Let’s do what not all of the Town Hall meetings are not accomplishing. Let’s discuss with civility Obamacare, by which I mean President Obama’s very serious proposals for health care reform, and let’s discuss today this question:

What are the problems Obamacare is addressing? How serious are they? How big are they?

After the jump I list what I see as the major problems. What problems do you see? We should at least be able to discern what the concrete problems really are and what problem it is that we are trying to solve.

Another way of asking the set of questions is this: Who has the most to gain if things stay the same? Who has the most to lose? I suggest answers to those questions will leads us to wisdom.

My own conclusion is this: the current arrangement — private insurance, business-sponsored insurance, Medicare and Medicaid — is less than universal and unsustainable or affordable. Something must be done. I don’t buy the rhetoric that our taxes will not be raised. To fix the problem will mean it will cost each of us, of that I am convinced. Let us not look simply to ourselves, let us  look to what is good, what is loving, and what is fair — for one and all. It is a Christian and humane duty to aid the poor. But let us do it the best way that preserves the dignity of all, our freedoms, the rights of all, and do so in a solid economic arrangement.

Here’s my other conclusion: I am convinced that neither the President nor the Congress really know enough about these proposals or the realities of what everything will actually look like to move ahead at the present time. Let’s listen to the facts and let’s listen to the people, and let the people decide. What happened with the stimulus package, which in the minds of many hasn’t proven effective and cost the public money beyond counting, looms large in the minds of many as they listen to the proposals for health care/insurance reform.

Now the problems:

1. 40+ million who do not have health insurance and, therefore, lack
ready access to health care. Nearly 15 million of that number are recent graduates of high school, young adults who aren’t covered by their parents, and recent college graduates. Some of these choose not to be insured; I’m guessing most have chosen to be uninsured. That’s sad.

(There is a difference between health
insurance and heath care — providing insurance might not reign in the
spiraling costs involved in health care. Health care reform, as I
understand it, involves making medical care affordable and sustainable while driving down the expenses and profits of some. Just this weekend it has become clear that a public health insurance option may not be what will be proposed; it may be a nonprofit health insurance co-op.)

I wonder if many Americans actually believe there is a problem here. I worry that far too many think either “I have no problem so there is no problem” or “Democrats think there is a problem so there is no problem” while others think “if Democrats think there is a problem then there is a problem” or that “Since I have a problem there is a national problem.” What do you think?

Which raises this question: Do you think everyone inside the borders of this country, even an illegal immigrant or a foreign visitor, is entitled to ready and good health care? Which raises this one and its chaser: If so, can this be accomplished without a nationalized health care plan? (If so, how?)

One more: if you are on either Medicaid or Medicare, are you satisfied?

2.
Insurance companies who gouge the insured with high prices in order to
make a profit and cover the insured, and hospitals who charge the insured more so they
can cover the uninsured in the emergency rooms. The insurance prices and the need for hospitals to cover the uninsured are at the core of the issue. By the way, our
emergency rooms, which serve as health care for many uinsured, now make
health care almost universal/national — if unsustainable because hospitals can’t keep this up etc. And drug companies are charging too much, passing along expenses to insurance companies and premiums and individuals.

3. Businesses having premiums raised because of insurance companies gouging the insured. Small business owners whose premiums invade too many of their profits. [I don’t like the proposal to charge small businesses if they don’t pay for insurance for their employees. We have to encourage small business formation.]

4.
Lack of information on the real costs of medical expenses. I recently
heard someone say that a knee replacement unit can cost a patient $5000
but that an older, but completely workable unit, can actually be purchased for $200. (The surgeon often uses the
newest and most expensive device; patients are not involved in the choice here; this is a significant issue from what I know.)

Why are premiums and medical costs so high? Why have premiums and costs risen so much in the last 20 years or so? Where’s that money going?

5. Medical lawsuit judgments that are too
high, leading to higher medical charges by physicians, leading to the
uninsured who choose not to pursue medical care because the prices are
too high. Tort reform is a problem.

6. Moral issues like abortion and euthanasia, etc: Do you think these should be covered by health insurance? Do you think they should be clearly not covered?

7. A massive lack of clarity at the level of details so
that citizens can understand the real proposals of Obamacare. These
things are being worked out, I understand, but goodness knows most of
us are confused — even when we are looking for actual details. Why the rush to install a program before the program is clear and workable and has been publicly debated for some months or so? I don’t want to vote for an idea — or have Congress vote for an idea.

Will the provision of Obama’s health care reforms increase competition with insurance companies and physicians, leading to the lowering of medical care costs, or will the provision of Obamacare drive up our taxes and, in effect, raise medical care costs? Will they destroy the profitability of insurance companies because of their lack of ability to compete with the non-profit government health care option?

Some pragmatics:

8. Self-aggrandizing insurance companies and businesses who are lobbying in order to scare the public into not supporting Obamacare.
9. Politicians who don’t understand Obamacare well enough to address an audience and field questions about concrete realities.
10. Citizens who don’t act with civility when Obamacare discussions are held in Town Hall meetings.
11. Citizens and others who have now turned to exaggerated, apocalyptic rhetoric in order fan the flame of political debate