Two Arguments Against Healthcare Reform

One set of arguments being made against healthcare reform and a government system targets/grounded in distrust of government. This viewpoint is reflected in the question, “Do you want to trust your medical decisions to the hands of government bureaucrats instead of between you and your doctor?” Of course the answer is “Absolutely not. Medical decisions should be made between me and my doctor.”

This viewpoint is also expressed something like this, “that at some point the government has to decide whether or not you are allowed to receive any more medical benefits if the cost outweighs the potential benefits.” This line of thinking plays off concerns that government will deny coverage as a means to save money or engage in euthanasia. This possibility horrifies the general public and is an argument already being circulated as a reason for keeping the proposed healthcare reform from passing.

On the surface these seem powerful arguments, but in reality these arguments are fallacies. Currently healthcare decisions are initially grounded in the annual decisions made by my employer. Level of healthcare can increase or decrease on what plan my employer elects to purchase. From year to year, deductibles can fluctuate, what is covered and not covered can fluctuate, and which doctors and hospitals I can use or not use is all determined by my employer. While it is noted that I can see any doctor I wish, when you have a 50% deductable for doctors off the plan versus a 15 or 20% deductable (deductable has changed over the years as the plan evolves) you have a strong incentive to remain with the doctors your plan authorizes.

Further, for many treatments outside all check-ups and basic tests you have to have prior authorization to receive treatment (excluding life and death medical emergencies). It is not uncommon for an insurance bureaucrat denying treatment or demanding a host of documentation before granting approval. In other words medical decisions are in the hands of insurance bureaucrats who have little or no medical training not between me and my doctor. Even more, the bureaucrat is making decision that are driven by policies designed in keeping with the plan and to ensure that the insurance company makes a strong profit while paying its top executives high six figure and seven figure salaries.

In Canada we never experienced pre-authorization for healthcare treatment. Decisions were made between us and our doctor. No consultation was ever made with a government bureaucrat and we had a far greater range of provider choices than the majority of Canadians.

Each year, subtle changes have taken place in my medical plan, changes which over years become increasingly significant by their accumulative impact. Fortunately I have an employer who is makes fewer changes than many others. There are some firms that have discontinued much of their medical coverage. Needless to say it is safe to say that my healthcare plan is not as vigorous as it was ten years ago.

I am not concerned about the euthanasia argument. To whom are insurance company bureaucrats and supervisors accountable? They are accountable to the chief executives who in turn are accountable and responsive to shareholders who are interested in making as large a profit as possible. To this end most companies have plans that have caps on life-time and/or annual claims, that anything above a defined figure is not covered.

Further compounding these caps is that companies can radically change their plan which in affect puts limits on treatment levels or type of illnesses covered. It is well possible for an employee or retiree still on the company’s plan to learn that the cap is suddenly dropped in a cost saving measure. Could this happen with the government? Definitely it could, but are the chances higher or lower than with what is being transacted between an employer and the insurance company? The employer and company are far more driven by profit than by responding to the complaints and protests of employees and retirees. Hence, I think any euthanasia type or denial process is much higher with private insurance than with government insurance since government bureaucrats ultimately answer to elected officials who are very sensitive to the whims of the electorate. So who is more sensitive to the complaints and needs of the general public, the elected official or the corporate executives? To me the answer is clear.

The two arguments against government healthcare are more applicable to the current private system.