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Tuesday, May 30, 2017

The Healthcare Problem

Healthcare in America is a major issue. Obama saw that and gave us "Obamacare", a system that has a hard time sustaining itself or even providing health care. While the number of insured may have gone up, the number that can afford to use that insurance hasn't, the cost of insurance has skyrocketed for everyone, and the number of people who couldn't afford insurance and are now paying for insurance or fines for failing to do so has gone up. Still, the Republicans, many riding a popular promise to "repeal and replace" that system, are having a hard time doing so because, well, it's a problem. Sure, the system before Obamacare wasn't perfect and, clearly, Obamacare isn't perfect, but now no one knows where to go to make it better.

Oddly enough, everyone seems to be focused on "insurance for everyone." California is considering its own single-payer healthcare plan where residents pay an additional 15% income tax to pay for healthcare provided by the government for all. This isn't new. Canada and Taiwan have such systems. Others like Australia, France, Spain and the UK have hybrid versions combining private and government institutions. Many states have tried. Colorado, Hawaii, Minnesota, Montana, New York, and Pennsylvania have all tried to pass such legislation. All have failed. Vermont was famous for their failure in 2014 to maintain such a system due to costs and tax increases. The problem is that this "insurance for everyone" approach fails to take into account the actual problem. The problem isn't that insurance isn't available or even that it's too expensive. The problem is the entire healthcare system.

Let's face it. Modern healthcare is expensive. It costs a lot to actually become a doctor, let alone a specialist. There is the cost of education and the cost of lost earnings (the income they could have had if they had jobs when they were spending years to become doctors). It costs a lot for a doctor to practice with regulations and cost of specialized equipment and malpractice premiums. One of the high costs of healthcare in America is that doctors on average are paid more in America than in other countries. On the other hand, studies indicate that this is a major contributor to the higher quality of healthcare in America than in other countries. It costs a lot to research and develop new technologies and medications, a factor which none of these single-payer systems take into account. Some costs are incalculable, like the category they refer to as "defensive mmedicine". These are the tests and treatments provided to guard against the possibility of malpractice litigation. Measuring that cost would require knowledge of a healthcare provider's motivation. Then, as it turns out, the medical industry actually charges more for people who have insurance than for those who don't; it costs a lot to have insurance and to use it.

The real problem, then, is the system. It is the system of education, operation, and, at the bottom, greed. Everyone wants their cut, from the educators to the doctors to the insurance companies to the researchers to the manufacturers and sellers of medical technology and pharmaceuticals to the administrators to the patients who see a chance to get some back in malpractice lawsuits. Greed. No amount of insurance or legislation is going to fix greed. It's very simple. Remove the incentive of greed and you'll remove the quality and availability of healthcare. Include the incentive of greed and you'll be right where we all are, struggling to figure out how to pay the high cost of healthcare.

As it turns out, then, the healthcare problem is not a question of insurance; it's a question of greed. As it turns out, neither insurance nor careful regulation nor universal healthcare will solve this problem. Interestingly enough, the solution to greed is found, of all places, in the person of Jesus Christ. You know, the One they want to ban from the public venue.

19 comments:

Marshall Art said...

Personally, I don't think it's greed, though greed impacts most everything to one degree or another. The question is whether or not it is a driving force. To some, and one must be careful with this one, the mere desire to earn as much as one can in order to live a life with the least possibility of financial distress is not, in my opinion, greed. For a doctor to want to recoup something for the major life sacrifices undertaken in order to become a good doctor (and for some of those, the ongoing sacrifices in order to stay current with the latest methods, as well as to simply serve patients effectively), is also a matter of return of investment (of time and one's life).

The same is true for pharmaceutical manufacturers (though I would concede that greed might be more a factor here, or at least seem to be). The cost of developing drugs includes all that never came to market, as well as all that was rejected on the way to that which wasn't.

The problem with Obamacare was that it didn't address the real causes of rising health care costs, or the problem with too many who actually had trouble affording it. That means two angles of attack: costs and the ability of citizens to afford health care.

