My friend Tiffany commented on part 1 of my healthcare posts on Facebook:

Please address how and/or why the US will remain on the cutting edge of health care without dissolving into the bowels of mediocrity. And, what motivates our most outstanding physicians to continue practicing in this capitalist society? I look forward to your thoughts and will end with a smiley face in order to maintain lightheartedness. :)

This received a very nice response from Tim:

Shouldn’t the same motivations still apply?

The physicians are still going to be paid, they are still going to help people, and the plans I have heard would make compensation better for non specialists, like your family doctor.

As far as the cutting edge, I think that was the point of the link. The US is not on the cutting edge of health care now

We may spend the most money, but we don’t get the best service, that’s bad Capitalism.

I will also end with a smile :) this is just a friendly post. I look forward to reading more about it. Thanks for the link.

I appreciate the genuine friendliness with which Tif and Tim signed their comments though I predict that this will deteriorate soon. I guess we’ll see how long it lasts!

I completely agree with Tim. Our current system isn’t the world class health care giant we all like to believe it is even though we’re paying through the nose for it. While those numbers are dated, more recent analysis is grim, too:

“It’s harder to keep deluding yourself or be complacent that we don’t have areas that need improvement,” said Karen Davis, president of the Commonwealth Fund.

The study, which assesses the United States on 37 health care measures, finds little improvement since the last report, as the cost of health care continues to rise steadily and more people — even those with insurance — struggle to pay their medical bills.

“The central finding is that access has deteriorated,” Ms. Davis said.

…the United States, for example, has reduced the number of preventable deaths for people under the age of 75 to 110 deaths for every 100,000 people, compared with 115 deaths five years earlier, but other countries have made greater strides. As a result, the United States now ranks last in preventable mortality.

I really think we can simplify and sidestep most of the controversy with a little logical deduction.

Premise: no one will be denied essential health care.

This is a fact today. If uninsured deadbeat Joe Shmoe (no offense, Joe) comes down with cancer, he will receive complete treatment at a hospital, regardless of his ability to pay.

Today’s financial impact: We all hope he can pay but with the cost of an extended hospital visit (easily in the six figures), let’s not count on it. So Joe declares bankruptcy and society absorbs the cost of Joe’s treatment through higher health care costs. Everyone loses.

Consider the same scenario but now with Joe being a mostly responsible guy. Suppose instead of being a deadbeat, he had saved away $100,000 for retirement…but neglected to carry health insurance. We’re a little better off because he can apply $100k towards his medical bills, but Joe’s seriously screwed. He’s probably still looking at bankruptcy and his life savings has just vanished. Sure it’s his fault for letting his insurance lapse but it still seems unfair, especially when compared to the deadbeat version.

Proposed financial impact: we cover Joe and everyone else with universal health care (not necessarily free, but mandated, just like car insurance in Ohio and elsewhere). He gets sick and the system pays, just like before. Only now, we’re accounting for it properly and Joe’s finances are not left in ruins. The cost to you and me is the same either way.

It’s great that we’re a compassionate nation that hesitates to let the sick perish, but perhaps I’m too generous when I assume that the uninsured are so well received. Some stats suggest that many die in need of medical care that’s out of reach (via Powazek, via Blurbomat):

Here’s what’s actually happening. The US is the only major industrialised country that does not provide regular healthcare to all its citizens. Instead, they are required to provide for themselves – and 50 million people can’t afford the insurance. As a result, 18,000 US citizens die every year needlessly, because they can’t access the care they require. That’s equivalent to six 9/11s, every year, year on year.

That’s embarrassingly sad.