On one side of the argument are those who understand that the US provides the highest level of healthcare in the world but accept there are issues that need to be addressed.
On the other are those who think that the moral high ground is achieved through a government provided scheme, which requires tearing down the existing structure and starting again.
Organisations such as the United Nations and The Economist don't help the argument by coming up with world rankings on healthcare that show the US a long way down the list.
How can this be when it's the US that all world leaders choose to fly to when they're ill? The country that has John Hopkins, Mayo Clinic etc etc?
The answer is that these rankings heavily weight whether the healthcare is 'free', insofar as anything is when provided by the government. When health outcomes are analysed, how long people live when diagnosed with cancer, diabetes, heart disease etc the US far exceeds the rest of the world.
Time and again we are asked by proponents of Obamacare, and its predecessors, whether it is fair that only the wealthy can afford the best healthcare.
For some reason, the questioners fail to appreciate the truism that wealth means health. One only needs to compare the outcomes in Africa to any halfway advanced country to find the proof.
Here's another question. Is it fair that only the wealthy can buy $100,000 Mercedes?
If the government provided cars to everyone then do you think everyone would get a Mercedes or, perhaps, something of much, much lower quality?
If there were no wealthy people then there would be no $100,000 Mercedes.
Equally, no wealthy people means no high cost medical procedures.
The fact is that the advancement in the quality of healthcare that has come about due to the remarkable achievements of the pharmaceutical companies in the US - which are responsible for two-thirds of the world's medicines - can only occur because of the free market system that allows them to spend billions of dollars developing a single drug and getting it to market. Even the large European drug companies can only develop the solutions they do because of the sales they achieve in the US.
Make no mistake about it. Without US drug companies the world will have lower quality medical solutions going foward.
Comparisons with the rest of the world fail to take into account that the rest of the world is sponging off the US health dollar by being able to buy treatments that it couldn't afford to produce itself.
Do proponents of the government plan think that these drugs will still be developed when it's the government deciding how much will be spent?
Rationing lowers quality. It increases the length of time to receive treatment including for serious conditions.
Is it fair that people die who otherwise wouldn't simply because they can afford better healthcare but can't get access to it?
If the public option was so great then Congress wouldn't exempt itself from it.
Public kills Private
Most non-Americans don't understand how the US health insurance system works.
Here in Australia we take out insurance with our preferred insurer and to the level we desire/can afford, pay the premiums for the rest of our lives and receive an OK level of service. With our low population and large area it's not possible to make a proper comparison with other countries, as we have issue unique to Australia, as do all countries.
Most insurance in the US is provided by a person's employer. You can look up the history of how that came about but it dates back to World War II and companies' attempts to attract workers in a low unemployment environment in which salaries were fixed by the government due to the war effort.
A major issue in the US is that when someone leaves a job then they have no health insurance until they start their new job. These people who are between jobs need to take out temporary insurance until they start their new job. Bizarrely, the ten or so million of them are included in the statistics that add up to the "47 million Americans without healthcare", as do more than that many illegals. The question asked in the health insurance survey is 'Have you at any time through the year been without health insurance?' Obviously, if you've left your job and haven't taken out temporary cover, or can't afford to, then the answer is yes in spite of the fact that it might only be for a week or two.
After taking into account the fact that young people choose not to take out health insurance when they can afford to - preferring to spend their money on clothes, a car or a now upside down home mortgage - there are only 15 or so million who are in genuine need.
Better tear down the system to address the 5% of the population with a problem, then.
So how does the public option kill private health insurance?
Let's leave aside the fact that Congress has a bottomless pit of money to play with and is not going to be inclined to see it fail thus guaranteeing even further increases in spending into the future.
Consider two companies:
Acme Corporation has 1000 employees involved in the production of a very popular widget. It's a publicly listed company that turns over $150 million and makes an after tax profit of $3 million.
Acme's major competitor is Blue Sky Enterprises that, coincidentally, has 1000 employees, makes a competing product to the Acme widget, turns over $150 million and produces a profit of $3 million.
Both companies provide the same health insurance cover to their employees, sourced from the same insurance company. The insurance costs them $5,000 per person.
Now, let's say that Obamacare enters the market offering $3,000 health cover. It's not quite the same level as the $5,000 cover but people think it'll generally be OK unless you get really sick.
The management team at Acme decide to shift all of their employees from the private option to the public option. Blue Sky chooses not to.
So what happens?
After one year with this new health insurance in place, Acme has turned over the same $150 million but due to lower insurance cost has increased its profit to $5 million from $3 million (1000 employees x $2000 saving = $2 million).
Meanwhile, Blue Sky has also had a solid year, posting $150 million in sales and at the expected profit of $3 million.
See the problem?
If you're an investor then which company are you going to invest in?
Obviously, Acme Corporation.
Therefore, Blue Sky Enterprises is forced to take up the public option, as well. Otherwise its competitor gains a huge advantage.
While this is all happening, private insurance companies are having to raise costs to maintain the same health cover level or reduce the level of cover to compete with the government option.
Thus, private health insurance slowly withers on the vine as more and more companies are forced into the government plan.
Not anybody who gets sick, that's for sure.
Medicare and Medicaid
No pro-Obamacare proponent has yet explained how the public option will not end up the financial black hole that is Medicare and Medicaid.
The following graph highlights the coming crisis, and when I use the term crisis I use it accurately:
Simple improvements are there for the taking
All Congress needs to do to make a huge improvement is the following:
- Allow healthcare to be portable between health companies and across state lines. This also deals with the situation in which people develop a condition that would inhibit their ability to obtain health insurance if they changed jobs.
- Implement tort reform. This is the biggest single cost in the medical system. Loser pays will stop people bringing frivilous lawsuits. Trial lawyers are the Democrat Party's second largest donor behind labour unions so don't look for this any time soon.
From President Obama the other day:
"We've got some work to do. I don't mind, by the way, being responsible. I expect to be held responsible for these issues because I'm the president," Obama said. "But I don't want the folks that created the mess -- I don't want the folks who created the mess to do a lot of talking. I want them just to get out of the way so we can clean up the mess.I wonder whether the President also includes the architects of the current financial crisis - Barney Frank, Chris Dodd, Alan Greenspan, Larry Summer and Ben Bernanke - in the list of those who should shut up and get out of the way?
"I don't mind cleaning up after them, but don't do a lot of talking," Obama said.