Philip Goldberg recently wrote an article in the Huffington Post comparing Healthcare to “Firecare.” He says, “Right now, our tax money pays for a government-run program that puts out fires no matter who owns the building, or who lives there, or who started them. “
Mr. Goldberg is comparing houses to our bodies, and fire fighters to health care professionals. He’s saying our “firecare” policy is socialist, and everyone likes it that way, therefore our healthcare policy should be the same.
On the surface, the analogy seems like it might work, but if you press even a little, the veneer of logic comes off in a heartbeat. My sweet liberal friends have really good intentions, and their hearts are really big . . . even bigger than their brains sometimes. We need BOTH hearts and brains to make things work. One without the other is worse than useless, it’s dangerous.
Let’s look closer at the “firecare” analogy. Does the fire fighter help you rebuild your house after it burns down? Does our socialist “firecare” arrange and pay to have the smoke and water damage cleaned up? If the house partially burned down, does “firecare” pay to have contractors, carpenters, electricians, and plumbers rebuild? Does it pay for the wood, nails, sheetrock and paint? Does it pay for replacement of your valuables that burned up? Does it pay for a place for you to live while you have your place rebuilt? Does “firecare” pay for “preventive” care in your home? Will they install smoke detectors and sprinklers for you?
Does “firecare” pay to rebuild ANYTHING after a fire? No. Your private homeowner’s insurance does. Your homeowner’s insurance, that YOU bought, pays for the contractors, carpenters electricians, plumbers, wood, nails, sheet rock, paint, hotel bills and replacement of belongings.
What is the true “firecare” equivalent of healthcare? It’s the Emergency Medical Technician (EMT). Fire fighters stop the burning . . . EMTs stop the bleeding. Just as fire fighters don’t pay for carpenters, electricians, plumbers and supplies to rebuild your damaged home . . . EMTs do not pay for doctors, nurses, anesthesiologists and operating rooms to rebuild your injured body. So, it seems to me we already ARE on the “firecare” model for healthcare.
Let’s turn the tables and see if “Firecare” would work if it was forced to operate under the new “healthcare” mandates. . . . Hey, State Farm! My house is on fire, and I’d like to get insurance NOW! You have to give it to me because you can’t discriminate against a pre-existing condition. It wasn’t my fault. Oh, and you have to pay WHATEVER it costs to repair the damage, there are no caps on claims.
How many investors would buy into that business model? For that matter, how many homeowners would pay for homeowner’s insurance every month if they can get it AFTER they have an emergency? You would logically expect that the insurance companies would suffer so many financial losses that they would be forced into bankruptcy. It’s just like the government forcing banks to give mortgages to low-income, high-risk folks. Many high-risk folks defaulted, as is logically expected, and huge losses were forced on the banks.
If private homeowner’s insurance collapsed, everyone would have to get government “firecare” insurance. You’d have go through government channels to get your home rebuilt. Have you ever tried to get a government building permit? Do you really want to deal with government carpenters, electricians and plumbers? Or find the ones that will accept government-limited wages? Perhaps some houses would be deemed “too old” and too expensive to be rebuilt. What then? (This is not a problem when you buy private homeowner’s insurance.)
For that matter, why should anyone go bankrupt because their house burned down and they didn’t have insurance? The fire wasn’t their fault, right? Government “firecare” should rebuild their houses for them! Everyone needs a home, of course.
We pay for “socialized firecare” because fires CAN spread quickly and do more damage. Yes, there are some contagious diseases that can spread, but there are NONE that spread as quickly as fire, nor are they as deadly to everyone caught in them.
Let’s compare “firecare” workers with healthcare workers. Most city governments can afford a few hundred (or more) fire fighters, depending on the size of the city. Smaller cities can even function with volunteer fire fighters. Can hospitals be run entirely by volunteers? No. Cities require THOUSANDS of doctors, nurses, and health care workers . . . not just on duty but working around the clock.
