The current debate on health care is confusing. I focus on five central issues. The debate would be improved if these specifics were in the forefront. The debate would be improved if these specifics were in the forefront. My points are, (1) heath in the US is more a product of lifestyle than the care system, (2) insurance company profits are a trivial part of health care costs, (3) justified changes in insurance regulations do not require the much large health care package, (4) a person will not be able to keep their present health insurance if employers drop the option, and (5) critical details of the new system are not disclosed.

1. Health is a product of lifestyle

There is often an unspoken premise that the primary determinant of health care in an economically developed society is the health care system. In poorly developed societies there are problems of famine and drought, and the basic public health measures of clean water, common immunizations, and simple antibiotic cures are absent. This leads to poor health of the populace. The imapct of modern medicine is dramatic. A hundred years ago the life expectancy in the United States was 47, most of the improvements were due to health care. This leads to the incorrect supposition that health care is still the primary factor in longevity. It’s not true. Now the primary determinant is lifestyle.

The health care system of Costa Rica is often ranked as superior to that of the United States, despite their spending about $350 per citizen in comparison to the U.S. spending of over $8000. The life expectancy in Costa Rica is only a couple of years less than in the U.S. What this proves in not that they have a miraculous health care system, but rather that they do not need a miraculous system. The U.S. longevity suffers greatly from deaths due to violence, drugs, traffic accidents, and suicides. If a person makes it to 55 in the U.S., life expectancy is then the longest in the world. That is despite all the clogged arteries and other consequences of horrendous habits.

The U.K. system is uniformly rated better than the U.S. by those who do ratings. The mortality rates for certain types of cancer are the same in the U.K. as the U.S. In the U.K., half as many people get those types of cancer, but one diagnosed, twice as many die from. That makes the U.K. lifestyle, or whatever it is in their environment that causes cancer, considerably better than the U.S., but their health care system considerably worse.

Obama and supporters of their concept of “reform” repeat the false premise chronically. It is flatly untrue that if our health care system is best our health would be the best. When confronted with this fact, the response is invariably, “That’s just an excuse for not improving the system.” It is not. There is broad agreement that the U.S. system can improved. It is a good reason for not copying a defective system on the grounds that it is better.

2. Insurance company profits are not the issue

President Obama in his town hall meeting supposed that high insurance company profits were a good reason to demand “insurance reform.” In a recent year, insurance company profits were about $12.7 billion out of total health care costs of about $1200 billion. If those profits were somehow eliminated, we are looking at about 1% of costs.

However, those profits are earned. Fraud in Medicare is estimated to be about 5%. In private insurance systems, it’s put at much less than a percent. Medicare makes only superficial checks for fraud and erroneous billing. Checking runs up their administrative costs, and government bureaucracies look better if their administrative costs are less. They need not worry about bottomline costs. However, insurance company profits are made the major issue, not the much great inefficiency inherent in government bureaucracy.

3. Insurance regulation is a separate issue

The new phrase for “health care reform” is “insurance reform.” In political talk a reform is absolutely anything you want to do that increases government control. Obama spoke at length about the need to have legislation that require insurance companies do not reject applicants based upon pre-existing conditions. He is quite right about that. California has had such a law for many years, and it works fine. It doesn’t harm the insurance companies, because each gets to operate under exactly the same rule. Republicans agree with this change. Republicans in the Senate Finance Committee, the only place in Congress where Democrats allow Republicans to have a voice, has proposed this legislation.

If everyone agrees, why hasn’t it already been passed? It is held captive to the health care package as a whole. It allows Obama to falsely claim that the only way to get this aspect of the legislation is to adopt the whole monstrous beast.

4. Employers may choose

President Obama assures voters that they can keep their present health care insurance if they like what they have. This is disputed on several grounds. In the current House bill, there is specific language that requires that if you lose your job, you must switch to the government program and then stay on it. It’s doubtful that Obama has read the bill, so he wouldn’t know about that. Beyond, that there is no guarantee that employers will not switch to the government program and drop the option you now have. Proponents argue that the government option will be cheaper; that’s the major argument for it.

How many employers will switch, removing the private options? The Heritage Foundation, a conservative think tank, say it will put 83 million of those now insured on the government program. I have heard estimates of 120 million. Proponents calim it will be zero. While the number is debatable, the point is that the claim that everyone can keep their current insurance is certainly debatable. It is extremely doubtful.

The related question is whether any private enterprise can actually compete with the government. Proponents say its possible if the program is structures correctly. Perhaps on lesser programs its possible, but government health care is ideologically too big to be allowed to fail. For example, the cost of Medicare turned out to be seven time greater than originally estimated by the Congressional Budget Office. A seven-times cost overrun would sink any private entity. Medicare, however, was guaranteed to be a success. The same Congressional Budget Office puts the cost of the new proposal at about $1.6 trillion. One wonders if the same factor of seven should be applied.

5. It is Big Bang, No Details

President Obama countered fears that the new health care plan requires mandatory euthanasia counseling. The plan will pay for end of life counseling every five years, but it’s optional whether the patient elects it. The subject is not euthanasia, but rather the patients wishes if they should end up on indefinite life support and unable to voice an opinion. That’s legitimate.

Nonetheless, while the immediate explanation is legitimate, it doesn’t put all the fears to rest. Oregon has a government universal health care system. Like all such systems it uses rationing to control costs. A case has come to light recently of a 64-year old woman who had cervical cancer. A $4000 drug called Tarceva offered a small hope of a cure. It was by no means a sure thing, but a hope. The state decided the drug was too expensive to be justified relative to the chance of success, and instead offered either hospice care or euthanasia.

The present health care legislation has a provision to reduce Medicare costs by $500 billion. No one to my knowledge has suggested any way that such huge cuts can be achieved other than through rationing of some sort. The cuts will be determined by a panel of advisory board after the legislation is enacted. It will be done in such a way that the decisions can only be overturned by prompt action of a two-thirds majority of Congress. That is a near impossibility.

With the Oregon case in evidence, and the prospect of indeterminate huge savings in Medicare already in the bill, it’s easy to see how people connect the dots. Proponents deny it, asserting that there is nothing in the bill that requires it, and it just won’t happen.

This is the strategy the Bush Health and Human Services Secretary Mike Leavitt calls Big Bang, Not Details. (Leavitt elaborated in an informative debate with Tom Daschle.) In the 90s, Hillarycare sank because it was both revolutionary and disclosed exactly what it would do. People didn’t like the revolution they were offered. The new strategy is to offer a revolutionary vision of free care with no downside, but conceal what it actually entails. Experts will determine that later, you are told not to worry about that now.


The way to debate health care is to debate it. It is not protesters shouting at elected officials, nor Obama’s orchestrated town hall lecture in which his every sigh was met with thunderous applause. Proponents should square off in public debate with opponents. For a start, my list of topics should be addressed.