The American Healthcare Debate
It's really not my intent for this to turn into a political blog, but a lot of the things I have to say lately are politically inclined. Our nation has become so emotionally driven around every political issue that we need to return to some civil debate over things.
One of the most valuable college courses I ever took was
logic. I thought it odd, that logic was a prerequisite for the computer programming course required for my business degree, but in the end it made perfect sense. Learning how to craft a logical argument that leads to a desired conclusion is the perfect way to understand how computers process data.
In my career as a writer, this skill has also proven valuable. Recognizing fallacious arguments during a debate and challenging them with logical ones that lead to the desired conclusion is a winning approach. As writers, it's a skill that can set us apart in our profession.
With all of that in mind, I'd like to address the ongoing debate over health care that's been dominating the national media lately. It's an incredibly complex issue that cannot be solved by mere emotional rhetoric. Hence, this is an extremely long blog post; I apologize in advance.
Why I'm addressing this issue
A recent social media post by someone on the left in response to a question about why Republicans oppose the Affordable Care Act (also known as "Obamacare" or the ACA) said the following:
...my understanding from conservative friends is that it's "socialism".
As a conservative, I appreciate the sentiment behind this, but mere "socialism" does not summarize opposition to the ACA. This post contains my observations on the issue. Even if I can't deduce a solution to the problem in this one blog post, taking a closer look can help us all understand the facts behind health care and the government's role in it.
One observation, to start off: "Obamacare" is really a misnomer. Nancy Pelosi and Harry Reid were the chief politicians behind the ACA. They directed its writing and pushed it through Congress before most legislators even had time to read all of it, with the approving vote along strict party lines. Obama may have signed it into law, but blame for the mess created by it should fall primarily onto the shoulders of Pelosi and Reid.
Who benefits from the Affordable Care Act?
My belief is that the ACA was
designed to fail. It was an intermediary step to get the majority of American citizens clamoring for
single payer - i.e., having the government control the entire healthcare system - rather than the private medical/insurance industry we have now. Having control over a population's health - and at times, whether someone lives or dies - is a tremendous amount of
power. And if career politicians in Washington have taught us anything, it's that power is the most addictive drug ever known to humankind.
The ACA was also
designed by politicians, which means that
lobbyists had a heavy hand in crafting the horrendously complex legislation behind it. I have heard that insurance industry lobbyists actually wrote much of the bill, naturally favoring their industry in doing so. That may or may not be true, but the law does little to tackle the underlying problems it was supposedly designed to address.
What's the goal of an insurance company? The same as any large corporation: to deliver value to their shareholders, which means
raising net profits by increasing income and reducing expenses as much as possible. Paying an insurance company premiums increases their income. Making a claim on a policy increases their expenses. Which do you think is of more value to them?
Insurance companies do not want the federal government to nationalize health insurance. This would dramatically impact their industry. So the input they had for the ACA made sure that health insurance would still be sold to the public - by them - even if the government administered the program.
Insurance companies want to sell more policies. The ACA not only makes that possible, it
mandates that American citizens buy their product. And who enforces this mandate? The most powerful arm of the U.S. government: the
Internal Revenue Service. If that doesn't frighten you, it should.
If you own stock in an insurance company - and many pension plans do, so even if you don't personally hold stock in one, their well-being may affect you - you want them to succeed financially. To have insurance companies failing the way banks did in the late 2000s would not benefit the American economy. The insurance industry employs millions of people and provides their livelihood. So it's easy to understand why politicians want to treat insurance companies favorably. Having millions more unemployed people is not going to benefit any of us.
Some individuals who were unable to buy insurance before have now been able to under plans offered as part of the ACA. They are often huge fans of the plan, ignoring its flaws because of their own personal benefit from it. Their reason for the inability to purchase insurance may have been pre-existing conditions that insurance companies refused to cover. Or their problem may have been more economic in nature. Subsidies provided under the ACA are either helping them pay the premiums, or allowing insurance companies to lower the policies' costs due to more healthy people being forced to buy insurance.
Who doesn't benefit from the ACA?
