The Health Care Debate: The Basics

“Read the bill!” chant angry voters to their congressional representatives. “The bill” is HR 3200, an 1,100-page behemoth that makes War and Peace look like The Cat In The Hat. There’s certainly not enough time left in the summer to make it your beach read. So, before you attend your own town hall meeting, bullhorn in hand, make sure you understand at least the basic terminology of this crucial debate.

Single payer system

Single payer is not part of the current bill, but some fear (or hope) that provisions in the current bill are a way to get there eventually.

Under our current health care system, people who have health insurance make a monthly payment (premiums) to a private insurance company. When these people receive medical treatment the insurance company pays at least some, if not all, of the bill.

Under a single-payer plan, everyone pays into a fund that would be managed by a federal agency. That agency would be responsible for paying for treatment. Private insurance companies would fall by the wayside.


Proponents say

It’s the best way to ensure the fairest health care for the greatest number of people. The need to make a profit leads private insurance companies to continually raise premiums, apply high deductibles and co-pays, and refuse to give insurance to people who have a preexisting medical condition. Medicare (the federal health insurance program for people over age 65) is a single-payer system and it works fine.


Opponents say

This is America and we believe that the profit motive forces companies to provide quality service at competitive prices. When the government provides services it’s “we’ll get to you when we get to you.” If you’re satisfied with your health coverage now, chances are you won’t be with single-payer as you will suddenly be paying higher taxes (you’ll be paying for all of those who don’t have coverage now) and it would lead to health care rationing.

The public option

This is the big enchilada in the current bill. Most people in our country have health insurance coverage through their employers. If you do, then you probably pay some of the premium via payroll deduction and your employer pays the rest.
Unfortunately, not everyone has a job that offers this benefit. You could go out and get coverage on your own, but it’s super expensive. Even if you can afford it, you may have a preexisting condition (like diabetes) and insurance companies will refuse to cover you. So the government would like to offer its own insurance plan for those who can’t get it or can’t afford it.


Proponents say

It’s needed to cover the two groups mentioned above; those who currently can’t afford health insurance and those who currently can’t get it because they’re already sick. The public option is also needed to keep health insurance companies honest. Right now when the cost for medical care goes up, these costs are passed on to the consumer in the form of higher insurance premiums. Premiums have skyrocketed in previous years, putting a strain on small businesses who offer it as a benefit and on individuals who pay at least part of that premium. The public option would motivate private insurers to work more closely with medical providers to deliver more cost-effective care.


Opponents say

The government-run plan would be an unfair competitor to private insurance companies by offering insurance at a lower price to consumers (since the government doesn’t need to make a profit). The government would also use its power to pay less to doctors and hospitals (like Medicare does). This would drive private insurers out of business and ultimately lead to a single-payer system. So, if you like the insurance you currently have, the public option is all about making it go away.

Health care rationing

Quality medical care is not an unlimited resource. You can’t reasonably treat everybody for everything. It would be way too expensive. So, is it possible that these reform proposals might lead to waiting lists for certain types of treatments and flat-out denial for other types of treatments?

Proponents say

We have health care rationing under our current system. Rationing happens when an insurance company refuses to cover a costly procedure. It also happens when people aren’t covered by insurance because they can’t afford it.


Opponents say

Do you want the government deciding which treatments and drugs you can use? Because that’s what will happen when they run health care. Health decisions are some of the most personal decisions we can make, and when the government runs it they will be the ones to tell grandpa whether or not he’s too old to waste money on a hip replacement.

Pay or play

Not all employers choose to give their employees health insurance as a benefit. The new bill proposes that all but the very smallest employers provide health care coverage to their employees or pay an 8% tax penalty to the government.


Proponents say

In many cases, people who don’t have health insurance rack up huge medical bills when they get sick or injured in an accident. They can’t afford to pay these bills so they declare bankruptcy and the cost for the care gets passed on to everyone else. So companies that already offer health insurance to their employees end up paying more for it because of the uninsured. So, in essence, the companies that offer health insurance to their employees are subsidizing those who do not. Even big, bad Wal-Mart came out in favor of pay to play.


Opponents say

The reason many employers don’t offer their employees insurance is because they can’t afford it. So how will they afford the penalty? Pay or play will put some employers out of business, some will have to lay off employees, and new jobs won’t be created as businesses that would otherwise start up will never get off the ground. As for Wal-Mart, they already offer their employees a health insurance benefit and this is their way of trying to stick it to rivals like Target who do not.

Tort reform

A tort is a legal term. Basically, a tort happens when someone does something so bad to you that you can turn around and sue him/her for damages. So when a doctor screws up your back surgery so that you’re walking around like Quasimodo, you can hire a lawyer to sue the doctor to make him pay for your suffering. Doctors have insurance policies to cover them in such a case (medical malpractice insurance). Some lawmakers have proposed setting up special “health courts” in order to address cases where someone has been harmed by a health care professional.


Proponents say

Medical malpractice lawsuits have become so common that doctors are paying exorbitant amounts for their medical malpractice insurance. They’re passing the costs for the insurance on to everyone else. Also, doctors are ordering expensive medical tests that might not be absolutely necessary. However, they feel compelled to do so in order to cover their butts. These special “health courts” would take the ambulance-chasing trial lawyers out of the picture and lead to settlements that are fairer and more consistent.


Opponents say

Your right to sue keeps doctors and hospitals honest. Our civil courts are sacred institutions that level the playing field and prevent the little guy from getting shafted time and time again by the rich, powerful corporations. Without the fear of a lawsuit hanging over their heads, the quality of medical care provided by large hospitals would suffer.