Posts Tagged ‘health care’
With a massive health care bill (PDF) being pushed through the American legislature, the big question pops up again and again: who will pay for it? And that’s a fair question that has many complex answers. An often-raised solution by President Barack Obama and Health and Human Services Secretary Kathleen Sebelius would be to tax the rich, particularly those who are making over $280,000 (individuals) and $350,000 per year (couples). But in addition to several objections to this idea, I argue that this sort of taxation on a section of population is an undue burden.
Most often applied to cases of disability or abortion, “undue burden,” as defined by Justice John Paul Stevens (PDF) in the aforementioned abortion case, means “[a] burden may be ‘undue’ either because [it] is too severe or because it lacks a legitimate, rational justification.” In the case of taxation, I argue that “undue burden” can applied to taxes that are unjustifiably levied upon individuals who have little to do with the reason for the tax. In this example, I take the rich, who are often looked upon as the answer to our government’s fiscal needs.
In addition to many other great reasons we shouldn’t tax the rich for health care, I believe additionally taxing them to generate the funds for national health care would be an undue burden. The first reason I would argue this is because the rich have nothing to do with the state of our health care system, as they are able to afford the best health care, even at rates lower than those of people who earn less. Instead, the causes of the downfall of our health care system include “the 15 most expensive health conditions account for 44 percent of total health care expenses” (AHRQ) and prescription drugs and technology. If the rich are able to pay for their own health care, then why should they be taxed additionally in order to pay for others’ health care? This doesn’t offer any solutions; it merely puts a band-aid (no pun intended) on the problem, which leads to my second point.
I further argue that as long as additional taxes are concentrated on the rich, the economy will further collapse from the bottom-up. If the rich are taxed so much that they become the “new middle class,” they have less to invest in solidified and entrepreneurial businesses. With less investment and capital, businesses are able to produce less, and thereby the unemployment rate raises. This is the last thing we need in the current economy.
Instead of a surtax on the rich or even taxing health benefits, as is proposed by many in legislature (but Obama is rightly adamantly against), I suggest that taxes first be increased on businesses that contribute to and exasperate the causes of the need for health care, including restaurant chains, energy and chemical producers, and other vice-related businesses. As many of our leading chronic diseases are preventable (such as much of heart disease, asthma, lung cancer, and strokes), I argue that we should then pay for the causes of such diseases with the corporations responsible for them. For example, I would first levy additional taxes on:
- Chain restaurants (franchises and owners of over 3 restaurants) and food producing businesses (and their consumers) that have menus/products which include transfat or excessive per-serving or per-item calories and fat.
- Tax cap and trade (emissions trading) and companies who partake in the trading, in addition to an inherent tax on being a company which necessitates the cap and trade policy.
- Further tax alcohol and tobacco-related products both on the corporate and individual level, as has been done previously to pay for health-related coverage.
- Roll-back tax-exemption for non-profit organizations.
Instead of taxing a portion of our population who has done nothing to warrant further taxation, we should put the responsibility of paying for detrimental health-related outcomes on the corporations which provide the products and the consumers who use the products. By taxing the rich for outcomes for which they have little responsibility, I believe it’s an undue burden to that segment of the population, regardless of their means and ability to pay for such an expenditure.
While the American healthcare system has many flaws due to finances, it’s also undergoing an epidemic that’s hitting the entire world: a shortage of primary care physicians. With more medical students going into specialties, the primary care field has a shortage on par if not worse than the nursing shortage, and it threatens to derail President Obama’s national healthcare plan, among other healthcare initiatives and reforms. The American College of Physicians isn’t any more optimistic given its article, “The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care.”
Although foreign doctors have picked up some of the absences, studies still expect a decrease in the number of medical students becoming generalists, and thus a 35,000-44,000 doctor shortage for adult care. It already impacts every state, and articles have been written about the dwindling primary care physician availability in Massachusetts, California, Maine, Alabama, Washington, and Wisconsin, among many others. Cities with large, reputable healthcare organizations aren’t excluded: even Boston has a problem finding primary care physicians. And you know it’s bad when it hits well-supported issues, such as the availability of mammograms.
There are several theories for solutions to the shortage, with the vast majority of them focusing on increasing the number of primary care physicians. These theories include:
- An article about Texas claims it cured its doctor shortage through tort reform. It argues that by decreasing the malpractice liability and the amount a patient can win from a suit, the doctor saves money on their insurance, and the patient then sees decreased costs. This isn’t an argument I support whatsoever. While I’m well aware of the insurance costs and liability to physicians and other healthcare practitioners, I truly believe the savings to the individual person or family would be very little. This also doesn’t particularly encourage medical students to consider primary care, considering primary care is still the least profitable field for physicians.
- We could also increase enrollment in medical schools, but I agree with the consensus that it would just further encourage medical students to pursue specialties. That obviously doesn’t solve the problem.
- I disagree with this doctor who says the easy solution is to increase medicare reimbursement by 20%. Throwing money at the problem won’t help, and creates a slippery slope whereby increases in the reimbursement may be necessary as the number of primary care physicians continue to dwindle.
- Another less talked about option would be to increase the National Health Service Corps, which, according to their Web site, “helps Health Professional Shortage Areas (HPSAs) in the U.S. get the medical, dental and mental health providers they need to meet their desperate need for health care.” But there are still liability and organizational issues with the corps.
I suggest, along with some others, that our healthcare system should be reevaluated and roles appropriated. Instead of attempting to encourage more medical students, with their $140,000+ in medical school debt, to pursue the least profitable field, it would make much more sense to increase the number of nurse practitioners (PDF) with the eventual goal of replacing all primary care medicine with nurse practitioners.
Nurse practitioners, a relatively young profession at just about 50 years old, has shown to be less expensive (for both the individual and economy), have less liability, and about the same efficacy as a primary care physician. According to the Mayo Clinic (via the American Nurses Association), “approximately 60 to 80 percent of primary and preventive care can be performed by nurse practitioners.” So why can’t it become 100%, allowing for cheaper healthcare, and allowing physicians, with all their schooling and debts, to pursue specialty fields upon being referred by the NP? It simply doesn’t make sense to invest, as a society and individual, so much in primary care physicians and all their schooling and debts to take a role which can be filled by equally effective nurse practitioners.
The main problem with this plan is the availability of nurse practitioners, but with less debts incurred by these students and less time of program competition, it’s easily more practical and affordable to increase the number of nurse practitioners with government and organizational incentives such as debt relief and bonuses. This also strengthens and makes our specialty care fields more competitive by allowing more physicians to pursue those fields.
While I have little doubt that this would be, in essence, a paradigm shift to the medical community, I think it’s one we’re going to find more practical as a long-term solution as the world’s population grows. There are only so many positions available in a medical school, and only so many people who can complete the entire program. We should allow nurse practitioners to assume the primary care role to increase availability and decrease cost of the medical services we encounter most often so long as the standard of medical care isn’t decreased. And current NPs have shown they’re up to the task in both education and training.