But there's another industry and a lot more people involved in this debate:
health care. One in every eight U.S. citizens is working in this industry, which includes not only doctors, nurses, and various types of technicians, but people working for companies that make medical devices and equipment, others that operate hospitals, some that provide services such as software for electronic medical records to those physicians, and still others that operate or build ambulances, bloodmobiles, etc. Just like the insurance industry, the health care industry also employs millions of people and provides their livelihood. So we certainly want to make sure it's also treated favorably.
People working in the health care industry have not seen many benefits from the ACA. Several doctors I know personally have
retired early because of it. Others have advised their children not to pursue a career in medicine. How did being a physician, which used to be one of the most respected professions in our society, fall so far from grace? This bears closer examination, which I will do in the sections below.
Some individuals have also come out worse under the ACA. My
premiums have quintupled under it. That's
five times more expensive than they were before it. Deductibles were also on the rise in recent years, even before the ACA, so I can't say for sure that it's made deductibles any worse. But the deductible aspect of a policy is a hardship to many. Those have, on the whole, greatly increased under Obamacare from what others are telling me.
Small businesses just on the cusp of being large enough to be forced to offer their employees health insurance under the ACA are suffering greatly from it. Some have been forced to shut their doors, or lay off some employees to take them under the threshold for offering insurance. This impedes the surviving companies' ability to grow and provide more employment opportunities to others.
While pro-government types tend to vilify business owners, they are what
drive our nation's economy. Without people willing to take the risk, invest the money, time, and effort into building small companies, our economy would stagnate and wither. Large corporations and the government cannot employ everybody. Smaller companies may someday grow into larger ones, and are needed to challenge the status quo and provide an innovative spark that moves us forward.
Far from exploiting their workers, these companies provide them with opportunities to grow with the businesses. But when too many constraints are placed on them, all that effort it takes to establish and grow a small business does not provide enough income to sustain the owner during the startup phase. Without that incentive, what's the point? Is anyone going to put everything they own on the line to build a business if the government is going to regulate that business out of existence?
The rise of comprehensive health insurance
As a sickly child, I required a lot of medical attention. My mother was always taking me to the doctor, and I was hospitalized eight times over a three-year period with asthma. The insurance my father had as a part of his compensation at work, however, did not cover the office visits to the doctor. In those days, my parents paid for most doctor visits out of pocket. Health insurance was called "major medical" or "hospitalization" and was designed to cover outrageous expenses.
What's more, my parents had to pay for those expenses up front, then submit paperwork to the insurance company to get reimbursed for them. While this didn't necessarily make them shop around for health care, physicians understood that they needed to keep their own prices affordable for people who would often be waiting a long time for the insurance company's check.
People were closer to their doctors in those days. There were less group practices and more individual physicians practicing alone. Patients respected the doctor's opinion; there was no internet for them to consult for another viewpoint. While doctors were not always right and people sometimes sought second opinions from another one, the physicians and their patients determined those patients' courses of treatment for whatever ailed them.
Only the larger companies in those days even provided health insurance for their employees; smaller ones could not afford to do so. As insurance companies saw their profits rising from selling group insurance plans to corporations, they wanted to expand that and designed different plans they could sell to smaller companies, as well.
Those plans then expanded to include more than major medical costs. Soon, health insurance covered every doctor visit, even routine check-ups and physicals. To minimize losses from these new expenses, insurance companies covered only a portion of their actual cost. Patients still felt like they were coming out ahead, since the office visits used to not be covered at all.
But because doctors were not receiving the money they had received before for them, the charges for these visits began to rise. They had to ask for more than they actually needed in order to get enough to cover the costs of providing the service. After all, their costs had not declined. They still had to pay office rental, staff salaries, utilities, and the cost of supplies to keep their offices running. Many doctors saw their own pay declining.
And here's an interesting statistic: If you look at the cost of health services over time, those not covered by health insurance - mainly things like plastic surgery and therapies such as chiropractic, acupuncture, etc. - have remained relatively stable. While not the same price they were 40 years ago, they have not risen as greatly as those covered by insurance. Services covered by insurance have skyrocketed in price. Why do you think this is?
