Basic Health Care and the Common Good, A Conservative Response
Eric wrote what I think is a very good and heartfelt post about Catholic Social Teaching and Health Care Reform. Because this is exactly the sort of substantive discussion that American Catholic was intended to foster, I’d like to see if I can pick up some of the themes which he brought up and explore them specifically from a small government conservative and free market angle.
To start with, I’d like to make a distinction between levels of care, though such things are always slippery because medical science advances so rapidly in our modern world. First, there is basic health care. This includes most of the healthcare which goes on most of the time in the US — unless you’re well outside the norm it’s probably all that you’ve needed within the last year.
Diagnosing standard diseases and infections, and treating them with anti-biotics. Standard inoculations. Basic screening tests. Treating basic injuries. X-rays. Standard ultrasounds and pre-natal care. Delivery in cases without complications. Well-child care.
With modern technology, these are elements of medical care which can be very easily and cheaply provided. They are also comparatively low skill. In all reality, a certified nurse or a pharmacist could deal with many of these situations. Certainly some sort of generalist doctor with a more basic sort of medical training could handle them.
The most humanitarian goal would, I think, be to have this kind of care as widely and cheaply available as possible. In the third world, charitable organizations do this by shipping in trained doctors and interns along with crates of basic medicines and medical technology. In the US, it seems to me there are basically two approaches one could take:
1) Create separate licensing and regulation models for “basic” healthcare, allowing large numbers of clinics to spring up providing these services at competitive rates. Because these services can at this point be provided very cheaply, and allowing this to function on a retail model would push providers to establing longer hours, efficiencies, etc.
2) Create a system for chartering free “charity clinics” run either by the government or by non-profit corporations whose mission is to provide “basic” care for free to anyone who is certified as meeting certain thresholds of need.
I think that of these 1) would probably work much better, and it could be supplemented by a debit-card style payment card which would be provided to people in serious poverty to allow them to use the clinics on a subsidized basis. Basic care would have to have serious regulations on liability, and it would be billed on a retail basis rather than through the whole medical billing nightmare which eats up so much time and expense in our current combined medical system. As such, I’m pretty sure that the costs would settle out to a very low level, allowing all but the very poorest to easily afford their basic care out of pocket. (And for the poorest, we’d want some sort of assistance.)
Beyond this Basic Care would be Advanced Care, which would consist of all of the more advanced treatments for more serious problems which modern medicine allows. This care would be provided through a system more like our own current system. Costs would remain relatively high, but you’d only need it at long intervals. I think the best approach would be to move to an individual insurance approach which covered just Advanced Care, with standard deductibles around 500-1000 per person per year. Because basic care would be taken out of the mix, claims would be much less frequent for any given family. (You might go years without using your advanced care insurance — just as with your homeowners insurance or your car insurance — but it would be there when you needed it.) There would also need to be legal limits on what criteria could be considered in setting advanced care insurance rates. This would raise everyone’s rates a bit (to account for not being able to turn down people with existing conditions or genetic predispositions to certain ailments) but the overall result would be positive in that it would allow everyone to be covered. For the poor, we’d need either a government policy or a system for a combination of government and charitable funds being used to pay for Advanced Care policies for the poor. Other models than insurance could also be tried, including Advanced Care cooperatives which pooled people in a particular region, profession, school or church.