How expensive is it to train Fire fighters? They don’t need a college degree. They get only a few months training. It’s nothing like healthcare workers are required to have. Most states have upped requirements for Registered nurses from 2 years to 4 years. Medical degrees can require up to 12 years of school and they often end up with over $100,000 in student loans. Governments can barely afford to pay fire fighters in our current economy, but Mr. Goldberg wants them to pay for all the required doctors and nurses, too. Shall we “control costs” by limiting what those dedicated health professionals can earn?
Fire fighters don’t work every hour of every shift. They would demand even higher wages if they did. Doctors and nurses DO work every hour of every shift, doing surgery, treating patients, and administering care. Doctors work more hours in a week than any self-respecting union worker would tolerate.
Do lawyers sue fire fighters for not fighting fires “correctly?” I’ve never heard of it. If they did, “firecare” workers would need to go around installing smoke detectors in every room of everyone’s house to reduce their chances of being sued. Do lawyers sue doctors and hospitals? ALL the time. Do doctors perform more tests than necessary to reduce their chances of being sued, and does it drive up the cost of health care? You betcha!
Has “firecare” technology changed tremendously in the past 1,000 years? Hhmmm . . . they still use WATER to put out fires. Health care, on the other hand, has advanced by orders of magnitude. If you want cheaper health care, we COULD go back to the days when all we had was aspirin. But no one WANTS that. Everyone wants the newest, best, and most effective health care treatments. That’s logical . . . but it COSTS. You get what you pay for . . . and its corollary . . . SOMEONE has to pay for what you DO get.
The laws of economics are as immutable as the laws of physics. For every action, there is an equal and opposite reaction. “You cannot fool Mother Nature” . . . nor can you fool human nature. If people think they can get something for LESS, they will try. If cost controls are imposed on a high-demand service or product, shortages result. ALWAYS.
Be prepared for health insurance companies to go out of business. If they cannot make the paltry 2% profit they already make, they will. What many people don’t realize is that not only do they pay for health care for millions, but they also subsidize Medicaid and Medicare. Medicaid passes much of its cost to private payers. In Washington State alone, $738 million were shifted to private payers to make up for underpayments by Medicare and Medicated in ’04. The same year in CA, private payers and hospitals paid $45 BILLION to compensate for the public care shortfall. Uninsured patients add only about 1%, but Medicare/Medicaid’s low reimbursement rates add as much as 10% in hidden costs to private health insurance.
Is it any wonder private insurance costs are going up? If private insurance goes out of business, who will subsidize the hospitals, clinics, and doctors for shortfalls from public care payments? Remember, economic laws can’t be changed any more than you can change the law of gravity.
Be prepared for doctors and nurses to retire in ever increasing numbers, and for fewer to train for (and go in debt for) those difficult and demanding careers, as the reward potential gets limited. It’s a law of human nature.
Mr. Goldberg, your bio says you’re a “spiritual counselor,” not a business adviser, nor an economist, nor a health care professional. Stick to your day job, and don’t stick it to the rest of us.
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Image from web site: www.workingfire.net
Posts
Interesting.
ReplyDelete(BTW...you left out "look" in para. 4.)
You are aware that comments you make here can and will be used against you, right? :) (I'll just leave you to mull over what I might possibly mean.)
Love you!
d
Hi D,
ReplyDeleteThank you for proofing. :) I read it at least seven times before posting, and still missed one!
My analysis of Mr. Goldberg's article was strictly to show the weakness of his analogy, and my points are to show why I think so, and what I think can happen, not what I want to happen.
If my logic is flawed or if my facts are wrong I want to know. Truly, I would LIKE to be proved wrong about this. :/
Love you!
Hi, Becky. :)
ReplyDeleteI agree that all analogies have a point at which they fail. I agree that that's part of the fun of attacking such an argument. The problem, though, is that once you put yourself out there, as you've done here (and as I do on my blog), it's no longer a simple case of a rational discussion of opposing points. It becomes, instead, a defense of ego.