Rather than patients paying up front and waiting for reimbursement, many doctors' offices also began offering the service of
filing insurance claims for patients. The plans grew more complex, which required hiring additional staff specially trained in the bureaucracies of various insurance companies. As paperwork became electronic, specialized computer software was developed to streamline this process. But rather than replacing employees, the software now required staff trained in its intricacies. These were additional costs that had to be covered, which also resulted in higher costs for visits to the doctor.
The process of doctors
auto-filing their patients' claims further evolved into patients paying a "
co-pay" up front that would not be covered by the insurance company. Patients started to think that co-pay was the amount a doctor visit actually cost; they no longer had a clue how much the actual total would be. Doctors who were getting additional patients from all the additional people now covered for doctor visits by their health insurance were seeing more patients, but insurance companies were not reimbursing them enough to cover their costs of providing the services and paying their staff. Some doctors would bill the patients for this additional amount, while others merely wrote it off.
Problems arising from comprehensive health insurance
Over the decades, these practices became normalized. People began to expect that health insurance would be offered by their employers as a part of their compensation...but not really viewed as compensation, more as an
entitlement. People also expected that they would not have any up-front medical bills to pay; everything should be covered by their employer-provided insurance.
As their costs for paying claims rose, insurance companies looked to the government-run
Medicare program to determine "fair" costs for medical services. Whatever Medicare paid for something became the industry standard. This was great for insurance companies; it helped them control costs and gave them someone else to blame if doctors said that wasn't sufficient to cover their costs of operation.
The idea that health care is an entitlement all people should receive for free is naïve. Whenever someone says this to me, I ask them what they do for a living, and if they think they need to be providing that service to people for free.
Doctors and others in the health care industry have spent years gaining the knowledge needed to do what they do. Not everybody can do it. Most of them have incurred hundreds of thousands of dollars in loans for this education, and must pay those off with the proceeds they earn from their work. It is an insult to their profession to demand that they provide those services for which they have studied many years without charge.
Should the government cover health care?
When people say that "the government" should pay for health care, this is another argument that doesn't hold water when examined more closely. The federal government does not manufacture any products. The only money they have is what they have seized from the citizens through taxation. So when you say that "the government" should pay for something, you're really saying that every U.S. citizen should pay higher taxes for providing that service.
Do you know how much you pay in federal taxes? Most people don't. Their federal income and Social Security taxes are withheld from their paychecks before they even see them. Sold to people under the guise of convenience, this is a slick way of making it less apparent to people how much they're actually paying out of each paycheck in federal taxes. Start adding that up every month, and you'll be amazed at how much is withheld from the total money you earned.
But what comes out of your paycheck is not all of what you pay in federal taxes. Consider how many embedded taxes you pay that drive up the cost of things like gasoline. Every time you fill up your car with gas in 2017, you are paying the federal government 18.4 cents on each gallon. That may not seem like much, but if you have a 12-gallon tank, that's $2.20. If you fill it up weekly, that's almost $115 per year you spend on gasoline taxes. If you have a 15-gallon tank, that rises to more than $143/year.
Diesel fuel federal taxes are even higher: 24.4 cents. You may not realize it, but that drives up your costs for shipping of products. This is more apparent as more people shop online and have items shipped to their homes, but it has always driven up the prices of items shipped to retail stores. Not just shopping for frivolous items, either, but everyday things such as groceries.
Gasoline is not the end of it, however. For example, there are federal taxes on every cell phone bill you pay. According to a 2010 report on National Public Radio, a national think tank known as the Tax Foundation estimated that the average American paid just over 24% of their income in taxes then.
The Motley Fool did a 2017 article to calculate the number, and determined that it had risen to 31.85% of your income since then.
"I'd be happy to pay more in taxes if everybody had health care!" people say. Again, this is a naïve notion. Remember the examples of government mismanagement of Medicare, Medicaid, and the VA? Those costs, once established as a government entitlement are always going to escalate. They will never go down, and they will never go away. When the federal income tax was instituted by the 16th Amendment in 1913, the top rate was 7% on income over $500,000. Most people paid 1%. Compare that to today's top rate of 43.4%.
Of course there are expenses for running the federal government. As outlined in Article 1, Section 8 of the U.S. Constitution, the federal government is granted three types of powers:
- Expressed powers: these include coining (or printing) money, regulating commerce, declaring war, raising and maintaining armed forces, collecting taxes, and establishing a Post Office
- Implied powers: these are what give them the right to make laws needed to accomplish its expressed purposes
- Inherent powers: these are powers that exist for all governmental entities around the world, including acquiring new territory through exploring or occupying it.