For the first, pre-ACA arguments pointed to a few solutions, such as addressing regulations with an aim toward eliminating some of the unnecessary and/or redundant of them. Another was the ability to purchase insurance from any state. And then there was tort reform. These were among the most prominent avenues that could and should have been traveled before choosing the let government get deeper into where they never belonged in the first place.

For the second, growing the economy through means of reducing regulations on the rest of the private sector, as well as tax reform would have gone a long way toward increasing employment and wages so that people could afford to heal themselves.

The above is certainly a less than detailed list of actions that should have been taken rather than forcing ACA down our throats, and now the GOP seeks to simply alter that plan with something no better, rather than to totally repeal ACA and begin again with more appropriate methods.

Greed is a personal issue that no system can eradicate. It has shown its face in every economic system and form of government. Belief that we can solve our health care woes by attacking that character flaw is misplaced.

Stan said...

"Reasonable pay" is reasonable, but when America doctors make 4x or more what doctors anywhere else make, one has to wonder if it's "reasonable". However, it isn't just doctors. The list of people with their fingers in the pie, so to speak, is unspeakable, up to and including patients themselves who believe that anything that has gone wrong is malpractice and they are owed exorbitant payouts for it.

You say, "Belief that we can solve our health care woes by attacking that character flaw is misplaced." I'd counter that believing you can solve it without addressing the problem of the sin nature is equally misplaced. No, no system can eradicate that problem. Maybe some laws could help. Maaybe a change in societal morality could help. But, as I said, the only real answer is "the person of Jesus Christ." I guess I'm a bit surprised that you would disagree that Jesus is the answer.

David said...

"the mere desire to earn as much as one can in order to live a life with the least possibility of financial distress is not, in my opinion, greed." I disagree. That is an excellent definition of greed. That mindset is mentioned in the opposite in Scripture when we are told to, "in everything, be content." Trying to get the most return out of the least effort, especially at the expense of others, is clearly greed.

Marshall Art said...

Stan,

I never disagree about Jesus being the answer. How can that be applied to health care?

David,

By your response, it's hard not to infer that you possess the same "simple living" ideology as Dan Trabue. For what is the line that separates greed from comfortable? Or even greed from luxury? It is the "especially at the expense of others" that you chose to throw in at the last minute. There is no need to acquire or achieve "at the expense of others". Wealth creation does not require that at all. In terms of health care costs, doctors seeking to recoup their sacrifices, not to mention putting a legitimate value on their talents, abilities and current sacrifices to perform their duties, is also not a matter of greed, except by those who would dare suggest they can impose their notions of what doctors should charge.

So, to be consistent in your position, refuse any pay from your job that goes beyond sustenance and be content. Anything in addition can only be greed on your part.

I totally reject the notion that ambition and the desire for a better life than one has is either a matter of greed. I also reject how you're understanding the concept of being content. That also does not prohibit improving one's situation.

Stan said...

"How can that be applied to health care?"

So ... you disagree that Jesus is the answer ... to the healthcare issue. How can it be applied? The problem is sin. Jesus is the answer to sin. People need Jesus. Spread the word.

" it's hard not to infer that you possess the same "simple living" ideology as Dan Trabue."

Them's fightin' words. But, of course, David referenced a biblical concept -- "in everything be content." Paul said in that biblical concept "I know how to be brought low, and I know how to abound. In any and every circumstance, I have learned the secret of facing plenty and hunger, abundance and need." (Phil 4:12) So you're "You'll have to turn down any pay raises" is just nonsense.

We're all aware that you believe that seeking to have more is not greed and not wrong; you've made that abundantly clear. But be cautious lest you be accused of trivializing Scripture like Dan Trabue. ;)

Danny Wright said...

Greed in the patrons also causes a problem. Insurance, by definition, is the sharing of risks. For the same reason that you can't purchase fire insurance after your house burns down, you can't purchase health insurance after you discover that you have a major health issue. IT's a pre-existing condition. That's not to say that insurance companies don't try to dump you as soon as you become expensive, but in the end you nailed the problem. Sin.

