Monday, August 10, 2009

A question about "healthcare reform"

This is not a Philly-specific question, although Philly is a world center of healthcare delivery and education.

I was viewing a comment stream on a Facebook page called SBABG (Small Business Against Big Government), and I saw this contribution:
I have a newborn baby Becky[name changed]... went to the NICU on her first day of life. She was diagnosed with 22q11.2 DiGeorge Syndrome. She has life threatening heart disease: Tetralogy of Fallot, Pulmonary Atresia, MAPCAs and more. The cost of her healthcare may bankrupt us, even with the BEST healthcare coverage possible. We are extremely fiscally conservative, but still can suffer from problems like this. I am against the Obamacare plan, but we certainly need reform.
I think I know what answers I'm going to get, but it is safe to assume that this individual is a believer in a significant role for government in managing the healthcare industry? Otherwise, what would he mean by "but we certainly need reform"?

What are the responses of my readers, to this person's statement? How would "reform" help him out?

If I may be a bit indelicate, think of how we work through the wrenching problem of a pet who has a serious health condition. Say that the pet will live if it receives a $20,000 treatment, but if it does not receive that treatment it will certainly die. Depending on the economic situation of the owner of the pet, and the nature of the owner's relationship with the pet, there's a spectrum of likelihood that the owner will spend the money for the treatment, ranging all the way from "Of course! How could you even think of not doing the procedure??" to "Sorry, [pet name here], there's nothing we can do." Wealth alone wouldn't be the indicator-- two people who both have a sizeable savings account might have very different ideas of the importance of the pet's survival, relative to other possible uses of the money. (Example: "daughter's wedding next year, or another several years with the cat?")

Now-- the huge difference here, is that we can be sure this man's baby daughter is at the very very top of his personal financial priorities. But why does the bald fact of his daughter needing exorbitantly expensive care to remain alive, lead to the conclusion "we certainly need reform"? Is "reform" a code word for "more generous health insurance policies for people like me"? What kind of "reform" will make it good business for an insurer to fork over $[x] million dollars for one little girl, if it isn't good business now?

The guy could be facing bankruptcy in a few years for a variety of reasons. He may have reached his insurer's maximum payout amount, or the coinsurance costs may be bleeding him dry. What can he do? Well... if we really believe in the market, then our answer is-- "sell your daughter". Ok, I said that for shock effect, but I kind of mean it. Go out into the world, and convince individuals and organizations (churches, businesses, whatever) to contribute to the treatments that Becky(TM) needs to have a shot at making it to adulthood. Right? ('Cause, otherwise, you're getting those contributions anyway, via taxes, but without asking for them.) When all these people and groups are approached for contributions for Becky, and for Jimmy, and for Bobby, are they going to give equally to all three? Who knows? It'll be a complex decision, but a decision will be made. And the wider you cast your net, the more "votes" you can count. The market will decide whether to provide the resources you lack, for the purpose that you wish to use the resources for.

I feel I'm going to ramble if I go further. What do people think? I think we need to develop more sensible ways of talking about these emotional hot-button things. Just because we are very emotional about our own children, doesn't mean we should justify taking money from "society" by force.

1 comment:

  1. "but we certainly need reform." may just mean they think how it works now is broken but don't know how to fix it.

    The best kind of reform IMHO would be to get the USA out of healthcare so prices drop, there is more competition and thus more accountability, among other things.