To Michelle,

Michelle,
I really appreciate your comments on my blog. I know this sounds weird but I kindof look at you like a younger version of myself- intellectually curious and adventurous (hope that doesn’t insult you because I definitely have a lot of, ummmm, less desirable characteristics which I am sure you wouldn’t want to be associated with). Also, congratulations on finishing your thesis!! That is such a relief- better, yet, when you defend. .Have you already defended or is that still looming?

In case you didn’t notice (not likely), I’ve written a thesis of my own—a comment thesis, heehee! I actually started leaving a comment on your blog and it got so long, I thought, “hey, I’ll just send her an email.” But, I couldn’t find your email. . . .so I posted here.

I am glad that you feel comfortable letting your opinion be known. I really do appreciate a healthy and well-thought discussion. I think as Mormons we sometimes just ignore charged and heated discussions for fear of offending. And truly, if you've had a great experience with Government-run insurance in Germany, you have every right to dispel the myths you hear. There are surely a lot of myths floating around out there. You certainly have more personal experience than most who live in the U.S.  It sounds like Germany has a pretty good thing going, but I’ve read there are some serious problems with Canada and Britain’s plans (from newspaper articles written in those countries)—long, long wait times to get non-emergency surgeries and denying certain drugs to individuals who would benefit from them, as well as programs that are nearing bankruptcy.

I loved reading your thoughts and ideas, but had some thoughts of my own in reply (I'm not trying to take anything out on you-promise):
First, I agree 100% whole-heartedly that every individual should have equal access to healthcare. I promise I am not some cold-hearted soul who doesn't care about the poor, elderly, and uninsured. My heart goes out to people, like the woman who commented on your post that has lost her coverage and is afraid of being denied for pre-existing conditions. . .that practice should STOP. . .that is what Congress should be focusing their energies on, FOR SURE. Our system definitely isn't perfect, and there is lots of room for improvement that legislation should be written to help. I think you’re right on that America doesn’t focus enough on wellness or preventative care.

I would assert that equal access to care is not the same as everyone being insured. Currently, in the US no one can be turned away from an E.R. because of lack of insurance, no one is denied life-saving surgeries or care. Every patient in the hospital is given the same standard of care according to my husband. If they are not, their doctors are not good doctors, end of story. In addition, if you are truly needy and incapable of purchasing your own plan, the government DOES provide you with options: Medicaid and medicare are there to help those who can not physically pay for their own plans. I would, therefore, assert that Universal Healthcare (aka government-run healthcare) is not the same as universal coverage -being able to walk into an ER and know they will treat you-no matter what or being able to apply for government-paid care.

I would also like to point out that China, who was blue on your map (also I think 1/6th of world's population), is a communist dictatorship. There is a one-child limit to families who want to have children. China's slums are some of the poorest of the poor. In addition, the former USSR was also on the map. I would be wary to trade Russia’s average standard of living even for the poorest American’s. . . .not to mention the cold, yikes! So I’m not sure how well the argument runs that the best developed nations who care about their poor provide Government-run healthcare to all- even at the cost of ‘forcing’ individuals to buy a plan. But, as I pointed out above, Americans do have programs for the poorest individuals in our country, so we aren't completely cold-hearted.

I totally agree that most Americans want exactly the plan that you outlined in red and from the 4-minute video. That platform was why Obama won the presidency. I want those things for our country, too! My problem is that when general ideas are presented without a specific plan, the ideas are just fantasy.  Some would call it a pipe-dream. My problem is not with the general ideas, it is how they are implemented and what the unintended results in the future may be.

For instance, Obama asserts that if you have insurance you like, you are welcome to keep it and there will be low-cost coverage. That SOUNDS great. But here’s the hitch: based upon the free-market system that currently exists, the public plan as presented would be subsidized by the ‘public,’ aka government, aka our taxes. This is how the plan would be able to be more affordable to those that currently can’t pay for their insurance. When you introduce a competitor (public option) into the free-market system that doesn’t have the same constraints as the rest of the market, they have a one-up, the can offer the same coverage for less because they are being subsidized from an outside source. Government intervention messes with the free-market, which often turns into a meltdown (see Fannie and Freddie). For example, if you are a business owner, and you realize you can switch your employees coverage to a different, less-expensive public plan, what in heaven’s name wouldn’t cause you to do so? So, slowly, over time, the insurance that you have and like from your employer would change- yes, this might be a gradual change, but the change would inevitably happen. The result: over 10-30 years that insurance you wanted to keep is no longer an option to you.