Marshall Art said...

Stan,

You haven't answered the question with regard to applying "Jesus is the answer" to health care. What does sin have to do with it exactly? As I read again your post, I think the problem is assigning greed as the basis for all our health care issues. I disagree again, except to say that the lust for power by those seeking to "fix" health care is apparent. We needed less interference, not more.

But on the side of the consumer, how is it greedy to want to be able to afford and acquire medical attention when needed? Are you "content" to be sick or injured and letting God take care of it like some Christian Scientist, or would you prefer a well trained medical professional to provide you with the proper and most effective remedies available?

To the extent that sin is problematic everywhere in every context is one thing. But that doesn't begin to address the tangible problems that can and should be addressed in order to result in better and more affordable health care for the most people.

I just don't get the connection of sin and the health care system that you're trying to suggest should be the starting point for correcting the flaws of the system. I also don't think those who are working to improve the system would see it either (regardless of who it is or what their angle for doing so might be).

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The reference to Phil 4:12 only supports my concern. It doesn't speak against ambition or the desire to improve one's situation at all, in my view. Paul says he knows how to abound. He doesn't speak of the morality of "abounding". But you and David seem to be inferring it. David refers to increasing one's wealth "at the expense of others" as if it is the only way it can be done. That wealth CANNOT be acquired with it or blatant greed as motivator.

So, I don't disagree that Jesus is the answer to our sin problem. I disagree that saying so in the context of "fixing" our national health care system is not helpful in a practical way...unless you can make a tangible connection between the concept and an actual plan that gets us from "Jesus is the answer" to improved health care systems.

Marshall Art said...

Danny,

I don't argue that greed in the consumer is an issue. But one needn't address that in order to adjust how the health care/health insurance industry works. In the most basic sense, it must start with recognizing what insurance is supposed to be: protection against the massive costs of catastrophic illness or injury. By the corruption of that basic concept to one where every hangnail us expected to be paid for simply because one has insurance, costs cannot help but skyrocket. It removes from the consumer the responsibility for living responsibly and shopping for the best care when one gets sick or injured regardless. It really doesn't matter whether or not one is greedy or sinful. It only matters as to what system is in place. Sin and greed will exist regardless.

While we strive to encourage all to sin less and be more Christian, people still need medical care and not go broke because of it. We can solve the latter while God works through us to achieve the former, but we can't wait to solve the latter until we succeed completely in eliminating sin and greed.

Stan said...

How does Jesus apply to the health care question? The point is that we're not going to fix the health care question. Insurance, laws, "single payer providers", there is no mechanism currently available to a world hostile to God to fix this problem. Just as new laws, better presidents, more capable Congressmen, or better judges won't solve the problems in our country today.

I don't know what you classify as "greed", so I can't respond to your view of greed. Nor can I correlate your apparent opposition to "contentment" with Paul's call for it.

As for Paul, he did not argue in favor of getting rich any way you can. He said, "I count all things to be loss in view of the surpassing value of knowing Christ Jesus my Lord, for whom I have suffered the loss of all things, and count them but rubbish so that I may gain Christ, and may be found in Him, not having a righteousness of my own derived from the Law, but that which is through faith in Christ, the righteousness which comes from God on the basis of faith, that I may know Him and the power of His resurrection and the fellowship of His sufferings, being conformed to His death; in order that I may attain to the resurrection from the dead" (Phil 3:8-11). "A strong desire for a more comfortable life" doesn't seem to fit with that sentiment. Paul indicated that when God provided much, he was satisfied, and when God provided little, he was satisfied. He wasn't going to make the pursuit of "more" his aim; he was going to count on God to provide what he needed (Phil 4:19). His primary concern was the welfare of others (Phil 4:17). His highest concern was God's glory (Phil 4:20).

Marshall Art said...