I say this because I quite understand how hard it is to even seriously consider another POV when you are already so deeply invested in your own. I've been there countless times, and will, no doubt, continue to be. And based on our ongoing conversations/arguments, you've also been there many times, so I know you understand.
I KNOW I want to understand the other side, and be fair to it, but I also know how hard it is once I've already formed an opinion. For this reason, I know you understand the same, from your point of view.
So I guess what I'm saying is, I'm not sure what sort of response would be fruitful. Maybe this is enough for the time being.
I love you very much. No matter what, never forget it.
d
You have to admit though, whatever the POVs involved, she did a good job of debunking the analogy.
ReplyDeleteI'm not convinced of that, to be honest. I acknowledge that every analogy fails at some point (which is why is doesn't serve as a logical argument for one's POV so much as a lens through which one may better understand one's POV).
ReplyDeleteAt the same time, I still like Goldberg's satiric analogy. He's pointing out that we already have many socialized programs which we not only use, but COUNT ON (and honestly, we'd probably revolt if they were taken away now). Also, the need to put out a fire (whether it is worth calling the fire department for or not) is communal (not unlike health problems). Even when some people/places are more likely to go up in flames, we all pay the same for protection. And we get it. The post she debunks here is a "what if" argument, as in "what if we applied our health insurance expectations to our firecare" (or police care, or military, for that matter).
How much anyone pays for her education or how many years she invests in that education is beside the point. All of that is beside the point. People will do what they WANT to do, what they are DRIVEN to do. Your husbands and I went into the military. Is this because we're uneducated? Stupid? Don't want to make money? Or is it because we BELIEVE in something?
Frankly, if I have a doctor who thinks the money he stands to make is more important that helping his patients, I'll take another doctor. I don't doubt that a few people have gone into medicine hoping to get rich, but I like to believe (and maybe I'm out to lunch here) that the vast majority do what they do because they like helping others. I just don't buy the whole "if they can't make as much money, they won't choose this career" argument.
Basically, there's something that's niggling me about her argument that I can't put my finger on (kinda like I didn't figure out why allegories are so pointless until just recently). Other than the general idea that she seems to have missed the point entirely, I can't pinpoint it. But maybe that's all that's necessary.
Most of it has little or nothing to do with the point of the argument to which she is responding.
d
So you would LIKE for the government to be in charge of homeowner’s insurance and rebuilding of your fire-damaged home? And you think it’s okay for a life-time smoker to demand unlimited health insurance coverage AFTER he/she develops lung cancer? (Like calling State Farm when your house is on fire.) Why would anyone pay for insurance before he/she needs it? The penalty for not buying it is less than the cost of insurance.
ReplyDeleteHow much training and education a person must have for their job is very much a part of the discussion. Your idealism is very sweet, but it doesn’t comport with reality (yes, you can use that line on me later :)
The cost (in time and money) for the education of medical professionals is pertinent to this discussion in several ways.
1) It’s not that doctors choose their career to make big money, but the costs to them are so high they must have adequate reimbursement for the decade of extra study and debt. They don’t become doctors to spill their blood in the water as chum for lawyers, nor to be vilified for “chopping off the feet of diabetics” who can't or won’t control their blood sugar.
2) Demand for doctors is high and we need lots more of them, especially in some disciplines. High demand, short supply drives up the cost of anything.
3) Governments can afford fire fighters, who only need a few months’ training.
4) Why would we WANT to suppress the earnings of people who DO want to go through what it takes? Do we make any effort to lower salaries of movie stars and sport figures? They aren’t essential. Let's reward what we need and want MORE of, and we'll get it.
Here’s another reason socialized fire fighting “works.” Command economies, like huge bureaucracies, are terribly inefficient when distributing goods and services to where they are needed (much less where they are wanted.) However, when there is a fire, it’s a simple matter to see where the resources are needed, it’s a flamin’ beacon. It’s the same with other 911 calls, the system tells the resource where to go.
