Tuesday, March 17, 2009

Health Care

If you're interested in health care, listen to this really great podcast on Fresh Air. Its in two segments, the first, a New York Times reporter talks about how her brother who suffered from kidney failure was denied coverage by the insurance company he'd been paying insurance premiums on. The second segment is an interview with a health care economist who discusses what's potentially ahead for our health care system.

What about our current system is deplorable:

1) Different patience get charged different rates based on the negotiating positions they happen to be in. Medicare and Medicaid insurance claims actually pay less then the cost to service the patience under those systems. Those under the single payer system pays a lot more....

2) Having your insurance tied with your employment is a horrible system. You lose your job, you lose your insurance and if your forced to go uninsured for some period of time and want to buy back into the system, you are at risk if you have pre-existing conditions. This sort of insurance is a complete accident, by the way, the came to us in WWII. During the war, government limited how much companies could pay employees in wages, the goal was to suppress wages during a severe labor shortage, when demand for goods were high and many of our workers were fighting and dying in Europe and Asia. To entice workers, employers started to offer health insurance, and that is the system we've lived with all of these years.

3) Insurance companies are in the business not to pay for claims, forcing doctors and hospitals to constantly haggle over payouts. As a result, the US pays by far the most for health care costs of any country in the world, but we are at the bottom in general satisfaction of our health care, and we are not near the top in the results we get out of the system (e.g. life expectancy, etc.)

4) If you are uninsured or under-insured, and you get sick with say diabetes, we do a terrible job in making sure you can pay for preventive care. But if the disease progresses far enough, when the treatment becomes really expensive, government will step in and finally pay for care...

Solutions - Obama has some nice solutions

1) He's going to extend government backed insurance plans (like Medicare and Medicaid) to a broader population - so that health insurance is more broad based, affordable and available to everyone. So that anyone, even those with pre-existing conditions can be treated.

2) Private insurers won't like option 1) because they fear they won't be able to compete with a plan that is backed by the government - and they are probably right, so there's a good possibility that 1) could lead us to a government provided single insurance coverage similar to Canada's or Europe's system over time.

3) Because of 2), what will instead happen is that private insurers will agree to new reforms in the way they handle health insurance:

a) They will no longer be able to deny coverage to folks with pre-existing conditions.
b) They will have to offer consistent and constant rates to everyone.
c) For options a & b to be profitable for insurance companies, government law will have to change requiring everyone - even the young and healthy to have health insurance. Otherwise the young and healthy won't pay for it until they need it, and insurance companies will no longer be able to deny them coverage. This system would bankrupt coverage.

4) Americans face a cognitive dissidence with regard to health insurance - we expect hospitals to take care of us say if we are injured in a car accident, but we don't want government to force us to buy health insurance. If we demand treatment when sick or injured, we have an obligation to pay into the system that provides this care.

5) Right now is our best and perhaps only chance to reform our health care system - we have a motivated president who has smart policy proposals in place. We are experiencing a massive economic crisis, where people for the first time in a long time are legitimately afraid of losing their jobs and their health care. The politics is moving toward a place to make reform possible. Let's hope it happens.

And that fools like Glenn Beck who seriously believes Obama is leading our country down a path toward totalitarianism won't kill sensible health care reform...

The good news (or bad news depending on your perspective) is that Beck and Limbaugh are leading the Republican party toward marginalism. But a marginalized Republican party might give Obama the space he needs to reform health care.

So, maybe I should say, keep it up Beck and Limbaugh, you're turning off Americans by the day.

1 comment:

Bill said...

I like the idea to extending medicare for a wider span of people. i do not see how you can force people to have health insurance. We are required to have auto insurance, and yet part of our insurance is for uninsured motorist covereage. The government just passed legislation that now requires employers to cover a larger portion of COBRA. This makes keeping your insurance doable while you look for work. Maybe a universal healthcare system is the way to go..but I can't see that coming. I wish there was a better way to contol the insurance companies. Let's hope that Obama can make a difference!