Cartoon20090812As I watch the post speech debate on what “health insurance reform” really means, I am reminded of the “Sultans of Swing” lyric by the group Dire Straits.  On the one hand, “the most interesting health care consultant in the world”, a Canadian PhD named Steven Lewis, has posted a very watchable video which points out flaws in the comparison of the Canadian system to the US system and makes a strong care for the advantages of “single payor”. I guess as a fan of Dan Aykroyd and Michael J Fox it shouldn’t surprise me that Canadians could be funny and serious.

In this country, however, the competition in the marketplace of ideas is not coming from the Canadians. It is coming from the Republicans as illustrated by the March on Washington yesterday organized by a group called FreedomWorks. Led by Dick Armey,  near as I can tell they are against lawyers (who isn’t  unless you need ’em) and for allowing “competition across state lines”. Not being a particular fan of the company responsible for 90% of the commercial policies in the state of Alabama, I thought this last idea might have some merit, until I looked into it further.

John McCain brought up the idea of competition across state lines in the 2008 presidential election.  I have to admit, it kind-of appealed to me. Since he didn’t win, I hadn’t thought too much more about it until now. It seems simple (why not let Mississippi Blue Cross into Alabama), American (companies should compete), and would seem on the face of it to produce lower costs.

The New America Foundation did not think any of those things would come to pass if “reform” took this guise. A non-partisan group, they looked into this policy change in October 2008. What they speculate would happen given the current state of regulation would be a race to the bottom. States that do not mandate such “luxuries” as emergency care, maternity care and pediatric immunization and prevention would quickly become the home state for many insurance companies so employer based policies would become less comprehensive. There would be even less types of policy choice under such a system. Integrated systems that we are striving to emulate such as Intermountain Health Care, Group Health Cooperative, and the Mayo would have their survival threatened as employers raced to the bottom. If employer coverage were not encouraged through tax policy, the number of uninsured would rise as insurers developed means to exclude high risk individuals and risk pools would become prohibitively expensive.

On the other hand, the foundation feels it could function with guaranteed issue (you get a policy no matter what your risk history is) and federal regulation of health insurance (back with the Stalin pictures), reforms such as are proposed for the “health care cooperatives”. Dick Armey has made his position clear on these addendum to his conservative policy position

“The only thing ‘guaranteed issue’ guarantees is more expensive health insurance and more government involvement. Imagine if they did this to restaurants—if restaurants had to serve dinner to everyone who wanted it (guaranteed issue) from a longer menu (to qualify for the national exchange) at the same price (community rating). The feast would be great—except that all the restaurants would close shop before I got dessert.”

What it comes down to is this: do we as a country see ourselves as having an obligation to provide for basic health care for our citizens? Do we see health care as a privilege along the lines of a restaurant meal? If it is a privilege, are we willing to allow the consequences of denial of care that we know would improve the well being of a fellow citizen because they have not had the good fortune of working for a company that supplies health insurance? Are we willing to do that while we gorge on excessive medical tests, medications for erectile dysfunction, and allow our physicians to make over $1,000,000 annually as they reassure us that America has the best health care in the world?