than pay for health insurance. Each group must be addressed individually and it must be admitted that it will cost the rest of us money, either through taxes or fees. We cannot cover these people for free, and pretending that we can merely means we are not paying for someone else's care.
Efficiency can make it cheaper to cover these people. When deciding how this part of health care should work looking at whether government or industry is more efficient should tell us how we will get the most for the money we have to spend to cover the uninsured. I doubt anyone would claim government is more efficient.
If we want to lower the cost of insurance we must broaden the insurance base. Insurance is a risk easement game. A group of people pool their money through an agreement that if someone gets sick the money for care will come out of the pool. Since the company that manages the pool is a business they skim a portion off the top and then use the remaining assets to pay for the care. The more healthy people that are in the pool the less each member must pay.
There are two ways to lower the cost to individuals. One is to limit the amount the managing company skims off. This is a finite amount. At some point the venture becomes unprofitable and the managing company goes out of business. So only a finite amount of savings comes form this method.
The other is to increase the number of healthy people in the pool. One way to do that is to allow insurance companies to sell anywhere in the United States. That way not only can they increase the number of people in the pool, but they are incentivized to keep their operating costs low, so as to be competitive.
At the bottom we should expect that some people will just not play. They will not get health insurance. Even under single payer they will remain outside the system, by accident or deliberate choice. When they get sick the more bureaucratic the system the less well it will deal with them. There will always be a need for Christian charity in the care of these people.

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