Today the Supreme Court essentially upheld most of the Affordable Healthcare for America Act (AHAA). While I do disagree with the individual mandate as being Constitutional (as a tax, yes, but as a mandate, no), to me the biggest problem is in the wisdom of the legislation. While the practicalities of such legislation are complex, the underlying issues behind healthcare are pretty simple. From the Christian perspective we should desire that healthcare be available and, more importantly, affordable to all.
For Christians, all humans are made in the image of God, thus all humans have intrinsic worth. This means that while all life is a gift, human life is seen as unique and special. Therefore, when we see that someone cannot get medical treatment for the simple reason that they lack money, we should see such a thing as an injustice. It’s simply not right for a human to be denied healthcare because he cannot pay for it. While we wouldn’t call the denial of an elective procedure that has no real health benefit (such a plastic surgery) an injustice, any denial of service that can lead to more serious health issues is a massive injustice; not to mention that it does violate the Hippocratic oath (how is one to treat patients if one refuses to see them due to lack of payment?).
The above is why some people have said that the healthcare system in America is broken and the AHAA (or derogatorily, “Obamacare”) is the solution. Of course, both aspects of that argument are absolutely wrong. First, the healthcare system is no more broken than a Mercedes is broken; the problem isn’t the quality of the product, it’s the cost of the quality. Thus, Obama’s solution, while possessing some good things in it (such as making it illegal to refuse insurance for pre-existing conditions), doesn’t do much to address the actual problem in our healthcare system. The AHAA may lower the cost of insurance, but it won’t lower the cost of quality care. In other words, bringing more people onto insurances without lowering the cost of the healthcare service is either going to (a) bankrupt the insurance companies, (b) eventually drive the cost of healthcare up, to the point where hardly anyone can afford it yet will be penalized due to the individual mandate, or (c) result in the government having to provide universal healthcare. Option C is what many people naively think is best, but it doesn’t work because the government either goes bankrupt (government’s do not have unlimited funds) or it has to cap the price of medical procedures, which of course drastically lowers the quality of healthcare.
Such a system might work in smaller nations or in nations geared more towards socialism, but it will not work in America. While it works in Norway, Norway isn’t the United States; there are certain cultural ideals, economic beliefs, and so on that allow such socialized medicine to work in one nation but not in the other.
At the same time, we have to do something to make medical procedures cheaper. Making insurance cheaper makes little sense – so long as the medical procedures cost money and the cost rises, so too will the insurance. Car insurance is cheap because there’s a natural cap to it; the average person will only spend $10,000 to fix a car. Any more than that and the insurance will simply cut a check and the person gets a new car. In other words, the idea behind the AHAA that car insurance is cheap because a lot of people buy it (and are forced to if they own a car) is somewhat false; while more people in the system helps, the real reason that car insurance is affordable is because there’s a natural cap within the industry. Within health, however, such a cap doesn’t exist because the average person cannot simply replace their body or life. Thus, it tends to be quite a bit more expensive, to the point that even if more people buy in it won’t have a significant impact. Not to mention that the most affordable of car insurance hardly covers anything; shall we desire the same thing for our health?
From a Christian perspective we want to create an option that maintains the quality of healthcare (and improves it) while making it cheaper. The point in making it cheaper isn’t just so that more people can afford health insurance, but so that charities can do more to help those who can’t even get cheap health insurance. Making healthcare cheaper benefits everyone. Yet, all of this must be done while respecting the dignity of being human, that is, we cannot tax the people into oblivion to accomplish our goals. We cannot nationalize private industries in order to make them cheaper as this robs people of their well-earned property. In short, we can be neither socialists or pure capitalists. We cannot trust socialism as this would rob people of their property and rob the market of its resources to continue to research. At the same time, we cannot simply leave healthcare to the market and let the market decide because supply and demand doesn’t work when it comes to essential services. The government has always had to regulate essential services, even in the early days of our Republic.
In addition to the above, the Christian view of man is one that views man as both angel and demon, both good and evil. This means we cannot suppress the profit motive within the business and expect everyone to perform medicine out of the goodness of their hearts, but we also cannot expect people to be motivated by more than profit. Within the socialist approach, the motivation for the doctors should be the greater good of society, not their own income. But no one goes into a business to break even; everyone wants to make a profit. In healthcare making a profit is vital because a lot of that profit goes back into research and development for better medications and treatments. At the same time, we don’t want our doctors to be solely motivated by profit. When motivated solely by profit people will cut corners and cheat their way to more money. No one wants a doctor that is in it solely for the money because the doctor, at the end of the day, could care less if the patient is healthy or not.
