The Straw Man Argument

A "straw man" argument is when you create an opinion that is ridiculous or false, then argue against it. Think of a debate between a congressman and a scarecrow, with the congressman being allowed to tell you what the scarecrow would say if it could talk. The idea is to make one position look stronger by making it appear that the only other choice is untenable.

The straw man in the health care debate is the argument that we shouldn't meddle with the health care system because the majority of Americans already have fine health care. Why risk making things worse for 80% of the country just to try to improve things for the other 20% ( some of whom, admittedly, are choosing to spend as much on cigarettes, alcohol and street drugs each month as it would cost to get health coverage)?

Why is that a specious argument? Well, the fact is that we aren't being given the choice of keeping things just the way they are. Things are changing all by themselves, and not in a good way. Those 80% of people are in for a rude awakening if the American people, through the democratic process, don't take control of their own future.

I spoke to someone recently who works at a big health insurer. Her job is to collect deliquent accounts, the premium money from the employers who are using that company to insure their workers. She's facing a possible layoff.

Who lays off collection agents during a recession? A company that has a lot fewer accounts to collect from, that's who.

Insurers are hemorrhaging subscribers. And the people they are losing are the young healthy people who aren't making high incomes yet -- exactly the low risk people companies prefer to insure. And the more healthy people decide to "go bare," the more premiums have to rise to cover the sick people who "can't afford not to have health coverage." People who are already sick will make sacrifices to continue to pay their premiums that healthy people may not be willing to make. Costs are going up at a steeper and steeper rate. Small companies see it first, because they don't have enough workers to absorb risk if one of their employees get sick. But it's going to spread through the entire market, with entire market sectors suddenly dropping employee health coverage once one big competitor does.

Repeat: You aren't going to have the choice of keeping your current coverage if things don't change. Your insurer will eventually (say in 10 years) make the decision to drop out of the health care market and invest its money in more profitable ways. Insurers are financial institutions at their core. Losing money isn't what they do.

A lot of people assume that "big insurers" and "big pharma" are opposed to health care reform. In fact, they were right there at the table from the beginning this time around. Their futures depend on it. They need to see it happen, and they want to make sure the final product is favorable to their own interests. As we all do.

Give up the notion you can keep things as they are. Understand that if insurers are afraid of competing against a public choice, they are expecting that in the future their coverage will be less attractive than Medicaid is now. If, in the future, your health insurance plan is so bad you're wishing you had the choice of being on Medicaid, you will be very sorry your only participation in the current debate was to wave a teabag and say you're against any change.

Covering illegal immigrants

President Obama's speech to a joint session of congress last night was marred by a Republican congressman who seems to have flunked "Raising Your Hand Before Talking in Class" in kindergarten. It was unprecedented in the U.S. Congress, which generally maintains decorum better than a lot of other legislative bodies.

It was particularly unfortunate that his shouted insult was directed to the first African American president of the United States. Many people will conclude, rightly or wrongly, that he would not have behaved that way to a president of his own race. It will just create a distraction by inflaming tensions that are completely off-topic to the health care debate.

But lets look at the substance here. What will health care reform mean in terms of the care given to illegal immigrants?

Probably nothing. I mean, let's get real. Look at what happens now.

Illegal immigrants are not eligible for government health coverage, no matter how ill or how poor. The only assistance the government is offering is a trip back to their own countries to get care there.

So any care they get they must pay for themselves. Few are able to get jobs that pay health benefits. They usually work for the employers whose wages and benefits are too low to attract legal residents.

Those jobs tend to be dirty and dangerous, and they tend to involve long hours. People are going to get sick. But they don't have the time or money to go to a doctor.

So they wait. And they get sicker. And eventually, they go to an emergency room.

Now, emergency rooms by law cannot refuse to treat emergencies. It's a federal crime to turn away women in labor or people with true emergencies because they can't pay. And some bureaucrat in an office thousands of miles away gets to play Monday morning quarterback after the fact to decide what was an emergency. So ER doctors are going to err on the side of caution in treating problems that might conceivably in some rare circumstances actually be symptoms of a true emergency. And they'll tend to avoid even asking about insurance or legal status rather than give someone any reason to suspect their decisions are based on financial considerations. So even those doctors who are so jaded by people who abuse emergency rooms that they have forgotten the compassionate impulses that attracted them to the field of medicine are currently treating illegal immigrants.

They just aren't geting paid.

And that care is costly, both because an ounce of prevention costs less than a pound of cure, but also because the lack of a "medical home" -- a primary care doctor who will coordinate care -- means that a lot of tests will be duplicated each time they show up at a hospital.

What will change in the new system? Like I said, probably nothing. No one ever lost an election because he lacked compassion for undocumented immigrants. And since the government doesn't need to worry about trying to get this population cared for more cheaply when it can already get doctors to provide this care for free, why would politicians or either side of the aisle bother to try to change things?

Everybody needs to chill. There are more important details to argue over than the one everyone already agrees on.