Why Kulongoski’s Kids Plan will fail.

“Healthy Kids” is an incremental step towards socialized medicine and a future fiscal and healthcare disaster on many levels. Whatever model is adopted for “Healthy Kids” will be the model for complete socialized medicine in Oregon. The current argument among Republicans seems to be simply over how to pay for it (or at least it’s being framed that way). I propose a different approach:

1. Establish what the minimum level of child and prenatal health insurance coverage ought to be.

2. Require every employed Oregonian to provide proof of employer provided health insurance that meets the minimum level or to purchase it from a private provider.

I would suggest a $25 co-pay for physician visits and a $10 co-pay for prescriptions, lab tests and diagnostics. This is inexpensive enough that anyone should be able to afford it. Since most of the cost of health insurance premiums is pre-payment for these types of expenses, this should keep premiums somewhat reasonable. Cover hospital stays 100%.

It’s pretty simple. It provides health insurance for all working Oregonians and keeps health insurance and health insurance administration in the private sector with a minimal amount of bureaucratic intervention/oversight.

There is an opportunity for Republicans to take a Democrat issue and own it in a way that does not increase bureaucracy and taxes and screw up what is, in spite of its few shortfalls, the absolute finest healthcare system in the world. Let’s not screw it up.

Socialized medicine is a disaster everywhere it has been implemented. The combination of bureaucratic inefficiencies, indifference and incompetence, the increasing cost of diagnosis and treatment, an aging population and doctor shortages have turned it into a nightmare for consumers and doctors alike.

I know more about socialized medicine that anyone else you will be speaking with on the issue. I am the only person you will talk to who has literally experienced socialized medicine cradle to grave – an untimely grave. I grew up in Canada. My Father died in Canada. I have two brothers still living in Canada.

The Canadian system – the model socialized medicine advocates most often point to – is now a train wreck.

Forty years ago, when I was a child, the model worked. Everyone got taxpayer provided basic medical services and preventative medicine and it was inexpensive. If your kid broker his arm or you got in a car wreck, you didn’t have to declare bankruptcy to pay your medical bills. If you got cancer or some other horrible disease, you died because there was no cure and little treatment beyond the prescription of opiates for pain relief.

Today, thanks to medical science, most of the things that would have killed us quickly forty years ago are treatable – if found early, but at a tremendous cost. A cancer that would have killed you outright in six months can now be cured – provided you have good health insurance or a couple of hundred thousand dollars. The array of medicines and machinery that has been developed in the last forty years is formidable. Even the cost of “routine” medical care has skyrocketed. The broken arm that cost $120 forty years ago now costs $6000. A routine delivery that cost a couple of hundred dollars is $8000.

The inevitable outcome of rising healthcare costs is rising health insurance cost and/or coverage limits. Canada has attempted to control the cost of its program by limiting coverage and limiting what providers are paid for healthcare services. The result is that the Canadian system has essentially become a system that covers only catastrophic injuries and illnesses and does an absolutely horrible job of it.

Limiting what doctors and hospitals are reimbursed for healthcare has had three deadly outcomes:

First, a shortage of doctors. Why go to medical school for umpteen years if you’re going to wind up making less than a plumber? This is not an exaggeration; in Canada a good plumber makes more than the average doctor. With a limited number of doctors, and an acute shortage of specialists, you wait longer to see a doctor. A lot longer. The wait can range from weeks to months (it’s usually a few days here, but can be the same day if your doctor thinks you need to see a specialist fast). As any doctor will tell you, the longer you wait for treatment of a medical condition, the greater your chances of dying. A doctor in Canada cannot easily emigrate to the United States, so this shortage has evolved slowly, over time. An Oregon doctor not wanting to practice under the deadly nightmare of socialized medicine can easily move to another state – as many already have due to high malpractice insurance costs – quickly leading to a doctor shortage.

The second deadly outcome of cost control is service rationing. If your hospital can’t charge enough to buy that fancy new MRI machine, there’s going to be a long line for the hospital that did manage to sneak one through the budget process. It takes a certain amount of time to perform an MRI and there are only so many hours in a day and only so many MRI machines. In the United States if there is a shortage of places to get an MRI done, some entrepreneur will open one and charge what the market will bear. In Canada – even if you were allowed to after the extensive bureaucratic permitting and authorization process – it wouldn’t pencil. If the State decides what it will pay for a patient’s use of an MRI – or any other – machine and it’s not enough to cover the cost running the machine, hospitals aren’t going to buy them.

The third deadly outcome is unavailability of service. What if no hospital in your area has an MRI machine? You either get in line for the one 600 miles away or you do what smart and/or wealthy Canadians do – you go to the States.

