Representative Paul Ryan said the following in 2010, at a health summit in Washington, DC:
[W]e don’t think the government should be in control of all of this. We want people to be in control.
Let’s discuss the opportunities and consequences of following through on the three implied principles in what he has said, and consider the potential for success without a centralized healthcare system. The three principles:
1. Healthcare should not be under government control,
2. We Republicans want market controlled healthcare, and
3. People should control their healthcare delivery.
All of these concepts have their advantages. Some of those people who see the advantages may be in a corporate structure with the primary objective of making a profit, or they may be among the people who live here and run businesses. That is, some think of healthcare as a service business from which they can prosper, and others have concern for everyone’s health so business people can prosper. In many discussions and actions, the case can be seen as healthy people vs. business-profit. Which, in politics, is liberal vs. conservative. Only one approach contributes to the healthiest population of poor and rich. The other approach creates a class that can buy any health care it needs.
The options are not totally binary. There are personal benefits from a capitalist free market and people benefits from government administration. There can be the optimized health of the nation with capitalism that has strongly enforced protections for the consumer, and there can be optimal health with a socialist system that includes a profit incentive for healthy outcomes.
In mathematical calculus, we take equations to their limits to get an understanding of their intent. We can do that in politics. From that conclusion, we can measure whether the process will work toward improvement of the lives of most residents with a ceiling on profits or if it will improve profits with a ceiling on the healthcare for the people. The issue can be reduced to a balance between people and profit. The synthesis of a system that harvests the best of each will serve us now and serve our children with an effective and efficient result for longevity and health. Neither system is the best answer and neither political view has the “one and only true God.”
The two conclusions have been adopted by two political parties as their identities. This builds into the system a polarization. Identifying with any extreme is not an approach that will get anyone to an operational result. This makes for animated political conversation and even, as a result of human behavior leads to some hostility and rudeness.
We will come together when we can discuss how to optimize both business-profit-from-healthcare and population-health-from-healthcare. Here are brief discussions of the above three principles:
1. Healthcare should not be under government control
A. Personal Profit view:
This is the optimal situation. Fraud is illegal, of course. It is to no one’s advantage.
Being able to make flashy advertisements to draw clients, and the ability of salesmen to make freewheeling oral statements, and all the methods available to deny claims and write in exclusions, make this the best healthcare system to make a profit. (The Michigan Supreme Court in 1919, declared the function of a corporation it to maximize profit. So it’s legal.)
Corporations can see that well-paid officers get healthcare.
Corporations don’t measure health outcomes, delivery techniques, or financing schemes.
B. National Health view:
Corporate officers and stockholders will be protected by a national healthcare system.
The function of insurance is to pool resources to cover losses for the contributors. Insurance can be administered by business structures for any risk exposure. Insurance can be offered by a central government for broader risk exposures because of a larger of a larger pool of contributors.
Regardless of who is the administrator, healthcare insurance needs funding collected from healthy people. The result would be care provided for rich and poor people, independent of their ability to pay. Selling insurance to people who know that they are more likely to need healthcare financing will increase the proportion of money paid out, potentially making the system bankrupt itself. The form of the benefits would have to assume some limits to assure claims don’t exceed resources. Care would be limited to standards of successful disease treatment, not covering untested modalities or cosmetics.
The role of government would be the most cost effective delivery system for a nation-sized beneficiary group. A government agency is more likely to protect the pooled tax funding with premium contributions or taxes paid by nearly everyone.
2. We, the Republicans, want market controlled healthcare
A. Personal Profit view:
This political party is the representative of free capitalism. A system that allows markets to sell anything for any price they can collect. The pressure is on the seller to raise prices and reduce payouts. For insurance, that means increase premiums and decrease benefits.
Capitalism is a system where a person in bad economic conditions is free to work their way out. Those with mental limits or physical challenges can get as much financial assistance as they are able to by their own initiative. Businesses have no obligation to society or their employees to offer any services like overtime compensation, healthcare, childcare, sick leave, or maternity leave. Death is a natural consequence of poverty starvation, so should not be manipulated by government or business intervention.
B. National Health view:
The Republican view of health care is to allow patients access to any care they can afford. The care provider is in business to provide those services and cannot do so if they don’t collect enough money to support themselves and return funding to maintain the operation of their delivery. This is consistent with the conservative “personal responsibility” idea because the people have created and financed a centralized system to take care of themselves – Personal Responsibility. Conservative extremists (not just purists) claim that each person should pay for their own healthcare. They have when they pay a tax or premium into a system they have approved to provide their care. Care is not just for those who can afford it from their personal income.
Corporate insurance will maximize profit when it limits access by either selling policies to the destitute or limiting the benefits they pay out for anyone. The popular view when the public is polled is that a great majority wants access to care when they are sick, in pain, or in decline, without regard to their ability to pay.
The nation is stronger when business people and everyone else is healthy, so there should be no limitation on access. A broad-based tax needs to be collected to provide funding to the risk pool. However, some adjustment needs to be made for the destitute and disabled.
3. People should control their healthcare delivery
A. Personal Profit view:
Capitalism is a system where competing corporations provide health care financing through insurance. The laws of costs and profits will be the foundation for that system. Patients (all of the people and business people) have very little control, especially when insurance corporations are lobbying for minimal protections for consumers.
B. National health view:
Patients (all of the people and business people) do not control day-to-day operations of corporate morality or money.
The alternative is to have a governmental agency maintaining the funding of the risk pool and administering the payouts for benefits. A broad-based tax would be collected from the healthy and the ill. Adjustments would need to be made for those unable to pay due to incapacity or poverty.
With universal coverage delegated to their government, the patients (all of the people and business people) will have evidence-based healthcare. It will cost less because it does not have the obligation to increase profit.
In response to three claims made by U.S. Representative Paul Ryan, this is a cursory review of the pros and cons for a government-administered universal health care system that covers consumers and corporate officers and stockholders – healthcare for all paid for by all.
Nationwide financial and patient-care outcomes of a profit-incentivized capitalist system with weak patient protections has shown us that we need a single-payer healthcare system with
broad-based access and financing.
