Sunday, October 28, 2012

A Conservative’s Dilemma

I’m a political and social conservative. I was born and raised in a conservative home, and except for a short period in college, have remained conservative ever since. (Although some die-hard social conservatives  would think I’m going soft on some social issues.) So, what’s my problem? Health care.

As a small-government conservative, I’d prefer that the government stay out of our lives as much as possible. Ideally, there would be no government intervention in insurance, hospitals, or pharmaceutical companies. The church and other charity organizations would take care of people who couldn’t afford health care.

In 2012, though, that’s not really practical. Healthcare costs a lot of money. Insurance costs a lot of money – and the cost is going up, not down. PWM and the kids have insurance that we’ve purchased on the open market since we can’t purchase employer-based insurance. We had a great deal 6 years ago, but the prices keep going up. I can imagine that there are plenty of families who aren’t poor, but simply can’t afford even high deductible insurance. Some churches and faith-based charities provide some financial support and run clinics and hospitals, but it’s hard to imagine them doing much more – they’re already stretched pretty thin.

So, what do we do? I don’t really want government taking over an entire sector of the economy. I’ve heard plenty about the H5N1 epidemic in Great Britain and how many people were treated after phone triage – very poor health care to my mind. I’ve met a number of Canadians, some of whom were happy with their health care, but several of whom were distressed by long wait times for elective surgeries. The US leads the world in medical research, in part because of our free market system. But, our costs are also out of control.

Yet something must be done. It really is immoral that people in our country die from treatable diseases. In many cases, there may be screening programs or charity programs, but it’s such a pathetic patchwork that no one is aware of them. For example, I diagnosed a woman with cervical cancer who hadn’t had pap smears in years because of financial difficulty. Yet, most county health departments provide free cervical cancer screening. This woman didn’t think it was important enough to go looking for until she developed symptoms. There are plenty of other times, though, that people have prioritized which medications they take based on cost. (Yes, some people make poor choices, like continuing to smoke despite needing medicine, but there are plenty who are truly in a difficult spot.) Not all of these folks are even poor. When your medications are $200/month, though, something has to go. When I was working as a physician, I was glad when patients were honest with me about their financial issues because we could look for the cheapest options and try to find drug company programs for them. But, it doesn’t always work. How can a rich country like ours justify this kind of inequity?

But I’m not so comfortable with a big government program either. I’ve had enough experience with big insurance companies to make me wary of anything that purports to “help” doctors do their jobs. Just this January, I had to ask my doctor to change three of my medications (that were already generic) to other medications because of my insurance. When I was working, this was an annual January event. And not a pleasant one. I’ve had plenty of experience writing to insurance companies for medical exceptions to use certain medications or other treatments. What they do to save money creates incredible headaches for doctors. And I don’t think it’s that big a help for patients.

So, maybe Romney is right and we should let the states figure out how to insure the people in their states. Medical Assistance (or Medicaid) isn’t any fun to deal with, but there seem to be fewer levels of bureaucracy to deal with. And, at least here in Wisconsin, BadgerCare seems to be a workable program to help people who aren’t poor enough for Medicaid but still can’t afford private insurance. The problem I see is that there is still a huge financial discrepancy among the states. Some states can afford pretty decent healthcare for their residents, but others could end up no better off than the current patchwork of federal, state, and charity programs.

But then there’s the whole “coercive” nature of a federal (and even a state) program that bothers me. When we chose insurance for PWM and the kids, we chose insurance that had a high deductible, choosing to pay more of the up-front costs ourselves. Being required to purchase insurance will give us fewer options in how we want to deal with our own insurance needs. I’m also quite disturbed that insurance will have to pay for abortions, because that means that my tax dollars are paying for the deaths of babies. And we don’t have any way to opt out of that.

What’s a conservative to do? I see both sides of this issue. And I feel strongly on both sides. This country needs to deal with the healthcare crisis – not only because it’s a financial issue, but because it’s a moral issue. The stock conservative, small-government answers don’t seem adequate, but the liberal, big-government solutions have plenty of their own problems.

I gotta admit . . . this one’s a dilemma. What do you think? Be nice in the comments . . . . remember, I can delete you!!

(And don’t worry, I won’t venture into politics again for a while. I don’t think.)


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