My point is that despite man's penchant for rebellion, the day to day functioning of society can move toward a more reasonable and workable system for providing health care, health insurance...or pretty much anything. That is, health care that is more efficient in its purpose, more affordable for more people and insurance that is more logical and tied to its actual purpose. We can be as sinful as all get out and still come up with a better way of doing all those things. What's more, our sinful nature doesn't excuse our not trying, or as average citizens, not expecting that those we choose to work for us politically should move to reach those goals. More specifically, there are indeed "mechanisms" by which we can "fix" most any problem.

This is not to say that our fallen nature won't continue to result in more, other or different problems. But the very existence of our nation as a world power demonstrates that your premise is untrue. Indeed, our founders were well aware that we are not perfect and that our form of government required a moral people in order to work the best. For a time, that concept resulted in our becoming the great nation we once were. But at some point, we began to work on the premise that we are all basically good and that's when things went south. I insist that we are meant to work toward solutions for everyday human problems and needs without regard to our ability to attain a "perfect" solution. This can be done as we are indeed capable of achieving improvements and solutions to problems.

continuing...

Marshall Art said...

"I don't know what you classify as "greed", so I can't respond to your view of greed."

I left a hint when I responded to David's use of the expression, "at the expense of others". I insisted that wealth creation does not require that one do such a thing. Thus, to achieve "at the expense of others" would indicate a greed in a person. More importantly, greed would be the attainment of wealth at the expense of God's will. Idolizing wealth...putting it before one's obligation to God. There is no amount of money that will entice me to disobey God, to ignore or forget Him...at least to the extent of my ability to guard against it. And THAT requires His assistance at all times, for I am weak and possessed of a sin nature as is anyone else. Were I to act in a manner contrary to this, I welcome any reminder and trust that God will send it in no uncertain terms.

"Nor can I correlate your apparent opposition to "contentment" with Paul's call for it."

My opposition is not with Paul's call, but with your apparent understanding of what he means by it in terms of practical application. My inference of your understanding is that contentment necessarily precludes any ambition whatsoever. My take on Paul's teaching is that it aligns with what I said above concerning greed. That no matter what my situation, God is key, sovereign, responsible and in Whom I trust. It does not mean I can't or shouldn't seek the most luxurious life I can. It refers to my state of mind regardless of whether or not I succeed at doing so. God is central in any case.

I chose to peruse several commentaries on the subject before responding here. They all appeared to validate my understanding...or at least agree with it. This one I found to be especially representative of my understanding. The following (in the next comment box) is especially relevant to this discussion:

Marshall Art said...

"Neither does contentment mean complacency. As Christians we can work to better our circumstances as we have opportunity. The Bible extols hard work and the rewards that come from it, as long as we are free from greed. Paul tells slaves not to give undue concern to gaining their freedom, but if they are able to do so, they should (1 Cor. 7:21). If you’re single and feel lonely, there is nothing wrong with seeking a godly mate, as long as you’re not so consumed with the quest that you lack the sound judgment that comes from waiting patiently on the Lord. If you’re in an unpleasant job, there is nothing wrong with going back to school to train for a better job or from making a change to another job, as long as you do so in submission to the will of God."

The emboldened portions align with my position exactly.

"As for Paul, he did not argue in favor of getting rich any way you can."

And fortunately for me, I'm not arguing that, either. I can't imagine what in my comments suggested as much to you or David.

""A strong desire for a more comfortable life" doesn't seem to fit with that sentiment."

Nor is it necessarily in conflict with it. When Paul indicated that God provided, he's not referring to the means or efforts through which that provision came, but simply the state of having. That is, we can sit on our butts and wait for God to send provision through the efforts of others, or we can get off it and acquire them ourselves. In my mind, God is still doing the providing by allowing/helping me to succeed.

"He wasn't going to make the pursuit of "more" his aim; he was going to count on God to provide what he needed (Phil 4:19). His primary concern was the welfare of others (Phil 4:17). His highest concern was God's glory (Phil 4:20)."