The stories of Canadians dying while waiting for routine diagnosis, treatment and surgical procedures are not apocryphal. I know, my father died from socialized medicine. His death certificate lists cancer, but that’s not what killed him. In the summer of 1987 my 62 year old father went to his GP for his annual checkup. He was pronounced in excellent physical condition with the exception of a tiny shadow on his x-ray. An appointment was made several weeks in the future for more x-rays. When the x-rays eventually came back an appointment was made several weeks in the future with a specialist. When the specialist reviewed the x-rays he made an appointment several weeks in the future for more diagnostics…etc. The short story is that it was a year before he was diagnosed with cancer and that he died an excruciatingly painful death three months after that. In the United States the diagnostic process my father went through would have taken a month, at worse. In the United States the cancer from which my father died had an 80% survival rate in 1988. I have been told by medical professionals that, given the early discovery of the shadow on the x-ray, my father would have easily been one of the 80%.

Socialized medicine is a great service provider if you are young and healthy. If you break an arm or have a kid you don’t go broke. If, however, you break your arm really badly of your kid has health issues, you’re screwed. If you are old or suffer from a chronic condition – make a will. As bad as the worst HMO is, socialized medicine is a thousand times worse. My youngest brother, who still lives in Vancouver, Canada and earns a middle class income, travels to the US for his health care and pays out of pocket.

According to the Governor’s website there about 117,000 uninsured children in Oregon. Half of these are from families making over $40,000 a year. 16,000 are from families making over $70,000 a year.

Every child deserves access to healthcare. Providing a means by which children can receive the routine and preventative medicine that will provide a lifetime of returns is the obligation of every parent. Unfortunately, some parents shouldn’t be caring for a goldfish, let alone children. As a conservative I abhor most government mandates. There are, however, some circumstances when people simply should not be given a choice. Healthcare for kids is cheap. Parents who choose to purchase consumer goods for themselves instead of healthcare for their children should not have that choice. Mandatory purchase of child and prenatal health insurance by all employed Oregonians with children eliminates this dangerous and irresponsible choice.

According to the Governor’s website there are 567,000 children insured through private insurance. If I am an employer, paying for all or part of an employee’s children’s health insurance, how fast do you think I am going to drop that coverage and shift the burden to the State? Pretty dang quick. “Healthy Kids” in its current form will likely add 500,000 children to the rolls of state sponsored health insurance, not 117,000, and if you think it’s going to be done for $160 of taxpayer money a kid you probably worked on the committee that said the Portland Tram would only cost $6 million.

If you want your medical system run like the DMV, support the current “Healthy Kids” plan. If you think Medicare is an efficient and cost-effective service provider, support the current “Healthy Kids” plan. If you hate your parents, grandparents and children, support the current “Healthy Kids” plan. If you want a system that works for patients and is sustainable in the long run, make a different choice.

In closing I want to address a note to all those misguidedpundits who will assert that socialized medicine, in spite of its worldwide failure, just hasn’t been done right:

Why aren’t you getting your health care in Canada?

A second note to all those “experts” who will spew facts and figures to prove the case that socialized medicine is the greatest thing since sliced bread:

Socialized medicine is like sex or an acid trip. You can study it all you want, but until you’ve experienced it you just don’t know.

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Posted by at 06:17 | Posted in Measure 37 | 12 Comments |Email This Post Email This Post |Print This Post Print This Post
  • Jerry

    Tim – you are absolutely correct on all of the above! The silly legislators are falling all over themselves to do something for “the children”. What a pathetic bunch of socialists. No wonder the republicans lost so big. They are all rinos without any common sense or any fiscal responsibility. I only wish they would listen to you but you know that they will not.
    Fools – all of them.

  • Bob Clark

    Tim-Thanks for the primer on Canadian healthcare. Most Oregonians I talk to want more government supplied medicene. They think it’s better than the prevailing system eventhough the prevailing system is already heavily influenced by government spending and regulation. The politicians see a way to build more government power with “Healthy Kids,” push for more tax revenue (note less than 50% of the anticipated cigarette tax increase will actually go to meet children healthservices), and businesses see a way of unloading the healthcare obligation they once used to entice employees. Bottom line: the tide is against us and we’ve got to look for a second best solution like that of Massachusettes or the one you outline.

  • David G

    I’d like to add a few more items to your list of problems with government managed health systems:

    Disease and Treatments Become Politicized. Politicians will ultimately decide what health conditions get the most funding for research and treatment. If you have a politically popular condition, there will be disproportionate funding for it. If you have anything else, good luck to you. We already are seeing this in the USA.

    There is No Incentive to Be Healthy. Estimates vary that from 60-80% of our health dollars are spent treating chronic conditions that are preventable by adopting a healthy lifestyle. Too many health professionals think prevention means getting more tests to determine what drugs you need. Prevention should mean adopting eating, exercise, and lifestyle habits that keep you from getting chronic diseases in the first place. Government sponsored health insurance or health care typically is the enemy of good health because it provides no incentive for just being healthy. Financial incentives work. Unfortunately, all the wrong incentives are built into goverment managed health care.

