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MARCUS: Health care bill opens doors to change

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Morton Marcus

Several readers have asked for my take on the health care bill passed by Congress. For what it’s worth:

The Patient Protection and Affordable Care Act is a major step forward. It widens the door to health insurance for those with pre-existing conditions, for employees of small businesses and others currently not covered. This was achieved in the face of great opposition from health-industry forces that stand to lose some of their economic power. In the fight to defeat PPACA, many lies were told and too often believed by decent people.

The United States will continue to rely on employer-financed policies written by private insurance companies. Small companies will be subsidized to offer their workers health insurance. To supplement these, we will expand Medicaid.

This approach maintains the existing, unsatisfactory insurance system we have had for three generations. We could have private companies that process payments to health care providers, root out fraud, and limit misuse of the system. These need not be insurance companies. Do we want insurance or do we want health care?

The trend in medicine seems to be recognition of how we induce our disorders and how we inherit tendencies for them. The insurance companies would like to match our insurance policies to our behavior as well as to our inherited characteristics. That’s why they want to know if you smoke or if your father had heart disease. Knowledge reduces their risks and protects you and me from paying the bills of high-risk people.

That’s why, when we applaud insurance for people with pre-existing conditions, we should understand that those of us without such conditions will pay higher premiums. Insurance ties us together. To some folks, insurance is a means of avoiding responsibility.

The essential questions have not been answered by the current health care legislation. Since we cannot provide unlimited services to all, we will need Sarah Palin and her “death panels.” That is, we will require explicit standards of care that reconcile the scarcity of resources with the expectations of the sick and their families.

Which is it to be? Will we have universal service available to all and paid for by all? Or will we have a health care system based on individual needs and individual savings? Is there a middle way?

The new legislation is another step toward recognizing our interrelationships.

If we focused on the individual rather than the society, your behavior and your genes would determine your premiums. You would be free of the pregnant women in your office and their innumerable sniffling offspring. No longer would you pay for the hypochondriac retiree who virtually lives in the doctor’s office.

The question is: Can we turn our backs on those in need who cannot provide for themselves? The civilized, compassionate answer is “no,” but the rhetoric of individual responsibility cries, “Yes, we can.”

PPACA also does little to curb the growth of health care costs. For too long, we have seen the health care system grow obese, fed by the virtually unrestricted flow of funds from the public and private sectors. We now have hospitals that are indistinguishable from resort hotels; we see medical offices and professional incomes beyond the dreams of modestly avaricious attorneys. The insurance companies have been conduits for these funds, absorbing their share for their self-glorification.

Little in PPACA increases consumer choice. The insurance oligopolies will persist. The hospital empires will expand. The medical profession will continue to block recognition for lesser mortals who are competent to provide selected medical services. Nor will medical schools restrict the numbers who would be highly paid specialists while the need for general practitioners goes unanswered.•

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Marcus taught economics for more than 30 years at Indiana University and is the former director of IU’s Business Research Center. His column appears weekly. He can be reached at mmarcus@ibj.com.

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  1. I had read earlier this spring that Noodles & Co was going to open in the Fishers Marketplace (which is SR 37 and 131st St, not 141st St, just FYI). Any word on that? Also, do you happen to know what is being built in Carmel at Pennsylvania and Old Meridian? May just be an office building but I'm not sure.

  2. I'm sorry, but you are flat out wrong. There are few tracks in the world with the history of IMS and probably NO OTHER as widely known and recognized. I don't care what you think about the stat of Indy Car racing, these are pretty hard things to dispute.

  3. Also wondering if there is an update on the Brockway Pub-Danny Boy restaurant/taproom that was planned for the village as well?

  4. Why does the majority get to trample on the rights of the minority? You do realize that banning gay marriage does not rid the world of gay people, right? They are still going to be around and they are still going to continue to exist. The best way to get it all out of the spotlight? LEGALIZE IT! If gay marriage is legal, they will get to stop trying to push for it and you will get to stop seeing it all over the news. Why do Christians get to decide what is moral?? Why do you get to push your religion on others? How would legalizing gay marriage expose their lifestyle to your children? By the way, their lifestyle is going to continue whether gay marriage is legalized or not. It's been legal in Canada for quite a while now and they seem to be doing just fine. What about actual rules handed down by God? What about not working on Sundays? What about obeying your parents? What about adultery? These are in the 10 Commandments, the most important of God's rules. Yet they are all perfectly legal. What about divorce? Only God is allowed to dissolve a marriage so why don't you work hard to get divorce banned? Why do you get to pick and choose the parts of the Bible you care about?

  5. Look at the bright side. With the new Lowe's call center, that means 1000 jobs at $10 bucks an hour. IMS has to be drooling over all that disposable income. If those employees can save all their extra money after bills, in five years they can go to the race LIVE. Can you say attendance boost?

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