NATIONAL HEALTH INSURANCE A "TITANIC" PROBLEM By Jerome Bigge The Titanic left France to cross the Atlantic on April 10 of 1912... Its destination New York City, its lifeboats capable of carrying 1200 people, but it with 2200 people actually aboard.... On April 14th, just before midnight, it collided with an iceberg. The rest of course is now "history", and the basis of a number of movies, some better than others, some more accurate than others. Some data: 336 men survived the sinking, 316 women, and 57 chil- dren. 1329 men were lost, 109 women, 52 children. There were in fact 709 survivors, while 1490 either went down with the ship or were killed by the extremely cold water they were then cast into. It becomes obvious upon looking at these figures that about five hundred MORE people could have been saved given more compe- tent action by the crew of the sinking ocean liner. This implies that the lifeboats wouldn't be loaded any fuller than their rat- ing. Secondly, the "rating" given the lifeboats was "calculated" upon the basis of how heavily the lifeboats could be loaded given a rough sea, not the dead calm that the Titanic found herself in. Which brings up the question of how "many" could the lifeboats in fact could have carried away from the sinking ship given the con- ditions under which the Titanic then sank on April 15 at 2:20 am? The lifeboats were tested with workers from the shipyard, in any case it is stated that they were big husky men, most likely I would guess weighing about 180 pounds each. As the boats carried by the Titanic were supposed to be able to carry a total of 1200, we can multiply the total tested weight by 1200, giving us a fig- ure of 216,000 pounds if the lifeboats were filled to their rated capacity and no greater. So how many could have been saved then? The total number of men aboard the Titanic were 1665. Women numbered 425. Children numbered 109. If we assign an average "weight" of 160 pounds for the men, 120 for the women, and 60 for the children, we get a figure of 266,400 for the men, 51,000 for the women, and 6540 for the children, giving a total of 323,940 pounds, exceeding the tested capacity of the lifeboats by 107,940 pounds, or just about 50% "more" than their "rated" capacity. We can of course ask just "how" this rated capacity was arrived at? And how much of a "safety factor" had now been figured into this. It becomes immediately obvious here that while the lifeboats might not have been able to carry off everyone aboard, they could have been used to carry off to safety a far larger number than in fact they did. Even using the no doubt conservative figures used in determining the carrying capacity, we can see that only about half the number the boats could have carried were actually saved. The problem was most likely lack of training combined with a philosophy that "nothing can ever happen this ship can't handle". And when the disaster did so happen, thinking and everything else by everyone literally went by the board. Even the person who now most likely would have been able to determine the true capacities of the lifeboats, Mr. Andrews, apparently lost his own abilities to consider what all the "possibilities" might be for everyone... Or otherwise it is quite likely that more might have been saved. And you may ask, "what" does this have to do with America's own crisis in the provision of medical care to all its citizens? As was obvious here, the high death toll in the Titanic dis- aster was in truth now as much due to lack of knowledge upon the part of the crew as any actual shortage of room in the lifeboats. And in our considerations of how to deal with the health care is- sue here in the US, could it be that we're doing the same thing? Some Considerations Here.... First, no government is ever going to devise any plan of na- tional health insurance that in fact does not have a "budget" of some sort, or at least some "goal" as to the amount of money that will be spent. So under any system of national health insurance, Congress will be definitely without doubt establishing a budget. There will not be any "blank check". That we can be now sure of! Second, the most effective way to control costs in any sys- tem of national health insurance is to practice preventive medi- cine. It is far cheaper to vaccinate people against disease than it is to treat them in emergency rooms and or hospitals after the disease has had a chance to become established in their bodies... It therefore makes sense to keep the costs of these services just as low as possible, even giving them away for "free" if possible. Third, while single tier systems are politically popular, no doubt due to the fact that the less well off feel that at least a poor person gets the same level of care here as a rich person, it may not be the wisest way to go, in that certain forms of medical care are "experimental", and are less likely to be covered under a single payer type system. Whereas under a "two tier" system, a system where people can opt to pay for additional services, these type of services can be provided here upon a "private pay" basis. Eventually then becoming "established", included in regular care. One of the reasons here why the British and the Europeans do "better" in terms of "percentages" of GNP is due to the fact that they do encourage people to practice preventive medicine. Too, I understand that they also have more utilization of physicians as- sistants and nurse practitioners, which means that their own cost of so providing medical care is less than our own. They use what "resources" they have more efficiently than we here in the US do. This is really their "secret", the way that they control costs... More efficient use of what they have, less "overkill" as we have. For example, if you want to have a new modem installed into your computer, do you need a MSCE to do it, or just a technician? The same is true in medicine. The federal