As it should be for us all. However, counting on God does not relieve us of our responsibility to work for our needs and wants. So using that as an argument against wealth creation is a misapplication of the teaching. It is not referring to such things. It is, as I said, referring to our attitude and state of mind regardless of our level of wealth or poverty, not our choice to be wealthy or poor and the efforts we employ to be one or the other.

As for concern for others, concern alone does others no good whatsoever. Having enough to donate without making of ourselves the reason others are concerned for us does. As I say to Dan, I can act on my concern for others far better when I'm possessed of excess time and money than when those are in short supply. By having more of both, I can be the person through whom God provides for others.

"God will provide", be it for one's self or for others, is an empty sentiment if one goes no farther than to express it.

David said...

I think Stan's point, and mine, is that if Christ was in everyone's heart, we wouldn't have the health care problems we have. It doesn't even need to be a perfect world, but a world of Christians. As for your non-greedy doctors, most of the doctors I've encountered are only there to help me tangentially. As in, helping me gets them money. The point Stan made about the customer greed wasn't about desiring good healthcare, but about the desire for money for apparent misconduct. One of the many reasons a doctor's visit, even just a physical exam, is so expensive is because doctors HAVE to have malpractice insurance because they WILL get sued for malpractice as some point. People will sue for malpractice even if the doctor did everything right but an undesired outcome still happened. The​ people may not win their case, but it still costs the doctors money for lawyers and such. I once visited a doctor and saw the difference in charges between an insured person and an uninsured person (long before the ACA). The difference in cost was ridiculous. So, don't tell me doctors aren't greedy.

Stan said...

On the supposed remedy of a better insurance system to ease our problems, what studies have shown, both in terms of human nature and in terms of how healthcare organizations operate, is that insurance increases the cost of healthcare. It's easy to confirm this by simply asking a doctor, "How much will this cost me if I don't have insurance?" Studies show that it always costs more for insurance than without. Our only view is "out of pocket expense", and that's not a complete picture.

"Therefore consider the members of your earthly body as dead to immorality, impurity, passion, evil desire, and greed, which amounts to idolatry." (Col 3:5)

Paul says greed amounts to idolatry. What is "greed"? The Greek word there is pleonektēs. It is a two-part word. The last part is a word that means "to hold"; the first part is a word that means "more". It is, then, a desire to have more. That my include more of what belongs to others -- covetousness -- but it is simply the desire for gain. Easton defines it as a desire for possession of worldly things. ISBE says it is the wish to have more than one possesses. Gill says it is the love of gain, a desire, often insatiable, to have more. Jamieson-Fausset-Brown says it is a "grasping spirit".

A focus on gathering here for personal gain -- what is typically meant by "ambition" -- seems to be a focus on self rather on God. Someone who, say, seeks eagerly to raise money for a cause such as missions or feeding the poor would not be focusing on personal gain and would not fall in this category. What Scripture says is, "He who steals must steal no longer; but rather he must labor, performing with his own hands what is good, so that he will have something to share with one who has need" (Eph 4:28). Obviously, then, you and I have a different view of both ambition and greed. Me, personally ... I believe I'm here temporarily, a stranger in a strange land, tasked here with things to do for my King, not for myself. I'd much rather have ambition to lay up treasures in heaven than here.

But, like I told Glenn elsewhere, that's just me. You and I will disagree on this.

Marshal Art said...

"I think Stan's point, and mine, is that if Christ was in everyone's heart, we wouldn't have the health care problems we have."

While that may be true, and I wouldn't argue against it at all, it means little with regard to whether or not we can "fix" the situation, even if that only means improving it most people's satisfaction. I would also suggest it would be the wrong focus for trying to given that some people would sooner give up their subsidies than give up their sin natures.

"As for your non-greedy doctors, most of the doctors I've encountered are only there to help me tangentially."

A very cynical view of doctors. I wouldn't argue that some doctors get into the profession for monetary reasons, but my experience with the doctors I've encountered suggests a real desire to heal. It was only about five to ten years ago that my personal GP retired. I had this guy since I was old enough to advance from the pediatrician. He was very involved with making sure I was healing from whatever it was that ailed me. Indeed, his brother, who was a surgeon, was my father's surgeon while suffering from colon cancer. I remember the dude crying when my father died. Those times when I sought his care (because of scheduling or surgery considered), he was joyful upon seeing me.

