A lively discussion of what type of healthcare system people would like to have occurred at my town hall meeting in Tamworth on June 7 and in this week’s Tele-Talk. In Tele-Talk there was a broad range of responses, some thoughtful and some ideological.
A basic question that should underlie any discussion about health care is: What is the responsibility of society to help those in need?
We are a species that cares for our fellow beings. If we find a person hit by a car lying along the side of the road, we do not leave them to become roadkill. We take them to the hospital and treat them, even if they do not have insurance.
It is critical to understand what happens to the costs that are generated by that uncompensated care. There is no magic fairy that pays the bill. Those costs are shifted either to those with insurance or to the government.
A similar problem occurs when an uninsured person walks in to an emergency room in a medical crisis, perhaps due to untreated chronic illness such as diabetes or asthma. When people do not have access to healthcare, chronic diseases are not managed in the appropriate setting in a cost-effective fashion and instead are treated in an expensive location like an emergency room.
It is not a matter of if we cover health care costs, but it is a matter of how we cover them. The costs of health care do not go away by leaving people uninsured. The only way to make health-care costs disappear completely is to choose to let people go bankrupt, suffer and die. If we do not accept that choice, then we need to move away from ideology and explore the actual data regarding currently successful systems in other countries.
The only way to prevent cost shifting of uncompensated care is to ensure that everyone is covered in some way. There are different ways to achieve that, ranging from compulsory, highly regulated insurance provided by non-profits, giving uniform basic benefits that do not discriminate due to health status or age or gender, with government subsidies capping the individual contribution at about 8 percent of income, such as in Germany and Switzerland, to publicly funded systems such as in Canada and the United Kingdom.
One response in Tele-Talk stated that our health care should remain with the private enterprise system — which “has worked fine.” Unfortunately, our current system of private insurance has not worked fine.
Many people blame Obamacare for our rising health-care costs, but a critical look at the data shows that health-care costs have been rising for decades. Our non-system of multiple, private, for-profit payers and fee-for-service compensation — which rewards excessive intervention and testing, under-values primary care, promotes fragmented, poorly coordinated health care, and lacks universal coverage — have led our system to be twice as expensive as other developed countries with the worst outcomes.
The current proposals being considered in Washington do not really reform health care. They do not provide universal coverage, address fundamental cost drivers (especially the fee-for-service system), nor address our fragmented and inefficient health-care system. These bills fulfill an ideological pledge to repeal Obamacare by stripping health-care access from the working poor in order to give tax cuts to the wealthy.
At times it feels hopeless trying to get real reform in this country.
Massive amounts of lobbying money goes to our legislators in Washington to perpetuate our broken system by those who benefit from it: pharmaceutical companies, medical device manufacturers, the for-profit health insurance industry, some hospitals and even many providers. They do not wish to dismantle a health-care system from which they have profited well.
It is our duty to continue to demand real health-care reform. People must continue to educate themselves on the issues and advocate for reform.
In the fall, I will be holding further town halls on health-care reform in our area and around the state.
There are some aspects of health care financing which we can try to address at the state level. New Hampshire does control Medicaid and health insurance for state employees, state retirees and university employees. Rep. Ed Butler and I are working with four other representatives to address improvements that we might be able to make at the state level, including transparency in pharmaceutical pricing, reform of payments to providers and a more rational approach to the overall health of our citizens.
Much of our discussion of health care revolves around financing. In Tele-Talk, a few respondents did bring up the importance of individual responsibility that transcends our payment system. Our health status is affected greatly by poor lifestyle choices such as a poor diet, obesity, smoking and lack of exercise. To this list we should also add environmental toxins and emerging contaminants in the environment which impact our health.
It is still important to realize that even if we make all the right choices, accidents and illness can affect any of us. We have an economic and societal responsibility for everyone to have access to a health-care system with universal coverage and effective cost controls. The question is how to do it.
Jerry Knirk is a freshman representative from Carroll County District 3: Tamworth, Madison, Freedom and Albany. He lives in Freedom.
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