OPINION — At the crux of the current and contentious, nearly decade-long, debate over health care is one question: What the hell is our objective?
For me, the humane objective is to ensure that everyone receives the medical care they need when they need it. In doing so, we must incentivize personal responsibility and supercharge our sense of moral obligation to provide medical care for those who are unable, at any moment, to obtain it on their own.
But as our all-knowing yet ever-learning president discovered, achieving this objective is complicated.
One solution currently on the table is the Graham-Cassidy health care bill in the United States Senate. Its premise is easy to understand: States, not the federal government, are where we will find solutions. This is the wisdom of the state Block Grant idea. This idea would allow each state to meet the unique needs of the uninsured in that state. So if you were wondering, yes, the Senate ought to pass the Graham-Cassidy health care bill.
I know, I know. If you have not heard, you will hear that there are a million reasons to not support the bill. But frankly, most of those reasons use a baseline drawn from the particulars of Obamacare. The point of these objections can be summed up by the circular argument that what now exists will not exist. Yes, we get it. If you repeal Obamacare, it will go away. But that is not the end of the story.
If not Obamacare, then what? Essentially, we would have 50 laboratories of democracy each trying to meet the real needs of their people. This would become the new baseline. Innovation would take place in the states. Among the states is where we will find that success is easily replicated. They just need to be free to do so. That is where Graham-Cassidy comes in – a nice balance of funding and freedom.
Once solutions fall back into the hands of the states, we will see that there is more than one way to skin a cat. Based on its own commensurate values and living up to its typically idealistic expectations, California might choose to supplement its Block Grant with large doses of state funds. Whereas Utah might be able to do more with less, as it does in education. (Although, Utah’s funding would go up, not down, under the Graham-Cassidy bill.)
If left to innovate, states would provide the uninsured with enough options to get medical treatment when needed. For some, such as the permanently disabled, the answer would remain traditional Medicaid. For others, such as healthy young single adults, an answer could be affordable basic catastrophic coverage. Still, for others, such as the able-bodied, work requirements could be part of the answer.
Once we create a new state baseline of public expectations centered on our commensurate values, anything is possible, and everyone can get their needs met.
The free market provides the best functional mechanism to incentivize personal responsibility. Let the marketplace do what the marketplace does best. For instance, let health insurance companies provide plans within a for-profit business model in a truly competitive environment. Of course, a true free market only works if we also prevent anti-market behaviors from both government agencies and commercial providers.
As with medical ethics itself, material self-interest among health care providers cannot be their primary interest. Yes, competency is expensive, but competence is not necessarily tied to the size of the fee charged. Yes, we want new medicines to relieve human suffering, but what is a cure if it is so expensive it is unavailable to most people? Profiting from human suffering is not the same thing as being reasonably compensated for relieving human suffering.
Health care is the perfect marketplace to embrace social and moral frameworks that meet our commensurate values. When those two things align, medical care would be available to all without sending anyone to the poor house.
But it all begins with a systemic policy change. We need a new baseline from which to measure any successful health care policy. The baseline for Obamacare is confusing and often contradictory: federal government-managed, insurance company-provided health care. Its focus is on government managers and insurance company profits and losses.
The Graham-Cassidy bill creates a new baseline: a 50-state, solution-oriented approach. Its focus is on effectively providing medical care for all people who need it, regardless of how that need is met.
I’m Paul Mero. Thanks for listening.
Paul Mero is an opinion columnist for St. George News. The opinions stated in this article are his own and may not be representative of St. George News.
Ed. note / resources
- According to the Congressional Record, Sen. Lindsey Graham (for himself, Sens. Bill Cassidy, Dean Heller, Ron Johnson and Roy Blunt) on Sept. 13, 2017, submitted to the Senate an amendment, designated SA 1030, to the proposed American Health Care Act of 2017, designated HR 1628, to provide for reconciliation pursuant to Title II of the concurrent resolution on the budget for fiscal year 2017.
- Read the full text of the proposed amendment here: Graham-Cassidy proposal – SA 1030 – submitted to the Senate 20170913.
- The Senate Finance Committee will consider the proposal via hearing Monday at 2 p.m. EDT, noon MDT.
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I remember what it was like for the chronically ill and sick children in this state before Obamacare. These are uninsurable people (because insurance companies cannot make money from them) so they are lumped in a high-risk pool. Every year, parents would be forced to descend on the hill bringing their sad-faced children along with them to literally beg for their life-saving benefits to not be cut.
What this bill aims to do will kill people. It will decrease the cost of insurance for the lucky, but will do nothing to decrease the cost of healthcare. Your insurance bill will be lower (if you are fortunate enough to not have cancer, arthritis, or a genetic illness), but it will be lower because the insurance companies will not be required to spend as much money.
