Deconstructing media on the healthcare debate
on
September 12, 2009
Deconstructing media on the healthcare debate
Given the highly polarised debate on healthcare reform, it is an interesting exercise to examine some of the arguments put forward.
There appear to be a number of simply false or illogical arguments in this report:
- The implication of a "slippery slope" that implementing the proposed reforms will inevitably lead a full socialized system. Do you know a pot smoker who isn't addicted to heroin?
- Comparing the proposed reform, which has an OPTIONAL fiscally self-contained government insurance plan, to countries which have fully socialized (non-insurance model) medicine such as the UK and Canada is like comparing apples to oranges. Even if these systems were defective, it does not tell us that the US government insurance will be, because it will be running in a completely different environment. Whats more, if the US government insurance does turn out to be in a complete failure in either cost or quality, no one will buy it so it will cause no damage (compared to the status quo).
- That because you can find individuals that can complain about a country's health care system they are (a) giving a comparative response to the U.S. health care system and (b) that this reflects the overall state of the country's system as a whole, rather than one fragment of it. It works great as propaganda, of course. Statistics would be the tool to use here, and of course there are statistics that support both sides, although of course discerning truth here is very difficult. Many statistics of course (such as waiting lists and access to care) simply don't apply however because of the previous point.
- An example of how far off these cherry-picked horror stories can be - when the story that US media has been using the UK as an example of healthcare system problems (sparked by a rogue Conservative MEP came on US television and suggested that the NHS be abolished) the response was a national outrage in the UK that lasted several days (with people who had experienced both systems overwhelmingly in favor of the NHS, despite it's imperfections) and had both parties jumping up and down to say how strongly they supported the NHS in it's current structure.
- It presents things as problems that are also problems with the current US system - for example, "people die because of waiting lists" (although this ignores the numbers of course) - however in the US people die all the time because they have no health insurance (because of cost or because of some pre-existing condition), or because they are denied care by their insurance company. The underlying problem of people dying is the same - all that matters is the statistics.
- Medical innovation is great, and the comparison given is no argument as to why it would be affected by this reform. Speaking pragmatically, innovation alone is also not a means to an end - given a choice between (a) coverage for a randomly selected 70% of the population (but they would get some future innovations that perhaps helped in a few rare cases or resulted in a shorter but equivalent outcome) leaving 30% out in the cold or (b) coverage simply as good as we have now, but for 100% of the population. Clearly it is impossible for any innovation to have an beneficial effect equivalent to providing health care for the remaining population.
Anyway - here is a second video that explains point about there still being competition nice and clearly:
Nick Kristoff's Op-Ed in the NYT on Sunday explains the dangers of the status quot and cites a statistic that 18,000 Americans die each year (one every half hour) because they lack insurance coverage and thus don't get sufficient health care in a timely fashion, often in the early stages of treatable conditions.
I think one of the very interesting problems around the language used in the "health care debate" is that "health care" and "health insurance" are seemingly used interchangably, when they are completely different. In the US, both need reform, but for different reasons. Health care's runaway costs are a problem, and a system that treats rather than prevents disease is a problem. However these problems with the "health care" system are more than likely a result of larger fundamental problems with the way we pay for health care, the "health insurance" industry and system.
We really should be talking about "Health Insurance Reform" rather than "Health Care Reform". Most of the provisions that have been outlined by President Obama and many of the bills circulating in congress now deal with the "Health Insurance System" and the public option is part of the "Health Insurance System" and not the "Health Care System," it is a way to pay for health care for people who cannot afford or would not choose an available private health insurer. Health Insurance Reform is what would preven private insurers from dropping people, or instituting lifetime caps, or denying insurance due to pre-existing conditions.
Many of the proposed changes would lead to improvements in the way "Health Care" is provided, because as Michael Pollan points out, it is far cheaper to prevent Type 2 Diabietes than to treat it, but if insurance companies can cap coverage or drop people once they get it, or not insure people who have it, there is no incentive to prevent people from getting it.