    Just a footnote on Canada’s health system: over the past few decades I have taken many trips to Canada. One thing I have noticed is that in every election campaign up there the policitians promise to so something about the incredibly long waiting lines for medical service. Unfortunately for Canada, some things will never change.

    • Tim Lyman

      It’s the perpetual unfulfilled campaign promise, the Canadian analog of the American “I won’t raise your taxes.”

  • Diania

    Wow, It is so refreshing to hear a politician tell the truth. You got my vote. Socialism is fast becoming the norm in Oregon. I’m looking to close my business and move out of the state.

    I suggest that all politicians who are for socialized medicine maybe should go to Canada for a year.

    My friend is a nurse in the Dr’s Office, she tells me the reason it takes so long to get in is because of the mandated ‘free’ care given to anybody to lazy to provide it for themselves.

    • dartagnan

      “Socialism is fast becoming the norm in Oregon. I’m looking to close my business and move out of the state.”

      Bwaaaaawk! Squaaaawk! Socialism! Socialism! Polly want a cracker!

      Don’t let the door hit you in the ass on the way out. The more of you braindead right-wingers clear out of Oregon the better this state will be.

  • Jerry

    Diania – you are not the only one ready to blow out of this place! The darn politicos are ruining this state.

  • Tim,

    Good post. Spot on, You should do more.

  • dartagnan

    This column reminds me of the old Steve Martin joke about how to make a million dollars and not pay any taxes: “First, make a million dollars …”

    Tim Lyman proposes to solve the health care problem by simply requiring everybody to have insurance. Brilliant.

    Hey Tim, do you know how much private health care coverage costs? Have you checked it out lately? My private coverage costs nearly $400 a month — and that’s just for me, not my wife, who has her own insurance through her job. We have no kids at home. How many working Oregonians can afford to shell out that kind of money? And what do you do about those who have existing health problems that make the insurance companies reject them?

    The fact is you right-wingers have no idea how to solve the health care problem or anything else — all you can do is squawk about “socialized medicine” like a bunch of demented parrots.

    • Tim Lyman

      I know exactly how much private health insurance costs. I write a check for it every month.

      If you read the column you would see that what I was proposing that every EMPLOYED Oregonian be required to purchase health insurance. You could make it a pre-tax payroll deduction.

      The decision of an employed person not to purchase health insurance is ALWAYS a choice to have more material possessions and amenities instead of health insurance. It doesn’t matter if you earn $20k a year or 200k a year. That’s just the way things work. If I chose not to buy health insurance, I could get a brand new car or lots of nice new clothes and a plasma TV instead. You have the same choice. Welcome to the adult world.

      It is unfortunate that you have a job so crappy that it does not provide health insurance, but your failure to obtain valuable skills prior to entering the workforce and/or your failure to upgrade your skills so that you can get a job with employer provided health insurance does not make it incumbent on others to pay your way. Self-improvement is a choice. If you invest in yourself by purchasing education instead of material possessions and amenities you will reap both financial and personal rewards. It will mean sacrificing today’s pleasure for tomorrow’s achievement, but it is never too late. One of the key traits of successful people is that they continually reinvest in their education. One of the key traits of financial and personal failures is that they do not.

      Thank you for bringing up the fact that I failed to address the issue of pre-existing medical conditions. It would be a simple matter to add a provision preventing insurers doing business in the State of Oregon from discriminating against those with pre-existing medical conditions. It would be important to specify only pre-existing conditions over which individuals have no direct control. For example, allow insurers to charge fat people and smokers more, but not diabetics or epileptics.

      The fact is that conservatives are the only people proposing workable ideas for health care coverage. As I have illustrated, and as everyone who lives under such a system knows, the “Government pays for everything” model favored by liberals is simply unworkable. If you think $400 a month is a lot to pay for health insurance, wait until you find out how much it costs when it’s “free.”

      As someone may eventually point out, I have not addressed the issue of healthcare for those with no income. At some lower income level there will need to be a public subsidy, but it needs to be a lot lower than the $70,000 proposed the Governor and, I think, lower than the $40,000 at which the Governor proposes a 100% subsidy. Any subsidy MUST be linked to a legal residency requirement (I suggest one year) or we’ll get an influx of unemployable freeloaders who will drain ALL our taxpayer provided social services.

  • John Fairplay

    The “problem” with health care is that we have here another manufactured crisis, courtesy of dartaqnan and the other folks that love government more than people. Health care is not a right, and the constitution does not give any level of government the power to regulate or pay for it. The fact is that people live good or poor lives depending on luck, circumstance, hard work and other factors. People get sick and die every day, even in nations with the largest and most oppressive government health care programs imaginable. There’s nothing you can do to stop it, there’s nothing any government program can do to make it more comfortable or give it any dignity. To be truly free, we must be free to fail.

  • Caper

    The libs say that big tobacco makes profit off people dying, now the state wants to also.

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