Nowhere in there does it say anything about providing health care to American citizens or nationalizing a private industry. And be aware: merely printing money does not give it value; international marketplaces regulate the value of the U.S. dollar. Printing more money does not magically create more wealth for the nation. Wealth is generated in the private sector: only when businesses prosper does the nation's wealth grow.
As the above illustrates, the federal government is not a big bag of money from which each citizen should be trying to get their "share." It is more akin to a big collection plate into which each citizen must contribute money in order to underwrite whatever it does. And over the past two centuries, the federal government has grown into a bloated, bureaucratic, unsustainable mess.
The illusion of cure-all drugs
Another contributing factor to unaffordable health care is an increase in the cost of
prescription drugs. And this is another area regulated by the federal government. Many Americans travel south to Mexico or north to Canada to obtain prescriptions they need at cheaper prices than they can buy them here in the U.S.
Why does the government protect prices of pharmaceuticals, making them more expensive for our own citizens? This is another complex issue and it involves another private industry that employs over 854,000 people. Reasoning is that if the companies invest millions in researching new drugs, they deserve to make that money back by selling them for more before the formula is copied and allowed to be copied and sold as generic equivalents.
Perhaps the bigger question here is this: why do we need so many drugs? There are natural or nutritional solutions for most health problems that we face. The costs for those tend not to be covered by most health insurance plans. Coincidentally, they also tend to be cheaper than pharmaceutical solutions. They do, however, require more time and diligence to work, and people tend to want a quick fix to their problems.
Antibiotics have been over-prescribed because doctors want to make their patients happy, so they'll write them a prescription when they don't really need one. Now we have antibiotic-resistant strains of bacteria that are causing serious infections. Now the country is facing an opiate crisis because pain medications have been over-prescribed and are commonly misused or stolen by addicts. Breaking our psychological dependence on the pharmaceutical market is going to be tough, but would go a long way toward reducing the cost of health care.
The specter of lawsuits over health outcomes
One of the main drivers of increasing health care costs is the cost of
malpractice insurance. This differs greatly by state, and is influenced by the growing number of
lawsuits against doctors and hospitals.
While genuine medical malpractice should absolutely be controlled, many of the lawsuits being filed today are frivolous. Babies are sometimes born with birth defects. People die every day. People become disabled from accidents every day. Some of these things happen because of an honest mistake made by someone caring for a person. Should every one of these instances be subject to a million-dollar lawsuit? Of course not.
Differentiating between honest mistakes and negligence, incompetence, or malicious intent, however, is what judges must do in these medical malpractice lawsuits. Lawyers are quick to urge people to sue, knowing that they will win a huge portion of whatever the settlement is. And healthcare providers are quicker to settle when their malpractice insurer is the one paying the bill. Often settling frivolous lawsuits out of court is cheaper than going to court to prove their innocence, even if they have done no wrong. It has become an expected expense of operating any business that provides health care to people.
What's the solution? That's a tough question. Limiting the amount for which people can sue a health care provider may not work because it would seem to increase the likelihood that unscrupulous providers would enter the marketplace. But without some type of
tort reform, malpractice claims - and premiums - will continue to escalate.
Problems...or opportunities?
One of the biggest problems with insurance companies covering most medical expenses and nobody paying for anything out of pocket is this: nobody really knows what health care costs any more. Some of the aspects of the ACA were supposed to make people "shop around" for health care. Physicians can't base their rates on what it actually costs them to provide the service, because their rates are, in essence, regulated by the federal government via Medicare and Medicaid. And patients are oblivious to how much they should be paying for anything because it's been so long since they actually paid out of pocket for medical care.
For power-hungry politicians, this ignorance is bliss. It means that the average voter doesn't understand what's at stake in the health care debate. They can play power games between the big players - insurance companies and large health care companies - lining their pockets with donations from both and reassuring voters that their interest is being put first...all the while making promises they know they can't keep once re-elected.
