Just before the holidays, I had my annual dinner with longtime friends -- all political liberals.
My friends' son, now in college, asked me a health care question as I munched on a delicious dish of short ribs. "If you're against government health care insurance, what should poor people do? What, just screw 'em?"
Having known him since birth, I was taken aback by not just the question. I knew that, like Custer, I sat surrounded by liberals. But the harshness of the question surprised me.
Because Republicans, like me, reject the John Kerry-esque argument that "health care is a right not a privilege," liberals believe we see a bipolar world -- those with the money have health care, and to hell with those who don't.
So I said, "This is a somewhat complicated question, but the short answer is free enterprise."
"The reason health care isn't accessible to so many people is because of government interference. For example, a medic in Iraq who attends to fallen soldiers -- but is not an M.D. -- could not return stateside and open a practice. My aunt worked for over 30 years in a maternity ward. She told me that many times the new interns would say, 'Nurse Maggie, what drug should I use, and what kind of dosage?' Yet laws would prevent my aunt from opening up a pharmacy."
"Do you think something like this will happen?"
"It already is," I replied. "Several pharmacies like Walgreens now open up many clinics and provide cheap health care for low-income people."
At this point, his father jumped in and said, "Really? I never heard of that."
"You never heard," I said, "that drug stores like Walgreens now have in-house, walk-in medical clinics so that people can get care for medical problems, the kind of treatment that most people need -- noncomplicated, nonsurgical procedures?"
"No, I never heard of that."
And so it went. But for the record, big drug store chains like CVS, Rite Aid and Walgreens, along with the largest U.S. retailer, Wal-Mart, are expanding walk-in clinics in their stores. Hundreds will be opened this year, and thousands over the next decade. Staffed by nurse practitioners who can examine patients, administer vaccines, and prescribe medications for minor illnesses, these clinics charge much less than a traditional doctor's office visit. Besides increasing access to health care and reducing costs, such clinics reduce the burden on overflowing, ridiculously expensive, we-have-to-treat-you-even-if-you-can't-pay hospital emergency rooms. Available, convenient, affordable walk-in care also catches some illnesses before they become serious and costly. And doctors will have more time available for complex cases.
Despite a growing and aging population, no new for-profit medical school has been constructed in the United States since the early 1900s. In 1980, the Department of Health and Human Services survey predicted a huge surplus of doctors by 2000. State governments stopped building new medical schools, and almost all 126 medical colleges cut back enrollment, and medical graduates declined. The American Medical Association just reported an increase in first-year medical school enrollees for 2006 -- the first increase in decades . The U.S. still has only 126 M.D.-granting medical schools, but some experts predict we need at least 90 more to meet the doctor shortage predicted for 2020.
How many people also don't know that laws prohibit interstate health insurance sales, preventing people in state A from getting medical insurance from a company in state B? According to The Wall Street Journal in 2005, "eHealthInsurance compared the cost of a standard family insurance policy ($2,000 deductible with a 20 percent co-insurance) across that nation. (A) non-employer-based family policy for four in Kansas City, Missouri, costs about $170 per month, while similar coverage in Boston tops more than $750 a month." Why? Most states mandate the type of services that must be covered -- podiatrists, acupuncturists, massage therapists, etc. -- whether the patient wants it included or not.
Some states force insurers to sell to all applicants at the same price, regardless of their age or health. The result? "Faced with higher premiums for insurance they seldom use, the young and healthy drop their coverage, leaving an insurance pool of older, sicker people -- and even higher premiums. After a decade of such political meddling, the average monthly cost of a family policy in New Jersey bests the monthly lease of a Ferrari."
"Finally," I said to my friends' son, "people with little money still manage to afford cars. And people with little money can, if government set the market free, afford health care coverage. It won't be the type a resident in Beverly Hills gets, but there would be some bare-bones type of coverage if only government got out of the way.
"Now," I said, "can I have another glass of orange juice?"