I could be wrong about insurance companies going out of business. They may be regulated into becoming like a “public utility” since their systems are already in place. The regulations imposed on them will not allow them to make a profit, and they will be “too necessary to fail” and will be bailed out by the government. Once again, some will cry “capitalism has failed” without critical analysis. Their ever-increasing losses will be subsidized by the taxpayer. Here’s another opinion:
http://www.discriminations.us/2010/03/nsurance_as_public_utility_no.html
I would like to be wrong and think that we can lower the cost of health care with a magic wand, but it can't be done. You can only SHIFT the costs . . . to the doctors, or to the insurance companies, or to the taxpayers when the insurance companies are gone. Well, you CAN lower cost by lowering quality and increasing wait times. :\ (Massachusetts got “universal” care, costs went up, and wait times for doctors spiked, in spite of having more doctors per capita than any other state.) http://pajamasmedia.com/blog/obamacare-a-national-version-of-romneycare/?singlepage=true
ReplyDeleteHere’s more about Mass. health care, from Tom Cahill the Secretary of the Treasury of Massachusetts. He says the new health care bill will BANKRUPT the United States within FOUR YEARS, based on his experience in Massachusetts.
ReplyDelete“We have what David Axelrod referred to as the pilot program. It started four years ago in Massachusetts — universal health care to mandate, to cover everyone in the state of Massachusetts. It wasn't going to cost us a whole lot of money, so they said and it was going to work.
We have a public exchange that was going to match up private insurance with people who couldn't get insurance, small businesses. It hasn't worked out the way they said it was going to work out. And it has increased cost in just in Massachusetts of about $4 billion over when this program was started in 2006.
And just today, the governor himself announced there's an extra $300 million hole in our health care line items. So, it is bankrupting the state and would have bankrupted our state if not for the federal government being overly generous with Medicaid reimbursements over these last four years. They've really propped the system up to keep it in place.
So, we have regular Medicaid that's costing us over $10 billion a year. And then you have this connector that is matching people up and giving them coverage of which they're not paying anything for.
[Insurance premiums] have gone up higher in Massachusetts than I think any other state in the nation. So, it has not created any competition, because you only have four major players, four major insurers. So, you got more people, complete access. It's a mandate. You pay a tax if you don't sign up.
We're limiting access to community hospitals. We've got seven community hospitals suing the state of Massachusetts because they're not being reimbursed at a high enough rate. They are getting all the poor patients and the government has only reimbursed them 60 to 70 cents on the dollar. So, they're suing because they're going bankrupt. Those hospitals that are outside of Boston in the neighborhood of Massachusetts are suing the state since this plan has been in place, which is going really limit access, not increase access.
And costs have not gone down. I mean, costs are still among the highest in the nation. I mean, we're high-cost state anyways because we have these teaching hospitals at Harvard and Beth Israel and it's not working. It's blowing a huge hole in the budget. I was challenged by our governor to say, where have you been on this issue?
We've been fighting — as a treasurer, I've been trying to balance the budget for the past two years and wondering where all the money is going. And what we've discovered in the official statement that the governor and I signed that all the money, increase money is going to Medicaid and to this health care reform — by over 52 percent increase over these last four years, over and above the rate of inflation. No other budget item in our budget has gone up even close to that.
So, that's where I say, be careful, country, because it's going to bankrupt us.”
http://www.foxnews.com/story/0,2933,589754,00.html
Here’s Charles Krauthammer’s opinion. He thinks that a national value added tax or VAT (sales tax) will have to be started in order to pay for the new all-encompassing health care. Which is why all of the European Union has huge VATs. Germany: 19 percent. France and Italy: 20 percent. Most of Scandinavia: 25 percent.
http://townhall.com/columnists/CharlesKrauthammer/2010/03/26/the_vat_cometh?page=full