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A short while ago, some folks tried to fund emergency rooms and hospitals with a new surcharge on phone bills. It turned out the electorate didn’t hate phone companies and those who used phones enough to vote the proposition in. So, this time we’re coming at it with more easily vilified targets (at least in California): tobacco smokers, growers, and vendors.

We hate smokers here in California. When I think about it, I’m surprised the folks behind prop 83 didn’t throw smoking on to the list of eligible crimes to improve their chances. How can you possibly vote against a measure that goes after smokers?

Well, first of all, let’s keep in mind here that smokers are really involved in the funding side of this equation. They are going to hit a massive tax increase per packet of cigarettes to help us fund emergency rooms and all other kinds of medical expenditures.

The real aspect of this bill is how it effects hospitals. One of the insane aspects of our private health care system in the US is that we still require hospitals to provide life saving health care to the uninsured. If they can’t pay, that’s the hospital’s problem. The logic is about as faulty as popular logic on tax policy that suggests one is cutting taxes if one reduces the tax rate, even if one doesn’t reduce spending. It’s silly, the bottom line is as long as you are okaying the spending (by requiring health care for the uninsured), you are okaying the bill as well. Sooner or later that money has to come from somewhere, or all your hospitals are going to declare bankruptcy.

Of course, by going the “save them and then try to make them pay even though they probably can’t” is horribly inefficient. You end up with people not getting cost saving preventative treatment but rather very expensive last-minute interventions. This leads to expensive bill collection expendatures for the hospital, and quite possibly bankruptcy for the patient. The bankruptcy process is just a more expensive way for the hospital not to get paid, and in order to make a profit that bill gets passed on to the rest of us in increased medical costs which finally present as… increased health care premiums.

So, we’re all paying for socialized medicine right now, but because we can’t just acknowledge it and build a system around it, it ends up being far more expensive for everyone. It’s kind of like the bond measures vs. tax increase situation that I’ve talked about on previous propositions. Proposition 86 attempts to buffer this insanity a bit by providing some funding from tobacco taxes.

My problem with this is that the measure doesn’t really address the fundamental problem, it just shakes down smokers to provide a small short term band aid on massive open wound. What I’d really like to see is a straight up or down vote on either going with socialized medicine or allowing hospitals to refuse patients they feel can’t pay for their services.

One other aspect of this bill that opponents have gone after is that it provides exceptions to anti-trust laws for hospitals trying to coordinate a emergency care (“how about you cover all cardio work on wednesdays when I give my specialist the day off?”). This just seems like another area where the existing system makes it far too difficult to provide medical services efficiently.

Okay, so my Canadian is showing a bit.

I’ve not really made up my mind on this one, but I’m leaning against it. It just seems like a bunch of half-measures that don’t come close to adequately solving the problem. The problem I have in voting it down is that our current situation seems so bad, even a half-measure seems better than nothing.