government here in the US has as a matter of fact probably inceased the cost of medicine in a number of ways, one of these being "qualification" and staffing requirements for hospitals well beyond what was really so needed. Additionally also creating a serious "shortage" here of nurses... So where is the problem? First, we have "vested interests". Those who "profit" from the existing system. Insurance companies for one, who would stand to lose a good portion of their business should national health insurance become fact instead of something to be talked about. Medical professionals who believe that their incomes will be cut once national health insurance becomes reali- ty. All the rest who are now making an excellent living from the misfortune of others.... Perhaps even trial lawyers when you get down to it. All these have "something to lose". And we can also include politicians who would see their campaign donations drop. The insurance companies being one of their major sources of $$$. Then of course it will be claimed that it will cost more to provide coverage for everyone. That we can't "afford" to do it. That our taxes are "too high" now, and adding medical coverage as a "benefit" to those now without would "bankrupt" the country.... It is of course never mentioned that all the other "First World" countries manage to do just this without bankrupting themselves. That in Great Britain they manage to "cover" everyone without in fact paying more than half the amount per capita that we pay for covering only 84% of our population. Some 9% of GNP to our 17%. The problem is in fact "political", not"medical". We could if we wished have the same national health insurance plans a num- ber of other nations have, or we could design our own unique sys- tem. We are not dealing here with "new technology", but a proven sort of information to work with. We know what "works", and what doesn't. We can also judge "costs" pretty well, drawing upon in- formation collected from those who have already established sys- tems of national health insurance. There is nothing "new" here. What is perhaps "new" to many Americans is the idea of pro- viding medical coverage to those "without". The last time we did this was when Medicare and Medicaid were introduced, and in these cases we had been sold upon the idea that it wouldn't cost much. Too, providing medical benefits to "seniors" meant that everyone else was relieved of the problem of what to do with their parents when they existed their own resources and lost all they ever had. Medicare in this context meant that your "inheritance" was safe. And Medicaid was a big help to doctors and hospitals, who previ- ously had been providing medical services upon a "charity" basis. There are really two ways of providing service to everyone. The first is a "single payer" system similar to those found there in Europe, Canada, the rest of the "First World" here. The other way is to provide money to people that can only be used for medi- cal services, but which allows them to now purchase whatever type of service they may feel will best fit their own medical needs... Medical Saving Accounts has been one such concept, although leav- ing out the poor, who don't have employer paid medical insurance. In such a case, you might have a single payer "major med" type of coverage, with ordinary routine care now covered under the MSA's. Such a program might be done as a sort of "negative income tax", as was once proposed back in the time when Nixon was President... One possible negative aspect of MSA's is that they encourage people to wait a bit before seeking medical care, avoid physicals and such when the cost of such attention comes out of their MSA's which may be designed (as some have advocated) as also being "re- tirement accounts". On the other hand running to the doctor all the time for minor ailments may be wasteful of money and of lit- tle if any actual medical value. This is of course a decision of the "sort" that a society has to make in developing any system of national health insurance that is going to now cover "everyone". Another possible "option" is a multi-tier system where peo- ple can buy into better levels of care that "cover" more advanced treatments. This of course will be objected to by some as allow- ing the poor to die or suffer from diseases the rich can be cured of. True, but we must realize that "all societies have `limita- tions'", and any society that attempts to provide top level medi- cal care to the entire population will be literally now writing a blank check to the medical industry to be filled in as it wishes. It is really doubtful that such a plan could ever pass Congress. On the other hand an "Oregon" type plan as the basic "tier" might well be just the sort of a plan that even Republicans might pass. THEN THERE IS THE LIBERTARIAN SOLUTION TO THIS PROBLEM! However there is another alternative we might want to consider. That is, taking "government" out of health care completely as I so suggested in "THE WAY". Without government enforcement of the 1938 law that so requires a doctor's prescription to purchase medication, the cost of maintaining your health would be far lower. Nor for a lot of medical problems do you really need an MD? Most likely not! So in a society without prescription laws the cost of maintaining your health would be far less than it is now! Then without laws that forbid you to purchase medicine at lower cost outside the US, the cost of the medicine you need would be a whole lot less! Then without the government setting laws, rules, and standards. it would be possible to have hospitals without the expensive technology that we have today, but completely adequate for most people's own needs. Doing all these things will reduce the cost of health care here in the United States of America to something much closer to the average cost of health care that the rest of the developed world now enjoys!