Fairly soon the U.S. Congress will pass health care reform. The various bills in the House of Representatives right now are being fiercely debated. Whatever the outcome, I can guarantee you some people will be happy with it, and others will not. And I doubt that whatever bill is passed will be the end of it.

Here are a few thoughts on the subject.

First, health care is not an entitlement. The Declaration of Independence declares “that all men are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” It does not mention health care. This is important, because once something becomes an entitlement, all other considerations go out the window. Everyone has to have it regardless of quality or cost. And we, as a nation, cannot afford this. We can afford better health care.

Second, you cannot pay for something if you don’t have the money. This sounds apparent, but it is often overlooked in these discussions. You can borrow against the future, but someday the bills will come due. In the meantime, you have to pay the interest on the debt.

So, how do we control rising health care costs? There are two ways I can think of. One is to put a price on every good and service. Insurance companies attempt to do this, to set standards, and in the current discussions they are reviled for placing “profits ahead of health.” However, someone must decide these things. It will either be an employee in private insurance or a government bureaucrat. Many people, thinking that health care is an entitlement, think it is also free—or at least the other guy should pay for your kidney transplant. The other way to lower costs is to drain money out of the system.

I can remember the 1950s, when a loaf of white bread cost 14 cents. The entire economy of scale was much smaller than it is today. You made less and paid less. My family was covered by Blue Cross/Blue Shield. My father had a good job, but we weren’t rich by any means. When I got sick, Dr. Bender came to the house with his black medical bag and told me to stick out my tongue and say “ahhhh.” It worked. I don’t know what we paid for health insurance, but it didn’t break the bank. My sister and I were never told that we couldn’t go on vacation that year because of unpaid medical bills. Blue Cross couldn’t charge a fortune for health insurance because no one could afford it. Once the federal government got in the business of health care with Medicare and Medicaid—and I don’t say they serve no purpose—medical costs rose at a higher rate, just as the cost of a college education shot up when federal funds became readily available to students and families. This leads to Point Three, which is really a corollary of Two:

If you scatter the bread crumbs, the pigeons will come. Case in point is an acquaintance of mine who had a cardiac stent put into his chest. He spent one day and night in the hospital and was released the next day. Cost: $10,000 for the operation, $10,000 for the hospital, and $10,000 for drugs. He was an employee of New York City and his union insurance paid for all of it. He wondered out loud, “I’d like to see the ten thousand for drugs.” And he wasn’t talking about heroin or cocaine.

If the union wasn’t able to command vast sums from the public purse, the entire procedure would have cost much less. You will notice that New York City is billions of dollars in the red with the highest taxes in the nation.

Four, the best health care is what you do for yourself. This is not to be confused with preventive measures like government-funded preventive medicine apart from regular checkups. Studies show that this kind of approach adds to health care costs overall because doctors can’t predict who will benefit from the care. They still must charge for the many preventive procedures that don’t help.

I’m talking about the things you can do for yourself, by eating a healthy diet (based on fruits and vegetables) and exercising, by treating yourself well and not getting sick in the first place. That you can control. It’s much better to take care of yourself and not go to the doctor then the abuse your body and become a chronic patient with serious disorders, even if someone else is paying. After all, even the best medicine cannot cure everything.

Which would you rather live in: A world in which most people are sick and in constant need of medication attention, costing ever larger amounts of the national budget? Or a world in which most people are well, taxes are low and medical expenses are light?

Health care is one of those issues that involve many players and a great deal of money. It doesn’t necessarily reward efficiency. The people who use it the most don’t necessarily contribute the most to the system; in fact, just the opposite. Lawyers will fight tooth and nail against tort reform because they benefit mightily from sky high costs for medical procedures and malpractice. I’ve read about doctors who became lawyers; I’ve never read about the reverse. If you want to know who runs the world, it’s not doctors.

However, tort reform is essential. Otherwise, there will be insufficient doctors practicing general medicine to handle an increased patient load under any of the plans under consideration. This will surely lead to rationing of care whether anyone admits it or not.

Many people think that the single payer system, as they have in Canada, for example, is the best way to go. Presidents starting with Harry Truman have argued for it. President Obama has said that if he were to start from scratch, he’d opt for the single payer system. Maybe it is the best way, I can’t say for sure. Single payer has the virtue of being easy to explain. Pull the knob on the health care machine and out pops a heart, a kidney, a root canal. It’s so simple and it hardly costs a dime! What seems simple in smaller countries and countries with smaller, less contentious populations, is not simple in America.

The countries that have single payer, or single payer plus a small private plan, including Britain, Canada, France, Sweden, Switzerland, all have or have had socialist parties in power. Their populations are accustomed to dealing with socialist governments, paying their high taxes and receiving their generous benefits. Americans have never supported socialism and communism at the polls. Americans think of themselves as individuals and value freedom of choice. When we shop, we like to compare products and get the best deal. We like to horse trade. In order to comparison shop, you need to know the value of the products, and right now, the numerous health care proposals are poorly presented and confusing.

Those who oppose ObamaCare, as it is being called, need to clarify their ideas and show more convincingly that they will solve the real problems of our present health care system by providing “quality, affordable health care to all Americans,” while preserving what is good about the present system. They need to show that their products, based on sound market principles, will save money and avoid a new giant government bureaucracy like the proposed Federal Health Board. Remember Ross Perot and his pie charts?

Maybe what we need is a dual system: Basic and Advanced—similar to computer programs that ask if you want the basic installation (recommended), or the advanced installation for more experienced users, where you choose which parts of the package to install. The Basic Plan would be for those who want to push the simple button and not think too much about it. They would get good care though not necessarily the best care. The Advanced Plan would be for those willing to sort through the details to make more intelligent choices. Their plan would offer greater risks and greater rewards, especially for those who take care of their health, as well.

By Hudson Owen. All Rights Reserved.

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