Free Lunch, Please

Today we'll take a break from statistics and math to peruse a typical pro-universal health care argument. My wife is a student in a persuasive writing class, and argued against Universal Health Care. Below is her professor's response to my wife's rough draft:

I made some comments below. Too often, the substance of the argument in the outline relies on what might happen, not necessarily what does happen.

To push your critical thinking skills, consider this. We already pay extra money, even with insurance. In my case, I have a deductible of $1,500 per person, a co-pay of $20 and $50 for specialists, and 20% for all tests. The important medications that my husband and I take, add up to several hundred dollars a year. Our average yearly pay is around $5,000, more if we have a surgery or two (which for five years or so seemed to happen regularly). I’m not alone in this. I would gladly pay this in “higher taxes” if I were to be guaranteed that I would not be dropped from the plan (I’m a cancer survivor) or that every procedure would be approved (I had to have the surgery I was trying to avoid because my plan would not cover the cost of a test!). The surgery was the less expensive of the two.

Since my husband has medical problems of his own, we see specialists routinely. My wait for the oncologist is several months! If I miss my yearly appointment, M.D. Smith will drop me as a patient. We often are not accepted by specialists because they refuse our healthcare. I can go on and on, but I am going to stop here to add that I have two brothers who live in Canada. One of them had cancer and the other respiratory illnesses brought on by TB. They see their doctors regularly and sooner than I can see mine, have all the tests they need in a timely manner, free medicines (one of my brothers has not paid for his medication ever), and would not trade their place with mine for the world.

Unfortunately, I’m not alone, so your audience is going to be somewhat skeptical of a future of “might be’s” when the reality of what we have that passes for healthcare is ugly and expensive. We have the most advanced medicine in the world, yet we are behind most industrialized countries in health. How this possible if the health care is the best in the world? These facts have been around for a while, so your audience is going to be hard to persuade. You are going to have to argue with the reality rather than with future possibilities.

Let's examine this argument closely, neglecting the fact that it's completely anecdotal. First, it's beyond me why the onus would be on those who are against massive changes to a system to prove that those changes wouldn't be for the better. I should think if you are proposing massive changes to a system that, for the most part, works pretty well (it allowed you to survive cancer!), the burden of proof would be on you to show me why we'd all benefit. But all we get are sob stories from cancer survivors about how they are forced to schedule annual checkups or find a new doctor. (yes, such is the horror of American medical care.)

"We already pay extra money, even with insurance. In my case, I have a deductible of $1,500 per person, a co-pay of $20 and $50 for specialists, and 20% for all tests."

This person is talking about the out-of-pocket expense, which is a price. This has nothing to do with the cost of medical care; only how her specific plan is set up. The assumption is that if she could pay for a plan that charged her higher rates so that she wouldn't have to pay the out-of-pocket expense, she would. In other words, she has a preference for a monthly or annual bill instead of many small expenses.

This makes little or no sense. Most people would rather pay small expenses regularly than a large bill all at once, because they are most likely to be able to plan for and cover those small costs since they're less disruptive. Nobody likes to get hit with a $5,000 bill all at once. If this professor does indeed want that, she could prepare a $5,000 bill for herself at the beginning of the year, put that money in a savings account, and pay for the incidental expenses from that account throughout the year.

However, that's probably not what the professor wants. What she more likely wants is for someone else to pay for these expenses. While understandable, this is an unsustainable position, since just about everyone would prefer that everyone else pay for their own expenses. This doesn't make the cost go away, and we've already discussed why this raises the cost of a service for all involved below.

Our average yearly pay is around $5,000, more if we have a surgery or two (which for five years or so seemed to happen regularly).

So the professor and her husband have an annual surgery (or two) and pay $5000 or maybe more per year for that service, which if they own two cars, is probably less than their car payments, gas, and car insurance costs. This seems more than reasonable to me. They aren't asking for the government to provide them cars, so why health care?

I would gladly pay this in “higher taxes” if I were to be guaranteed that I would not be dropped from the plan (I’m a cancer survivor) or that every procedure would be approved

Ok, so she wants a guarantee and is willing to pay for the entire cost of it through higher taxes. She's willing to pay taxes high enough to ensure that she can have any procedure she wants at any time.

But wait, that's not really what she means, by her own admission. By paying out-of-pocket the option she wants exists already, but she obviously is unwilling to foot the bill. She can go to any hospital or specialist in the country and pay cash for any procedure she desires, and not have to ever worry about insurance again. Too expensive? If so, then she is unwilling to pay the cost for the service she desires.

The underlying assumption here is that someone else is going to cover the difference between what the professor is willing to pay and what the medical care she desires costs. She does not specify who that "someone else" is.

(I had to have the surgery I was trying to avoid because my plan would not cover the cost of a test!). The surgery was the less expensive of the two.

We're getting to the root of it here. Not only is she unwilling to pay higher costs for surgery she wants, she won't even pay out-of-pocket for a test to avoid surgery she doesn't want. Her unwillingness to pay any additional expense beyond what her insurance covers seems quite astounding; how would we expect that she'd gladly pay this cost if it came in the form of taxes? That doesn't make any sense; she obviously wants other people to pay for her care.

Since my husband has medical problems of his own, we see specialists routinely. My wait for the oncologist is several months! If I miss my yearly appointment, M.D. Anderson will drop me as a patient. We often are not accepted by specialists because they refuse our healthcare.

Again, problems that would be alleviated by paying cash, which she is unwilling to do. I have another anecdote; my parents pay through the nose for Blue Cross/Blue Shield and have none of these problems. This professor could have opted for that insurance, but odds are she didn't want to pay that cost, either.

They see their doctors regularly and sooner than I can see mine, have all the tests they need in a timely manner, free medicines (one of my brothers has not paid for his medication ever), and would not trade their place with mine for the world.

It's starting to sound like the professor believes in the medicine fairy, because I'm quite sure that her brother does indeed pay indirectly for his medicine. If not, then someone else is paying for it, and from what she's said I can understand why she'd be enamoured of that circumstance. However, none of this makes the cost of providing the medicine go away.

Unfortunately, I’m not alone, so your audience is going to be somewhat skeptical of a future of “might be’s” when the reality of what we have that passes for healthcare is ugly and expensive.

Translation: I don't want to pay the entire cost of my health care, and there are many more people like me. We want someone else to foot the bill, and are completely unsure who that might be. We don't expect that the "someone else" has medical expenses also, or that we are the people that would be paying extra for other people with even higher medical expenses. Things are so bad here that I survive cancer and have annual surgery for $5,000 a year. By the way, this is such a big deal to me that I am unwilling to move to Canada where my family is. I think the U.S. would be better some other way, and prove to me why it wouldn't, because my intuition trumps your logic.

This professor probably didn't set out to prove why universal health care is unsustainable, but I'll be damned if I could find a better argument.