And make no mistake: getting re-elected is a politician's ultimate goal: that's what feeds their power addiction. Any desire to actually make a difference or do good they may have had when first elected goes out the window once they taste the sweet perks of power in Washington. Of course they meet with constituents and reassure them that they will fight for their interests...and some actually think they are. Those are typically are being played by others whose primary motivations are perpetuating their own wealth and power. Politics is an ugly business.
Chicago Mayor Rahm Emanuel once said, "Never let a serious crisis go to waste." He and many like-minded politicians view such times as opportunities to seize more power and subjugate the intent of the U.S. Constitution. But the purpose of that founding document was to limit the powers of the federal government, not expand them.
This gets back to the long-debated issue of "statism" - i.e., a strong, autocratic federal government that micromanages the nation's affairs - versus "federalism" - the argument that government is more effective when closer to the people, so most things should be regulated by local or state laws rather than the federal government. Even the Founding Fathers debated this issue, but the more revered of them were federalists.
If health care issues provide any opportunity, it should be the opportunity to improve the first word in that phrase: health. If Americans stay healthy, we won't need as much medical care. Everybody gets sick sometimes, but many of today's chronic diseases are caused by poor life choices: eating unhealthy foods (and too much of all of them), and not getting enough exercise. Those choices aren't something the federal government needs to mandate, however.
The health insurance safety net
For a long time, we have had a few "safety nets" for those who cannot afford private health insurance. The first example of this is called
Medicaid. It's a disaster. Fraud is rampant in it, and billions of dollars have been wasted in this system. Criminals who view the federal government as a big bucket of money create companies with the sole purpose of defrauding the Medicaid system. Illegal aliens have flooded across our southern borders to get "free" health care in our nation's hospitals.
The second example of the government running a health insurance program is
Medicare, designed for people over age 65 (approximately), or those who are permanently disabled. This is also a system rife with opportunities for fraud. It's far easier to collect a small government check than it is to work, and there are people who think that's a grand idea. They go to great lengths to hide their good health so they can continue to live on their government disability checks...I know one woman personally who did this for several years before she was old enough to go on Medicare due to her age.
Others, for example people who have children with severe chronic conditions or handicaps, depend heavily on help from Medicare to get the help their children need. It is a lifeline for many families.
Medicare, remember is the agency that
sets reimbursement rates for most medical procedures...the ones followed by private insurance companies. According to physicians, they do so with little understanding of the actual costs involved in providing those services. Bureaucrats who have never worked one day in the health care industry are sitting in offices and arbitrarily setting these rates, oblivious to any new treatments or procedures that could save patients' lives if they were covered. Many procedures or drugs that are helping people in other countries around the world are not covered by Medicare.
The final example is one of an actual government-run health care system. It's called the
Veterans' Administration, or
VA for short. Ask a veteran who's waited years for treatment or surgery for a serious health issue if they think the entire U.S. health industry should be controlled by the government...but do so with the understanding that you won't get a response that would be repeatable in polite company.
Do you really want the entire healthcare infrastructure in this country to be run like Medicaid, Medicare, or the VA? These are the three examples we have of what it looks like when the government runs a health care or health insurance system.
But there are
other safety nets that have been in place for decades, and they're too often overlooked in this debate. Emergency rooms are required by law to treat people who come there, regardless of their ability to pay. Too many who could never afford health insurance before the ACA were using these as their safety net for regular health care, which was one of the justifications used by politicians for creating it: the cost of providing regular health care in emergency rooms is much higher than if it's provided at a clinic. But to make the claim that people were dying because they couldn't get emergency treatment is dishonest; those facilities exist and must treat emergency patients.
And non-emergency
clinics serving the poor exist, as well. Physicians regularly donate their services to community-based programs to provide health care to the nation's homeless and others who can't afford health insurance. Many other people of means contribute to these local organizations all over the country. These clinics may not provide Cadillac-style health care, but they cover the basics normally covered by someone's family physician.
Where's the patient in all of this?
Probably the biggest problem in today's health care system is this: the expectation that a person's health care is between that person and their physician is no longer the norm. Insurance companies and the government have poked their noses into this relationship that used to be very private. In many cases, they now dictate to us whether we're allowed to receive treatment for a disease. If it costs too much to treat, or if we're "of a certain age" we're told that we're not worthy of receiving that treatment.
