I was engaged in a conversation regarding the future of health care in America when a third person (W) gave her opinion that she was happy with ObamaCare since her son could now get insurance. In New York State the cooperatives will not begin until Oct 1, 2013 for those without any other options. However, her son does not live in New York, where the state has provided Healthy New York insurance to those who qualify. We then had a conversation which I will relate. It demonstrates the severe problem facing our country resulting from the poor educational system we have underwritten for generations:

I: Why do you like the federal system Obama helped create?

W: My brother could not believe that I voted for Obama. He is a conservative Republican living in California. I am a registered Republican but we needed to do something for those without insurance. After all, Obama cares. What do you expect, I am a social worker and I care and must be liberal.

I: Do you mean that the Republicans don't care?

W: Well I don't know. They supported those greedy people in the health industry.

I: do you think it is greedy to ask for a raise?

W: What?

I: Did you ever get a raise at work?

W: I am not working anymore, since the summer.

I: Do you think it is fair to get a raise?

W: Yes, I deserved a raise when I worked. I was not greedy.

I: Do you think that the hospitals, doctors, nurses and other personnel working in health care are greedy if they get a raise? Do I deserve a raise?

W: Yes, I would say so. But the insurance companies are greedy.

I: When you get a raise, who pays for it?

W: What? I don't know. My boss, I guess.

I: Who is that?

W: My boss.

I: Who did you work for?

W: I worked for the County at the nursing home and before that for a private nursing home.

I: Who do you think paid for your raise?

W: The County.

I: Where do you think they get the money for your raise?

W: I don't know.

I: The taxpayers. That's why the taxes on your home increase. It is why older retired people on fixed incomes can't afford their house and lose it.

W: Oh. But the insurance companies are greedy.

I: Do you think that your insurance is good?

W: I have private insurance and Medicare. I like it but it cost too much and keeps going up.

I: Why do you think that is?

W: Greed on the part of the insurance industry.

I: I know that some people are greedy and make too much, but do you think you should use your insurance when you need it?

W: Yes, that is why I pay for it.

I: Do you think you should be limited from using it too much?

W: No, because it is for those who need it.

I: When you use the insurance more, that increases the utilization rates and increases the cost. The insurance company raises the premium to cover the cost and make a profit. The executives may be paid too much, but then the workers answering the phones are often paid too little. Who should give up their salary? Better, yet, should we bankrupt the insurance company because they charge us more than we want to pay?

W: No, I like my insurance. But the Medicare goes up too much. The Republicans want to cut Medicare.

I: ObamaCare has cuts to Medicare. The cost of health care in America is subsidized by the private insurance and private pay patients since Medicaid and Medicare do not pay the full cost of our system. In addition, many uninsured patients receive care without any payment.

W: Really. You can't get care without insurance.

I: In America you cannot be denied necessary care if you go to an emergency room at the hospital. Accreditation requires that these people get care. The ERs are loaded with people without coverage.

W: Really. I did not know.

I: When you use the medical insurance more, then the cost increases and that means higher premiums. When you do not pay the cost up front, then the utilization rates increase faster, speeding up the insurance premium increases. Insurance companies may not be great, but they pass on the higher costs that we helped create. Add to that the cost of modern high tech medicine and the premiums get higher. Do you want newer technologies?

W: Yes.

I: I guess then you must pay for it. Otherwise, you will have to deny care to people because they are too old or too sick to get better. Obama Care was designed to get us to a single payer system within 10-20 years by destroying the private insurance system which helps pay for Medicare and Medicaid. Eventually we will have a form of Medicaid for everyone.

W: I won't have Medicaid, I have Medicare.

I: Medicare runs a deficit every year, so at some point we won't be able to afford it. When the private insurance system declines, the cost of Medicaid and Medicare will be unaffordable and will not be able to sustain the present health care system. Then your care must be impacted. The government will eventually only be able to afford a form of Medicaid as the costs escalate. Otherwise, they will have to limit Medicare severely. Either way, we will get less care for more money. You will have to wait longer in the waiting room as more people seek care. It takes 10 -15 years to train a physician. We will see more nurses or nurse-practitioners as they cost less to train and are reimbursed at lower rates by insurance companies.

W: Oh.

I: But then I apologize for lecturing to you.

It takes four years of college to train a social worker. A Master's Degree requires another two years. Clearly, most social workers are liberal and have no clue how our health care system is financed. The same can be said of many of our political leaders. They view business people as greedy and uninterested in the public. Of course tax increases are not seen as hurtful to the public by the political left. This is not a rare viewpoint. Equal care may be terrible, but it is fair.

Our high schools have fostered the view that the business sector has little value. They teach that the "robber barons" were finally countered by the brave union workers. It is little wonder that this conversation occurred and that Obama was re-elected. It is time to change our education system and teach honest social studies to young minds. By the time they get to college, it is hopeless. A recently retired and now happy dentist told me that we are part of a noble profession. I wonder whether I will be able to say the same when I retire?