Millions of Americans fear health care reform would lead to "nationalization" (or "Government takeover" or "socialized care") of health care in America.
I've read or heard "nationalize" used this way dozens of times now in the last month -- enough to know that it is a widespread idea. Just lately, this same idea is being expressed often with additional phrases that have the same meaning.
A significant part of the opposition to health care reform -- the major part -- springs from fear of a Government takeover of health care, which would seemingly lead to rationing of health care and all the other familiar ills of a big, impersonal Governmental bureaucracy.
Arbitrary power. The idea of "pulling the plug" on Grandma is only a representation of this more general fear of impersonal, arbitrary power.
"Nationalize" has a meaning which is clear to most people -- a government takeover -- government owns and thus fully controls the business or industry, such as a nationalized railroad or even an entire nationalized sector of the economy.
So a nationalized Health Care System in the true, genuine meaning of the word would be when most hospitals were taken over and owned by the government, along with most clinics, so that many or most doctors would work for the government directly or through a thinly separated veil. Most health care workers would be government employees -- their paychecks would be directly from the government.
This would be nationalization, in the true sense of the word.
Now, in contrast, the proposed House bill HR 3200 leaves private, free-market hospitals private and free-market.
Private or self-employed doctors remain privately- or self-employed under HR 3200.
Instead of nationalization, the private health insurers and a public health insurer would compete to gain policy-holders and would pay doctors and hospitals according to negotiated pay scales, just as now. Some low-income individuals and families would receive help paying their premiums, regardless of whether they choose a private or public insurer.
Did you get that last part? Those choosing private insurers would get the same subsidy those choosing the public insurer get.
Level playing field. From the beginning.
The conservative Heritage Foundation points out "Individuals will not be permitted to use their subsidies to purchase coverage that does not meet the definition of 'essential health benefits.'"
But...who would want to purchase insurance without essential benefits??
People purchase such policies only because they are fooled by the insurers.
There is indeed private insurance available right now without essential benefits -- that is why medical bills piling up on people who actually had/have insurance is the leading cause of bankruptcy!
Those bankrupt families and individuals had insurance without essential benefits.
So those on the other side of the debate, who do not worry about "nationalization" can reasonably ask:
Where's the Beef?
Where is the nationalization??
It is then tempting to conclude that this fear is simply the result of intentional fear-mongering.
I concluded this myself after hearing of Palin's "Death Panel" idea.
That was indeed a lie.
There never was anything remotely similar to death panels, or panels to choose who gets what care, in the legislation. There is a public panel to help form the standards of minimum acceptable benefits insurers can offer -- the opposite of a death panel. This is more a life panel, which helps prevent insurers from tricking policy holders with loopholes. Of course this isn't the panel Palin meant.
There is a panel to oversee comparative effectiveness research -- research to find out what treatments work the best. Again, more of a life panel, since finding out what works best will improve all of our odds of getting the best possible treatment. Of course, this isn't the panel Palin meant. I'm not sure if I can find the panel Palin meant.
Instead, the last panel of note is the patient-friendly panel the administration has proposed, IMAC, a panel of experts (including doctors) given the task to think up ways to improve among other things Medicare quality, access to care, and reimbursement rates and to consider broader reform ideas such as increasing effectiveness. IMAC is to make proposals, which the President and Congress can reject or accept each year.
IMAC should help to improve Medicare effectiveness. Effectiveness, for instance, would mean at times paying $200 to repair something now so that it won't break down in a year or so and cost $2000 instead.
"Effectiveness" does not mean refusing to pay $2000 when necessary.
It means smart choices such as planning ahead and choosing better treatments, often reducing costs while maintaining or increasing quality.
The effect would be to improve health by encouraging more effective treatments (such as by higher payments). Savings result since more effective treatments save time and expense, and reduce patients' suffering.
That would be like quality auto-repair.
In other words...just ordinary common sense.
There're the panels.
Where's the beef?
So the "Where's the nationalization?" question is quite reasonable.
But...there is an indirect way in which one can fear that there would be a sort-of "nationalization" of health care, in a sense, in a way that is somewhat related to the word nationalization.
The entire issue boils down to this single question -- and only this one single question -- whether the government would take over all health care reimbursement over time and then decide what is paid for in a top-down way, so that most doctors and hospitals would then only be able to do what government would decide to pay them to do.
In a word, control.
Notice the crucial distinction here. This isn't even about whether there will be a Single Payer system. No, it's more exact.
It's about whether the decisions will end up, in the long run, being made in a top-down way.
Single Payer, or the very different Public Option (which is a competing public health insurer), either one, could be top-down, or not, depending on how it is set-up.
A strong, popular public insurance provider itself could try to operate in a top-down manner, but if it did...many people would choose to go elsewhere for their insurance!
Indeed, there is a severe problem right now with private insurers making top-down decisions!
That's why people are so sensitive about it!
So there is only one real issue here in relation to a Public Option or HR 3200.
Will doctors and patients have most of the control in deciding what care/treatments to have?
That's it, nothing else.
That's the fear that dwarfs the others, in real opposition and fear of heath care reform.
Cost is also a central issue -- one this blog has focused on in multiple posts (see Reader Favorites in the right-hand column) -- but the fear and larger anger is about losing control and such possible imagined outcomes as severe rationing.
That issue of choice (control) is one this blog has addressed and 100% satisfied in a major post on how to structure reimbursement for health care.
Here's how to correctly set up reimbursement to doctors and hospitals (click here).
Let me suggest to President Obama that he needs to be still more plain-spoken. For now, he needs to leave behind lengthy, technical paragraphs.
In a short, brief statement, Obama needs to communicate on this real issue.
Without any other competing issue or information or topics during the statement.
This one question by itself.
I recommend 150 words or less.
Here's a suggestion:
Some political figures and commentators have made-up some distortions and outright fabrications in the last couple of months to try to torpedo our much needed health care reform. One of these fabrications is using the word "nationalization" to refer to health care reform when in fact hospitals and doctors would remain completely in the private free market just as they are right now.
I am proposing to Congress today that we clarify our reform legislation to explicitly leave all the choice and control of health care in the hands of doctors and patients, and that we do this by changing payment to be primarily for the outcomes of treatments. We will begin to pay for outcomes over time, instead of just for the sheer number of tests and procedures regardless of effect. It won't be the number of tests you order, it will be the number of patients you help that determines your pay. In this way the actual choice of what treatment is used by a doctor or hospital will be entirely up to that doctor or hospital and the patient, and never up to any government bureaucrat. Paying for care in this way will increase innovation and unleash the real power of the free market to improve our health care.