Now, with the advent of electronic medical records, we all have to worry about any hacker gaining access to our private medical information, and how it may be used against us. Will we be denied credit due to a medical issue that should have been private? Or employment?
And perhaps, as we've ceded paying for our health care to insurance companies, this is something we've brought on ourselves. When our parents and grandparents paid for health care, they lived simpler lives. Not everybody had all the perks of modern life we all think are entitlements now: TVs, cars, cell phones for every family member, McMansions...at one time, these things were not the norm. Our entertainment-obsessed culture has driven us to value material goods above the basic necessities of life.
There is significant personal responsibility on the patient in health care. We have a responsibility to keep ourselves healthy: to eat good foods, get some exercise, and tend to minor health issues before they develop into major ones. If we neglect to do these things, why do we think that someone else should suddenly become responsible for our care?
The worst is yet to come
The worst provisions of the ACA are only now beginning to fully kick in. It's my belief that was
by design, so that whoever succeeded Obama in the Oval Office would get the blame for those parts of it, even though they had been there from the beginning.
With the media only too eager to vilify Donald Trump for everything, this is certain to happen, no matter what steps he takes to correct the problems with the ACA. If he lets it fail, it'll be his fault. If he tries to correct it and anybody loses coverage or has to pay more, it'll be his fault. It's a no-win proposition for him. Ah, politics.
If you couldn't afford to buy insurance, even with the plans available through the ACA exchanges, you're now going to be hit with a fine for that. But if you could afford to pay such a fine, you would have been able to afford to buy insurance! How did the logic of that not escape those who wrote this flawed law? It's probably the most egregious problem with the ACA. The answer: it didn't. They were fully aware of this clear imposition on the poorest among us. But they delayed this provision of the ACA until Obama was safely out of office so they could blame it on somebody else.
What other alternatives are there?
Those in favor of a single-payer health care system run by the U.S. government point to
similar systems in other countries that they claim work beautifully and cost little. Canada! Cuba! Sweden! Denmark! The UK! According to them, every country in the world has better health care than the U.S.
But closer examination of those systems does not reveal any one that actually works without considerable costs or problems...the lack of awareness among individuals covered by the plans does not negate those problems' existence. People from other countries travel to the U.S. for many major medical procedures. Why would they do that if their own countries' health care systems were so spectacular?
I once had a client from Sweden who told me their socialized medicine program there was so bad that doctors basically gave people a pill and told them to go home and get better. The rate of suicide among Swedes suffering from
gender dysphoria - one of the darling groups to the same people clamoring for a similar healthcare system in the U.S. - is astronomical. If they cannot afford to travel to other countries to get the treatment they need, they have no hope under the Swedish health care system. Many take their own lives as the only form of relief. Is that what we want here?
Federal regulations prohibiting insurance companies from selling policies
across state lines cause premiums to differ widely between states. Why not open up the entire country to any insurance company that wants to sell policies there?
Insurance companies should also be offering different levels of policies to people,
cafeteria style: younger, healthier individuals may want to purchase a hospitalization-only policy and pay for regular office visits to their doctors out of pocket. They should be able to. Women who are beyond their childbearing years shouldn't need to pay for coverage of those expenses. Let people pick and choose the things they want included in their plans. More customization should equate to savings for patients, and better assessment of risks for insurance companies.
Thankfully, there is some thinking outside the box when it comes to covering health care expenses: MediShare and Liberty HealthShare are two examples of systems in which people pay into a
pool that covers the costs of its members. These operate similarly to insurance companies, offering different levels of coverage and pricing coverage on each member's age and household size. With MediShare, submitted medical expenses are posted monthly, with costs shared among the members, who contribute a monthly amount for coverage. These companies have been around for decades and have shared billions of dollars in medical expenses. They are real people providing real solutions without government help.
Many private physicians are setting up their practices as
"boutique" medical coverage, where they essentially offer their patients their own form of insurance. Patients pay a monthly or annual fee and receive office visits or other specified services in exchange for that fee. These plans remove the insurance companies from the equation altogether, returning to the patient-doctor relationship as the primary one in health care.
