There’s a lot being said these days about health care, from Medicare to Obama Care. Get past the lies and rhetoric, and most of it boils down to questions of financing and access. Think of them as “who makes the rules over who gets to play”.

Republicans believe that we should ‘get government out-of-the-way” and let the free market provide financing of health care, and people can choose and buy whatever they can afford; Democrats believe that the most cost-effective way is partnership between government and the private sector, with basic health care available to all Americans whether they can afford it or not.

Beliefs that are as different as can be.

“Getting government out-of-the-way” is a catchy phrase that sounds good on paper, until we stop to consider that it’s our government that makes possible Social Security and Medicare and Medicaid and WIC (a Federal program for Women, Infants and Children). Only those who will never need those programs are against them being available for those of us who do.

My parents and grandparents (and one great-grandmother too!) benefited greatly from social security and Medicare; my nieces and nephews and their kids have benefited from Medicaid and WIC.  Not because they  refused to take personal responsibility for their lives, but because they were either very young and victims of un-employment and divorce, or retired after a career of working and paying in their fair share, or very old and widowed to men who did the same.

I think about what life would have been like if Social Security hadn’t been there to keep them independent, in their own house with their own stuff; if Medicare hadn’t been there to get them the lowest prices on their health care, and to cover their hospital bills which ran into the mid six figures for each of my parents.

It’s a picture that more people need to consider.

Once upon a time, when I started working in health care, Medicare operated as a fee-for-service operation. What that meant was, we provided a service, any service for any reason, and we’d get paid what we billed.

When I worked directly for the hospital, we had guidelines for care. When I worked for the private, free market company that the same hospital contracted with to provide services, instead of “care” guidelines, we had “charge” guidelines.  That’s our first clue as to the differences in purpose between a public and a private health organization in how they approach treating patients.

The one that still rings in my mind’s eye is PRN (as needed) oxygen. We put oxygen equipment in every room, and charged every patient every day, whether they used the oxygen or not. I filled out enough charge forms to still remember the totals after all of these years: $37.50 per day, for just in case.  Another example was post-op breathing treatments ordered to ‘prevent’ pneumonia. Every surgical patient received not one or two, but three different breathing treatments, each four to six times a day until discharge.

The first big round of Medicare reform in the 1980’s stopped those practices, as the Medicare powers that be, among other things, declined to pay for that which wasn’t used, and only covered those things that were proven to be of benefit.  What a concept!

Think of the car dealer that charges for undercoating we don’t want or need, but no undercoat was ever applied. Think of the restaurant that charged you for an appetizer that you neither ordered nor received. None if us would stand for that, nor would we likely continue doing business with those businesses.

My free market industry screamed foul, and said government had no place in health care, and said government was stifling business, and said that government was killing jobs, and they still lost. Millions were saved that very first year by not paying the free market what they said they deserved, just because they said they deserved it. No longer would everyone pay for oxygen they didn’t use; no longer would treatments be covered to prevent pneumonia when pneumonia wasn’t even a risk to be had.

That’s millions in Medicare (taxpayer) dollars, saved by the recommendations of Medicare panels, the first ones to get the moniker ‘death panels’ for daring to come between “the physician and his patient”. My field, respiratory care, was still a relatively new field when I entered, helped lead the way to data driven health care, using good science to get data that showed us what worked, and what had the same or worse impact as not doing it all.

Facts are powerful, but only when people listen to them.

Those Medicare rules didn’t apply to other insurers, although the insurance industry was quick to adopt any reason that limited their payments on claims, because fewer claims paid means higher profits. That’s why they have pre-existing condition clauses.

It didn’t change for the un-insured, however, who to this day pay higher (retail) prices for everything in health care than does Medicare (big volume discount) or private insurance (big stick discount).

And that’s the key, folks… you see, it’s the un-insured, those who are charged retail, that eat up the space in our emergency rooms. They’re the ones who increase everybody’s costs, and by the retail price, not the much lower volume price.  Most un-insured still get emergency care, in the most expensive way possible, but also in a punishing way, one that demands that their basic health needs be neglected until they become emergencies. One shouldn’t have to suffer a life threatening pneumonia just because of lack of money to treat a chest cold. One shouldn’t be forced to buy an ICU stay or lose a leg because of lack of money to treat diabetes or a scraped shin that becomes infected.

I know of a man who spent over 3 months in ICU, on and off life support, because he lacked the money to buy insurance to see a doctor to get a tetanus shot.

He got tetanus. Really.

We all paid his bill, through our higher prices, a bill easily hundreds of thousands of times more than the cost of a tetanus shot.  Now think about that for a second…

That’s just one reason universal health care is a more cost efficient model than what we have today.

Every business in America, and especially insurance companies, are in business not just to make a profit, but rather to make the most profits. That’s how so many were able to literally (and legally) soak Medicare all of those years, and why Medicare went along with it. We should thank them, because it’s because of that soaking that Medicare became data driven and has the control it has today.

I’m not against capitalism, but because I believe that health care should be a basic right, and not just a privilege of the wealthy, I believe that government has to not only be involved, but has to be in the driver’s seat of the financing.

The government has shown, through the VA Health system and Medicare, that they can be both smart with our money and make sure that all qualifying Americans are included. That’s not saying that they each do not have their issues, but it’s a much better system than it was when I started. Much better.

The free market has proven to be into profits, and profits alone, the rest of us be damned. Deaths from the tainted compounded drug, now up to eleven, that fungus filled injectable drug from the unregulated compounding pharmacy which chose profits over our safety… that’s as good an example as any against letting the free market run health care.

Fee for service and the free market works with cars and trucks, and restaurants maybe, but not for health care.