America is counting down the months toward another election season. The first presidential ballots will be cast in Iowa roughly one month after this article goes online. That means the combustible issue of health care is going to be thrust on to the agenda once again. Nature abhors a vacuum, and with issues such as terrorism receding in the public mind, the question of how to control our seemingly out-of-control medical care system are going to step in to fill the void.
The personal nature of the issue creates an explosive and divisive atmosphere in public discourse. Most everyone agrees that health care is too expensive in the United States, but there is little consensus on what to do. Some candidates will call for a single-payer system similar to Canada’s, where the federal government essentially takes over the insurance business. Others believe the problem is rooted in excessive government involvement as it us, which combines with spiraling junk lawsuits against doctors to create the increased expenses.
There’s also disagreement as to the size and scope of the problem. Those that tend toward the Democratic Party point to 40 million people without health insurance as a prime example of a system in crisis. Those with Republican leanings point out that the United States still offers the best medical care in the world, and it is people in Canada that look to come here for critical procedures, not vice-versa.
Catholics are as divided as the rest of the country on this issue, and that was borne out by a recent poll here on 4marks.com. Unlike most political polls, in which one particular course of action emerges as the favorite of the membership, health care produced divided results. No one option even got forty percent, much less a majority. Even if you combine results, no overwhelming favorite emerges. Picking the two “Yes” options produces a slight majority, but nothing clear-cut. Picking the two middle-of-the-road options comes no closer to a consensus. If even people of more or less the same value system have a hard time finding agreement, how much more difficult will be it to build a consensus in the Congress, where sixty votes in the Senate are necessary for any controversial legislation?
Perhaps that points us to the political reality that a solution will only come from embracing the best ideas that both parties have to offer. In this article, I will make the case for combining Republican hopes for empowering individuals in the health care market, along with Democratic dreams of guaranteed coverage for all.
One of the biggest factors driving up health care costs is that the prices for medical care are hidden from consumers and there is no incentive to bargain shop. This is a consequence of the employer-based system of insurance. Individuals have no need to buy their own insurance. Once they are working and covered, they have no incentive to shop out costs at different doctor’s offices. The bills are taken care of, virtually unseen. Is it any wonder that traditional market mechanisms for cost control don’t work? They aren’t in place. Furthermore, tying health coverage to one’s job only exacerbates the insecurity felt during periods of unemployment.
Shifting to an individual-based system, along the lines proposed by President Bush would go a long way to solving this problem. Tax deductions can be given to those who buy their insurance independent of their employer. The IRS code can be further revised to allow for people to build up a tax-free fund that can cover routine medical visits. This enables them to purchase lower-cost high-deductible policies. If they need to pay the deductible, the fund is there to cover the bills. If they have a good year, the money can be withdrawn and used for things such as college tuition or a down payment on a home.
These changes would reward both the value of shopping prices and determining what really requires medical attention. They would also further the process of making the health insurance market more analogous to that for auto insurance. Do you ever hear of someone worrying about losing their job because their auto coverage comes through work? Doesn’t the idea of letting your car insurance be so dependent on your tie to one place (the employer) seem foolish?
One other thing about the auto insurance market would have to be applied to this new emerging market in health coverage—the need for the government to mandate that individuals purchase coverage. The ability to control insurance costs comes from having the healthy people (presumably younger) in the same pool along with those who require more care. Furthermore, those without coverage end up choosing to get health care via the emergency room in cases of extreme need—the most inefficient way to deliver medical services. The mandate should be as flexible as possible—there’s no need to require that everyone buy the most lavish plan possible—but part of being a member of society is exercising reasonable means to take care of oneself, as far as one is able. And having a basic package of health coverage should be considered a part of that.
Clearly, not everyone can afford a basic plan though, and here the government should step in and ensure that everyone gets coverage. In Laborem Excercem, John Paul II teaches that medical assistance should be available to all, “cheap, or even free of charge.” While this statement does not carry the weight of infallibility, certainly the teachings of a pope at the level of an encyclical should be given great weight by Catholics seeking to form their own judgment on an issue.
Getting health care coverage may be the single most important factor for someone looking to get their life on track. An unwed, uninsured mother of three may have made mistakes in her past to create her situation. But when she tries to start anew, getting—and affording—health insurance is going to be her hardest task. A man may have wrecked his life with destructive drinking. But if, in his middle-age, he’s going to AA and trying to live right, are we ready to deny him medical care because he may have to be at the bottom of the employment ladder? While no one should be given a free ride and no one should be guaranteed coverage that will simply enable them to live destructive lifestyles, those who want the hand up, should get it. And private charity can’t cover everything.
There’s no easy solution to this complex issue, in spite of the simple soundbites that will reverberate throughout the political arena. Each side can be expected to issue false characterizations of the other. The Republican candidates really don’t want to leave sick people on the street to die. And no leading Democratic candidate has proposed socialized medicine. False portrayals of either side do little to move us to the needed consensus—in fact, the more we are polarized, the more a solution slips further away.