With the above foundations for healthcare, which stem from the Christian perspective (though they are not exclusively Christian), I think there are a few very broad practicalities that could help lower the cost of healthcare while maintaining the integrity of our healthcare system (and even improving upon it). I leave the specifics to the politicians, but I think some generalized solutions could possibly get people going:
Eradicate the Patent System for Drugs and Medical Equipment – before the conservatives jump down my throat on this one, I’m not saying we should eradicate profit. Rather, I’m pro-free market because this fits best with the dignity of man. A patent, on the other hand, is not a free market solution. A patent allows the developer to hold a monopoly over their invention for quite some time, allowing the company to charge whatever price they want to gain back the money that went into developing the item.
The problem should be obvious – if Company A can charge whatever they deem necessary to recover their research, then the price of their product will increase. Now, some argue that the market is a natural check on patents and in some cases it is. If Apple has a patent for a new iPhone, it means no one can copy any innovative component of that iPhone for the duration of the patent. Of course, Apple can’t in turn charge $30,000 for the iPhone because they’d never gain their money back; no one could afford the iPhone at that point and thus no one would buy it. In cases like this where competition exists a patent has a natural check on it.
In the medical field, however, where there is no natural check (remember, insurance companies will pay for it because they have to pay for it; the medicine is essential), a monopoly causes the price of medication to rise up. In such a system you really have only two options: a free market solution or a regulated solution. The regulated solution is one that most people would reject, which is where the government puts a limit on how much medication can sell for. Thus, if a company puts $100 million into developing a drug and it will take them 15 years to gain that money back, but they sell it at a price so they’ll gain it back in 10, the government would come in and force them to go with the lowest price. This solution would work, but it wouldn’t be as efficient as a free market solution; it would provide less incentive to develop a drug if the maker figured they’d never make a return on it, likewise it wouldn’t make things cheaper because the cap would still be relative to the amount of money put into developing it (if anything, creative companies would fudge the numbers to make it look like they put more into the development than they actually did, thus increasing their cap).
The better solution is to eradicate the patent system entirely with drugs and medical equipment and instead force them to create a license. In a license, a royalty fee has to be paid to the creator of the drug/equipment by any manufacturers. Under a licensing system, some companies could simply move into research and development and simply forgo manufacturing their drugs or equipment; they could instead license out their discoveries to multiple manufacturers. In turn, the license would last longer than a patent allowing the company to make back their money and then make a profit. The best benefit, however, is that if you end up with 10 companies manufacturing the same drug, all with the same licensing fee, the original developer will make their money back, yet the drug will be cheaper due to competition. Obviously drugs would still be expensive, but they wouldn’t be as expensive as they are now. It would lower the cost and make it far more affordable, which is what we’re aiming for.
Multiple Safety-Nets for the Uninsured – Right now if a patient goes to a hospital and cannot afford treatment, there’s no established system to help him find a way to pay for his treatment. This is one area where the federal government and state governments could really help out. The state governments should create a database of charities that help people who need healthcare coverage. These charities would simply register with the state or the federal government, depending on if they intend to help people in their state or nationwide (thus, a local collection of churches may only help people in their city, but the Catholic charity may help people from any state).
Each hospital, in turn, would then help the uninsured go to these charities first. The person would help with paperwork, help them fill the paperwork out, and exercise all private options first before turning to a government option. The government option would be either the government simply pays for the debt, or the person can enroll in a government loan (if eligible) that can be paid at a minimal payment relative to the person’s income.
The reason for the above is that right now if someone doesn’t pay, that cost is passed onto the next patient. In other words, we already have universal healthcare coverage, it’s just not structured and it’s poorly designed. If we were to put together a cohesive system where charities could be contacted or some accountability is built in for the person paying the bill, we could limit how much (if any) unpaid bills get passed on to other patients. This would lower the cost of healthcare and insurance, since insurance companies wouldn’t have to pay for other patients. This is where the AHAA works as a short-term solution; if most people have insurance, less unpaid bills are passed around, which lowers the cost of healthcare. But this one component doesn’t fix the cost of the entire system (as I explained above).
Create More Competition – there needs to be more competition between hospitals, between insurance companies, between medical manufacturers, and so on. Competition creates cheap prices. The more natural competition that exists in a field, the cheaper products are in that field. How this competition is to be created is up for debate; as a distributist I would support the idea of constructing medical guilds, each one in competition with the other, where they are in charge of handing out licenses and then creating degrees of licensing. While there would be government oversight of the guilds (to prevent them from turning into monopolies), the guilds would essentially be left determining the quality of their doctors. In doing so, competition would exist. But I don’t want to get bogged down in details on this point because I first have to defend having guilds and then defend placing guilds within the medical community.
In short, the above three solutions are not perfect. But they hold to the basic principles that everyone deserves healthcare, but we don’t have to destroy individual freedoms to secure it. Certainly the above would require much debate, some things changed, but overall it’s a solution that I think goes to the heart of the issue while trying to appeal to both liberals and conservatives. Most importantly, however, is I believe it’s part of an overall system that respects the dignity and freedom of man.