Sep 14, 2009 | It’s not (only) the insurance, dummy!

It has been increasingly clear that the debate over healthcare and insurance is sorely misguided. Allow me to explain…

The general idea of the current healthcare overhaul is to address the high premiums of current healthcare insurers, with provisions to fix such ludicrousness as pre-existing conditions that allow them to prevent providing new or alternative insurance for those with an illness. The idea of universal health care has been diluted to a public option, but at least it’s a good that there are more options to choose from, and a good safety net for the many millions that fall between the cracks in the disastrous affair that is medical care in the United States. More options is good.

But it’s a band-aid solution.

Analyzing the costs for insurance forces us to examine why they are high in the first place. No doubt some doctors charge high premiums for their services, but I’ve heard from far too many doctors that they don’t get paid enough. What is the baseline for “enough”? To be able to live in a mansion, own a boat and live luxuriously? Largess is acceptable to a certain degree, and it would be unfair for me to dictate what is excessive and what isn’t. But a good bottom line for “enough” is being able to live without the burden of debt incurred by another problem of American society: education.

It’s no coincidence that the jobs with the highest earnings combine both longer investment in education as well as higher costs. It’s an economic and social sieve - those who can afford both the time and money in their education are given the opportunities to live well. At the same time, in restricting those who can afford to do both, those who choose to educate (rather than practice) are a relative minority, and they can increase tuition at will.

Those who can’t, well, they’re stuck. Those who decide to become doctors incur, on average, $154,607 in medical school debt, according to the AMA. The British Medical Association estimates that costs will increase to a staggering £46,000, or $76,000. Medical school in France is fiercely competitive, but it has the notable distinction of being free (or at least very close to it). However misleading the ranking may be, WHO’s health system table makes the contrast (and the rather obvious conclusion I am working towards) very clear:

High educational costs drive high medical school debt which forces, or at least encourages, doctors to charge higher premiums for their services.

Insurance companies act as a buffer but are clearly not the original source of the problem, though they certainly aggravate it. Approaching the same issue from the opposite end, the other ill in American healthcare is prevailing attitude about maintaining a healthy lifestyle- it seems to be improving, at least. Not surprisingly, proper education is the remedy for it.

So the issue isn’t about whether or not there will be death panels, or whether illegal immigrants receive care, or how many people we can cover under the banner of coverage. The question isn’t even about whether or not health care is a fundamental right. We ought to instead re-evaluate whether or not accessible education is a fundamental right.

Image courtesy of the New Yorker.

Also written on this day..

• 2010: Travelling across the country