John Kerry and John Edwards have spent the last several days promoting their view of a universal healthcare for America. This is an extremely popular issue with Democrats and other social liberal political groups. It seems that once or twice a decade the idea resurfaces only to fade soon after election time. With all of the talk about universal healthcare there are a huge number of questions that are not being asked. Well, I am going to ask them, but I am sure I will get no answers.
How much will this cost? OK, this has been asked but the answer depends on the party affiliation. Republicans are throwing around numbers like $1.5 trillion or more over 5 years. They are sure that the cost will be astronomical. Democrats are rarely talking about the cost, preferring to imply that almost the entire cost can be covered by repealing tax cuts for people making more than $200,000 per year. I don’t know who is right but it seems to me that the cost will be the most important aspect of any healthcare reform.
Who will be covered? At first Kerry stated that universal Healthcare would be universal – everyone is covered. During the last debate he seemed to backtrack on that and target mostly poor and middle-class people for coverage. I think the ultimate goal of the Kerry plan is to cover everyone.
Who will provide the medical service? Is this a plan that is like a giant HMO in which the program will employ the doctors or more like a giant PPO where you will be able to visit any doctor you want? I really have no clue on this one. It seems that the giant HMO idea would be pure insanity.
Who will administer the program? Will this be an expansion of an existing government agency or an entirely new one? It does not seem possible for a program of this size to be administered by the government without adding an enormous amount of people to the federal payroll.
What happens to the existing health insurance industry and the employees of these companies? It seems that if you nationalize an industry or a large part of an industry the jobs impact can be very large. Will all these people be employed by the government? Will the loss of this portion of the insurance business adversely affect the stock values of these companies? Will a hit on the stocks of these companies impact the market as a whole? The economic ripples of a change this large will be very significant and should be overlooked when considering a program such as this.
What types of treatments will be covered? One of the complaints of an HMO system is that the HMO will control what types of treatments are available as a matter of company policy. Would our federal system attempt to control treatments in the same way? Will the government have input on when treatment should stop?
How will a federal healthcare system impact important debates over issues like abortion? Would the government have to pay for all abortions? How will abortion opponents feel about their tax dollars being used to pay for all abortions performed? This has the potential to be a very contention aspect of the plan.
What will the government’s claim to medical records of patients be? Since they are paying for the care will they make claims to the records? Who will have access to the information and how will the information be used? Rush Limbaugh is already seeing the potential for government intrusion into personal medical matters, will this system make this easier for the government to get information about you and your lifestyle? Will they use this against you and continued medical care?
When the program fails to reduce medical costs for the system as a whole will there be pressure to force behavioral changes in patients? What if you are a smoker, will the government now have the right to force you to stop? Will patients be forced to have procedures for their own good, like gastric bypass surgery for the obese?
How will this new program impact old programs like Medicare/Medicaid? What about VA medical benefits, will they be rolled into this new program or will they remain separate?
The more I think about this idea of universal healthcare the more questions I have. The more questions I have the fewer answers I can find. It seems to me the public cannot properly evaluate a program such as the one proposed by John Kerry without more information – a lot more information. Everyone in the country should be asking these questions and more before we allow anyone to attempt such massive change to our healthcare industry.