But anyway, like you, this is anecdotal. Greed or not, there are tons of expenses in training for and maintaining a practice.

The same is true for patients. Some especially when a death occurs, are moved by the several stages of grief, more than greed, in seeking compensation for alleged malpractice. Sure. There are those who see misfortune as an opportunity to profit, but in any case, that is one area that was discussed prior to ACA as one way to reduce costs...tort reform. Capping judgements and such, which would reduce malpractice insurance costs and the need to perform unnecessary tests to lower the risk of being accused. But rather than greed, I would argue that such things are compelled more by an attitude of "my love one died...someone must pay" revenge and anger.

Cost differences are problematic. But it can work both ways...for you or against you. As to how it affects the cost of health care, insurance complicates it because of how insurance works. If providers list their pricing, even if there are differences between cash, credit or insurance, personal choice can reduce personal cost. There's a lot of nuance the way things work now, but that can be remedied far better than ACA or the GOP alternative.

Marshal Art said...

Stan,

I touched on in a bit in my response to David, but the reason insurance drives up costs is due to the fact that is no longer used solely for the catastrophic...which was the original purpose. When it began covering every hangnail, or pap smears for men, that's when things got messy. But that was largely due to insurers being forced to include such things, rather than simply letting the customer decide what it was he wanted to be insured against. My father-in-law has ALS. His house became his own medical center as his condition worsened. With or without that, it was an expensive illness to endure before it killed him. Thankfully he was somewhat well off financially and that allowed him to be home until the end. But unless such people are expected to accept their fate and die quickly, it's pricey proposition and likely still would be. It would cripple people financially or burden friends and relatives.

As to those definitions, they are too ambiguous for teaching Biblical concepts. Even the use of the Greek word, if used exactly as it is defined, does not capture the spirit of the concept that is being taught. When one doesn't get enough, one naturally wants more. How is that wrong? It first requires determining what is enough. I may not get enough to no longer feel hungry, so I would naturally want more to eat. Is that greed? It is by virtue of how you described what the original Greek means.

None of the other definitions capture the spirit of the concept, either, as far as I'm concerned. (And it ain't because I'm greedy, either :D ) I think the Biblical teachings on such things are specifically referring to putting desire for stuff above desire for God...worship stuff more than God. Having more at the expense of living according to God's will. When Job's trials concluded, God gave him more than he had before he lost it all. He was given more after living a life where he acquired more. While acquiring more, he was held in high regard by God. So greed has to be more than simply wanting more, but the manner in which that wanting and desire manifests...the place it possesses in one's heart...the rank it has there compared to God.

Being content isn't about not wanting more. It is about accepting that regardless of whether we have or have not, whether we want or want nothing more, God is Sovereign and it's all about Him. We can live a life without ambition and still be miles away from living as God wants us to live, or even not give a care about God at all. "I'm quite content living in my little tent, but no, I don't care about what God wants." or "I wish to live in a mansion, I care about being sure the the methods I use to get there are not displeasing to God but I'm good whether I get that mansion or not." I think the latter is but one good illustration of what Paul is teaching about contentment.

As I continue to tell Dan when he uses that "laying up treasures" angle against me, laying up treasures on earth is cool with God so long as I have as my first priority laying up treasures in heaven. When that ranking flip-flops, now we're talking about greed.

Stan said...

As I said, Marshal, (I noticed you changed to one "l" instead of two), we will disagree on this. We always have. Not surprising.

Marshal Art said...

Really? I can't recall these particular topics ("what is greed" or "what does Paul mean by 'contentment'") being discussed between us. Maybe we did, I just don't recall.

You're not suggesting we disagree often, are you? I don't think that's the case, do you?

Stan said...

Yes, we've discussed contentment before. No, we don't often disagree.