Assessing the root problems in health care
Ensuring adequate health care for everyone is such a complex issue that it will never be addressed simply. Instead, efforts to address it need to start getting to the
root causes of the problems being experienced. We can only do this by asking, "
Why is that?" every time a problem is expressed. Starting at the highest level, with the problem itself, we would then work backwards to focus on solutions for the root causes of that problem.
Some of the key issues that led to the passage of the ACA, expressed in the simplest of terms, are these:
- Some people who need expensive health treatments cannot afford them on their own.
- Some people who have chronic health issues are unable to get health insurance.
- Health care costs are spiraling out of control.
- Health insurance premiums are unaffordable for many people.
- Health insurance deductibles are unaffordable for many people.
Taking the first of these, if we start asking "Why is that?" we can identify a number of answers:
Problem: Some people who need expensive health treatments cannot afford them on their own.
Why is that?: Some health care treatments cost a lot. Some people are not making enough money to afford the basic needs of life, much less extra expenses like this. Some people cannot find jobs. Some people do not have family who could help them with their unaffordable expenses. Some people made poor life choices that have given them serious medical conditions that could have been avoided.
Each of these "Why is that?" answers will take us into deeper steps if we ask the same question. For example, again taking the first answer to the above problem's question:
Problem: Some health care treatments cost a lot.
Why is that?: Research into health issues is expensive, and companies making this kind of an investment need to be able to make enough on the results to justify the cost. Medical equipment used for some treatments can be expensive. Some treatments require medical experts with a high level of knowledge, which costs more to acquire and thus more to deliver. Insurance companies typically reimburse only a percentage of the amount requested, so medical providers ask for more than they need to hopefully get enough to cover their costs and pay their owners.
And taking it a step deeper with the first issue raised above:
Problem: Research into health issues is expensive, and companies making this kind of an investment need to be able to make enough on the results to justify the cost.
Why is that?: There are government standards for testing of medical devices, drugs, etc. that must be met. Medical testing must be done in appropriate facilities, which can cost a lot to set up and maintain. Companies or universities that conduct these studies have expenses: employees, facilities, supplies, sometimes payments to people participating in studies, and shareholders who expect to make money on their investment in that company.
People who research such matters will need to conduct in-depth reviews of each issue raised during these sessions to get to the root causes of each problem with our current health care system. This will arrive at the root causes of the issues and help us design better solutions for them.
Conclusions?
My view is that the government does not need to run the health care industry. Nor do they need to run the health insurance industry. Federal bureaucrats have made a mess out of the portions of health care they have already taken over. When the free market is given a chance without government intervention, it regulates prices. Any solutions implemented by the federal government need to keep this basic truth in mind.
Any type of federal solutions to health care issues also need to address the realities of our capitalistic economy. Everybody deserves to get a paycheck for the work they do, and everybody has to make a living to support themselves and their families. Nobody should be expected to provide products or services for free, unless they voluntarily make the decision to donate some hours for the good of their fellow man.
People need to take more personal responsibility for staying healthy. This is not something that can be regulated by the government. Nor is it something for which we need to feel guilty about neglecting to cover when those people need medical treatment. Better education about good health habits can help with that.
By addressing the root causes of the problems being experienced in today's health care world, which can only be identified by continuing to ask the right questions, we can perhaps start to find real solutions, instead of trying to seal a a gaping wound with one small stitch.
Regardless of what problems our U.S. health care system has, there are many things we do well. People travel to this country from others for medical procedures all the time. The ACA threw out a lot of these good aspects of our medical care system to extend care to a minority of the population that didn't have it. Some of those people didn't even want it. It was poorly crafted legislation, unnecessarily cumbersome, and needs to be repealed.
Sources: "U.S. Health Care Force Larger Than Ever" All Things Considered, NPR, March 19, 2012; "Adding it up: How Much Does a Taxpayer Pay?" Tamara Keith, NPR, September 8, 2010; "How Much Does the Average American Pay in Taxes?" Brian Feroldi, The Motley Fool, March 14, 2017; "History of Federal Income Tax Rates 1913-2017" Bradford Tax Institute; "The Founders and Federalism" American Government, USHistory.org; "Pharmaceutical and Biotech Spotlight" Select USA
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