By Evan Falchuk
It’s been all over Facebook and Twitter the last couple of days. People updating their status with this message:
No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day.
It strikes me as odd. I mean, who can disagree with these statements? And for what policy proposal are they meant to encourage support?
How about just changing it to “no one should die, and no one should go broke”? I’d be in favor of that, too.
But think about what the Facebook slogan is saying.
- No one should die because they cannot afford health care. Let’s say I have a terminal disease and I want an experimental treatment in Europe that costs $500,000 and has a 50% chance of curing me. If I have the money in the bank, I’m going to get the treatment. Should the government or an insurance company be required to pay for it if I can’t? Does your answer change if it only has a 1% chance of curing me? What if I have half the money? “No one should die,” right?
- No one should go broke because they get sick. Let’s say I don’t own health insurance even though I can afford it. I smoke, don’t exercise and am overweight. One day, I have a heart attack and my treatment costs $50,000. I can’t afford it, although if I had an insurance policy, almost all of it would have been covered. I’m broke. Should the government just pay for my care? If “no one should go broke,” then the answer is yes.
As I’ve noted before, when we talk about reform, we are really talking about dozens of different issues. Is reform about covering the uninsured, or competition in the insurance market? It is about a “public option “, or changing reimbursements to doctors? Is it about longer life expectancies or insurance cooperatives? Is it about medical malpractice, or comparative effectiveness? Is it about healthier lifestyles, or cutting the cost of prescription drugs? Is it about taxes on employee benefits or administrative waste? Is it about the cost of end-of-life care or the federal deficit? Is it about new health care IT, or the profits of private insurers?
It’s about all these things, and many more. Which presents a problem for reformers – how to package this in a way that makes sense? So far, it hasn’t gone well.
So I understand the appeal of the Facebook slogan. It’s like a virtual bumper sticker. It reduces all these issues to a simplistic slogan that suggests you are morally suspect if you disagree. But it’s too bad.
There are real issues at stake in health care, and a real need for reform. We ought to be having a more thoughtful and extensive discussion.