Every medical organization that matters, including the bipartisan directors of Medicaid in all 50 states, agree that this plan is horrible.
I know that insurance is expensive, but if you are not getting out what you are paying into your insurance, you are lucky. You have your health and you also have assurance that if you ever do have misfortune fall upon you (as it has fallen upon my wife and son), your fellow Americans will have your back. This bill tells my family that we don’t matter.
When natural disaster strikes our country, destroying homes and lives, we band together to help rebuild. I happily do this even though I didn’t choose to live in a flood plain in the path of hurricanes. We support each other. This bill is a huge middle finger to the 10 percent of Americans that will lose their insurance. We are better than this.
The most significant problem with health insurance in the US is the way it has been funded for years. What other product or service do we buy that has such a vast separation between the purchaser and the end user? An efficient economy functions best when the purchase decisions are made by the one directly benefitting by the product or service.
The current system includes 4 parties and looks like this:
Purchaser – employer (or government in the case of Obamacare)
Provider – physician
Payer – insurance company
Beneficiary – consumer
The price would be far less, for many reasons, if the consumer purchased directly from the provider. Buying a car for instance. When the consumer works directly with the dealer there is opportunity for both to come to an equitable agreement that both parties are happy with.
If health insurance was purchased more like home insurance where only catastrophic events were covered, the cost would be far less. Home insurance does not cover everything that fails in your house, but only catastrophic events such as fire or storm damage. Unfortunately, the healthcare consumer has come to expect every trip to the doctor will be covered and every prescription will be paid by the insurance company and that their rates won’t go up even if they have a bad health record.
If you like your doctor, you should pay your doctor directly and buy insurance for those catastrophic events that might occur.
Your recommendations only work for those who are healthy, which isn’t comparable to home owners insurance. Home owners catastrophic insurance works because buyers have a choice in buying the house in the first place and avoiding day-to-day pitfalls found in the due diligence period. We are born into our bodies with no choice. We don’t get to choose if we accept the day-to-day illnesses and pains that come with our lives.
OK, let’s carry the analogy about getting medical care, and automobile buying. I can see it now, “LET US PULL YOUR TONSILS! We pull here, and finance here.” Or “WE DO OPEN HEART SURGERY! Come in and meet our doctor, Honest Sam.” Or “BLEED HERE, PAY HERE!”
OK, I’m done with being a smart arse now.
The biggest problem I see with your idea, statusquo, is that it would put all the health insurance companies out of business. Somehow, I just don’t see that happening. Much like the drug problem, there are too many people, making big money, with the health care situation being the way it is now.
First two comments above are really good. If the current skinny bill passes it will make the Republicans own Obamacare withdrawal for years to come. Once again the Republican Congress is losing focus. Moving $ to the states solves no problem, just makes new ones. This bill does nothing to help the average American and in fact will cause many to lose coverage . I can just see the commercials now. Get tax reform done, or give me death! That should be the mantra, but bozos will be bozos.
States can’t afford there own system, but I stopped reading where Mero stated Utah’s education system does more for less.
Wow and more wow!! The State of Utah ranks as one of the lowest in education because Teachers are under paid and class sizes are double over other States.
I think what he really means is Republicans want you to have less access.
Why do you Republicans hate humans so much??
I agree that Utah should spend more on education and pay their teachers better. If they do more with less than imagine how much more they could do with more.
That said, Utah ranks pretty high when you look at K-12 metrics already. They rank in the top 20 of states in many assessments. The NEA figures should give any one pause about how abysmally we fund our schools but our students and schools do pretty well considering the lack of funding.
I think a least one element Mero is missing is that legislation should solve more problems than it causes. I get the ideological and even practical concepts that support moving it to a more state oriented distribution but that type of legislation will harm alot of people in the interim. As well, a 50 state laboratory only works for consumers if they have geographic mobility which is less common with the shrinking mobility. It doesn’t help if people are stuck in a state whose system doesn’t meet their needs. And that becomes more cumbersome when you factor back in limitations on pre-existing conditions, ie uncovered for a year or more on new insurance.
oops, shrinking middle class
Apparently Mr Mero can’t be any more honest than Cassidy or Graham. This bill is a total disaster for the people of Utah and thank God it is going down in defeat!!
The ultimate problem with government is the shift in government from governing to taking care of the people. The people should take care of each other while being governed be the laws of the government. The laws of the government should not dictate the populous to care for each other. This will never work. Govern over me. If I want care I will consult my doctor, neighbor, or minister.