Next, these bullet points:

• There will be no denial because on pre-existing conditions

• There will be no dropped coverage when you are sick

• There will be caps on how much you have to pay

• There will be required coverage for preventative care

I think these are great ideas. But providing a whole new system of healthcare for these? No, we can legislate each individual point without a bloated public plan.

To assert that no new dime will be added to the deficit by Obamacare, to me means one thing: new taxes. We all know the saying, “you can’t get something for nothing.” Some politicians have explained they will use the experts to eliminate waste in the system. . .okay, so DO IT!! Why do we need this huge bill to eliminate waste?? These smart politicians make no sense to me on that one. But, for arguments sake, say they do find waste, how do we know they will find enough waste in the system to keep our taxes low? I am especially wary because most government-run programs are bloated and inefficient themselves. . . Medicare as currently run will be bankrupt in the next 20-30 years (right when it’s time for us to retire, yep). Didn’t they see this one coming? Why don’t 'they' hire those experts to help Medicare get back on it’s feet and eliminate waste? Is it really so easy to cut costs by having an expert look at it all? And what you may deem a must for your health plan might be considered waste to those experts. Can the plan truly be ‘deficit-neutral?’ I personally don’t believe so, and several studies have come out to say the current legislation, as written is NOT deficit neutral.

Both the Senate and House bill ignored TORT-reform entirely (medical malpractice doohickeys). . . I know you wrote your post before the bills were finished so how could you know? To me, this just adds credence to the idea that these platforms sound wonderful and tell us what we want to hear, but don’t deliver on promises. The highest malpractice insurance is in the state of Florida where Ob/gyns pay $500,000/year to cover the threats of lawsuits. That bill gets passed on to bill-paying patients and hospitals. That’s one of the reasons we pay so much. Why did the drafters of this legislation ignore this? I don’t know for sure, but I do know trial lawyers (who make a living on lawsuits) pay out a lot of money donating to the Democrats' election campaigns.

I don’t know anything about the prescription drug hole. . . .but, again, is the only way that can be fixed through a public-plan?
Okay, so now you are probably thinking, “1) I told you not to take this out on me-sorry, and 2) Camilla's ideas make sense (or am I just thinking wishfully), but I’ve seen government-run healthcare in action here in Germany and it's not bad at all. . . .so THAT is the ultimate argument for government-run.” Am I right? (I’ve had the same thought myself).

My counter-argument would be this: German’s taxes are higher than American’s (I’ve heard around 50%, is this true?), they have a vastly smaller population with no shortage of physicians per capita (a huge problem in America that is only getting worse). In addition, their whole system of health care education and wages are different from ours: physicians’ medical school is totally paid for by the nation, physician salaries are set and paid by the government (at a much lower rate than American doctors), and physicians have protected work hours (they are required to work far less hours than American physicians).

In America, hospitals are starting to move toward salaried physicians- which is great and in some studies has shown better patient satisfaction (like in Germany) with their care . It also means longer wait times, which, with a shortage of physicians in the U.S., is not sustainable without other changes. Most commonly when a person works for less money, they don’t work as hard (decrease hours at work). This would spell disaster for the system as we know it.

In America, the average medical school indebtedness is $120,000 and it takes 4-8 years post-medical school training of about $40,000-50,000 salary (for our family of 6 that is at or below the poverty line: my kids would qualify for free school lunches) before you become a full-salaried doctor, so you can’t pay off that loan during training, thus accruing interest on top of what you already owe during the residency years. I would also like to add that most residents work 80 hours per week, so they are busting their buns for minimal pay. . . . . In fact, the average number of American applicants to medical school has decreased in the last ten years. . . .potential applicants (potential doctors) are less willing to go through so much time, with so much debt, and a trend toward lower pay. Add on to that the skyrocketing costs of malpractice insurance (does Germany have a problem with frivolous lawsuits?) and it is getting harder and harder to induce doctors to a field that is shrinking.

Wow. Okay, I know I am totally long-winded. . . . and I didn’t even cover everything I was going to say, believe it or not (I really wanted to talk about private-run healthcare and innovations to care- America currently is the trendsetter in standard of care). I hope I’ve brought up some relevant issues. I also thought a lot about what you said. Definitely, something has to give! Given the track record of American-run public programs, I am wary about adopting a new system without further exploring the implications of each new change we make. I like the idea of change. Change is certainly needed, as you pointed out! What I’m still trying to figure out is why Congress can’t just tackle one issue at a time, instead of writing a behemoth bill that the public can hardly wade through. They’ve been going about in a secretive and backhanded manner that makes me wary.

I welcome your counter-thoughts and once again, apologize for the length of this post!