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Health care debate not really about costs

The U.S. debate is not about costs. It's about who bears those costs. It's about what we mean by costs.
Written by Dana Blankenhorn, Inactive

NFIB logoSome national health debates are about costs.

The debate now beginning in Australia, a plan to push more primary care to nurses and others, is about costs.

The U.S. debate is not about costs. It's about who bears those costs. It's about what we mean by costs.

This is very clear in listening to the rhetoric at the NFIB meeting in Washington, which takes this phoniness to a whole new level.

"What’s bugging small business owners?" writes MSNBC small business reporter Eve Tahmincioglu. "Costs, costs, costs, especially health care costs."

Nonsense. Most small businesses left the health insurance system long ago. Tahmincioglu's conflation of "small business" and "entrepreneur" shows her confusion on this point.

Very few small businesses are truly entrepreneurial, they just pretend to be for political reasons. Growing businesses can bear rising costs. Small shops can't.

This conflation has been used by the NFIB for years to campaign against health care planning. They have not served their members well by this.

When small businessmen say they can't afford health coverage now, they mean they can't afford it for themselves, not just their workers. And they are paying for this lack of coverage, sometimes, with their lives.

The real question, as The Politico makes clear while watching the group's ideologues craft its "health care survey" so as to come up with the answers they want, is who bears those costs and what we mean by costs.

It's the ever-shrinking number of people who participate in the health insurance system who pay, the 250 million who subsidize the 50 million who "can't afford it," which now includes many small business owners.

The hard question, one every other civilized nation has begun to struggle with, is separating those costs we consider basic, which everyone must bear, and those which are truly optional, where insurance or business perks may safely play.

Trying to shift these costs onto those willing to pay has only raised the nation's total bill, as those without coverage wait until it's too late for prevention, and often too late for a cure.

Those without coverage, and again these include many small business owners, often pay for that lack of coverage with their lives. Our outcomes are on par with those of Cuba as a result.

It's time to stop fooling ourselves. Can Elizabeth Edwards bring an answer? I don't know. But until we get past the phony rhetoric about "costs," and get to the real questions of who pays, what's basic and what's not, the debate is going nowhere.

You can't get answers until you ask the right questions.

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