Friday, November 25, 2011

The National Conversation We Desperately Need to Have Regarding Health Care, But Probably Never Will

Most of the population in the US (probably honestly everywhere else to, but I can't speak as definitely of them) remains in abject denial of the fundamental axiom of reaction

Put simply:  every decision in a political arena WILL suck for at least some real persons.

This greatly complicates our health care debate---causing us to fail to actually ask the questions and determine the answers that could drive a policy that could improve things somewhat, or at least, create a policy that a supermajority of us could live with going forward.

Here's the first question, I'll put the premises of the question in parenthesis:

What fraction of our governmental budget are we willing to spend on the subsidy of health care? (Premise:  Health care desires are unlimited, should we wish to, we could easily spend our entire budget in this area).  How much money are we willing to spend--that's the first and most important question.  Get a supermajority answer to this question and you can actually approach the next questions reasonably confidently.

Who do we want to subsidize, and how much?---In crude terms, how will we divide the loot from question number 1?  Do we think particular medical procedures are deserving of more subsidy?  (e.g., delivery of babies).  Do we think that particular people are deserving of more subsidy?  How do we feel about injuries/illnesses that are largely self-inflicted? (e.g. Type II diabetes).  How do our answers to all of these questions change as the income/social status of the recipient changes? (e.g., should we subsidize a Type I diabetic with impeccable self-discipline in caring for himself who makes more than 200K per year?).  Do we want to insist that anybody we subsidize makes lifestyle changes to prevent further self-inflicted issues?  How do race and sex play into these questions?  Do we want to subsidize those with more years of life remaining more? 

How do we want to pay for all of this through taxes?  Who...whom?

If we could actually ask these questions, and debate them honestly and without attempts at shaming, we could probably reach a compromise that most of us wouldn't have any grave issues with.  That compromise would probably entail something like a subsidized catastrophic coverage policy with something on the order of a 10k/year cap (my guess is on the order of a 5K deductible with a fairly long transition to full coverage).  That's probably about as generous Americans are willing to be when they're made aware of the fact that they actually have to pay for it.  But the question is a moot one, perhaps because the whole constellation of them can't be debated openly because we're collectively in such denial.

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