Is this healthcare or politics?
If you would have asked me just a few months ago if the healthcare system in this country needed fixing, my immediate answer would have been, “hell yes.” Like most Americans, I hated high deductibles, costly procedures, tiresome claims, ambiguous benefits, dysfunctional emergency rooms, etc, etc. Unlike most Americans, I had a chronic condition, so for me the madness was amplified. But now there is a president and congress committed to helping. So why am I not excited?
I guess, without much thought to detail, that I am like the protestors. I have been to the local DMV, post office, county court, and city hall, and I have seen the black hole of institutional dysfunction. The local ER is pretty bad, but compared to the local Social Security office, it is Nordstrom’s. But if the government cannot help, then who can? Can we make things better or is this as good as it gets? I figured instead of starting a new wave of protests, I would learn a little more.
What I learned is that people are living longer and more healthcare dependent lives. Remedies have become more profitable than cures. For these reasons demand for healthcare is up. The costs to practice medicine are rising as well, because of litigious risks and advanced research. The high demand and high costs make healthcare less affordable. And to make things worse, fewer businesses and people are paying into the system.
This is not to say the system is completely broken. Most Americans have health coverage. I am insured through a former employer and quite sick, but I am covered for all doctor visits, operations and medications. My premium and out of pocket expenses are over $500 per month, which is inconvenient and expensive, but not impossible if you adjust your lifestyle. Those who cannot adjust their lifestyle because of severe income restraints might qualify for Medicare or Medicaid. Others are given exceptions for treatment, but these exceptions cost everyone. A small percentage is refused treatment altogether.
The president, like everybody else, wants to improve this situation. He first proposed a co-op insurance with which everyone could choose either a private or governmental plan. Then he scrapped this controversial plan once opposition grew to the idea. Political rivals and protestors argued that any universal coverage would cause rationing. Many argue still that government intervention into healthcare will create bureaucratic inefficiencies, and further bankrupt the country via more debt, taxes, or both. In the House now there is a $900 billion bill with a public option awaiting revision. The details of the bill seem not just ambiguous to Americans, but to Congress as well.
If you take away the politics, the real argument against government intervention is that free market solutions are better than social ones. However, this is not always true, even within classroom macro-economic theory. For instance, infrastructure like roads and bridges do not thrive on supply and demand because no one person or group of people would pay for an entire interstate. The free market model also fails where competition is inherently infeasible, or where ethical provisions are elusive. Healthcare has some of these characteristics.
So would healthcare do better in the hands of the government? It depends if providers and insurance companies can reconcile some of these shortcomings in the free market. Can they do business with a quasi- benevolent mission, while government helps create a more competitive market? If they can then less government intervention would succeed, based on the fact that free market solutions are directly driven by demand and competition, and hence reflect higher quality, lower prices, etc. Therefore, the challenges and solutions of a successful healthcare system lie more within business trends and businesses plans than the politics of the day.
Many experts agree that improving healthcare is a business problem, and subsequently set out to benchmark other countries’ healthcare systems, much like how Ford would look at Toyota’s business model to make better cars. And while it is true other developed countries in Europe provide free and quality healthcare, those same countries are much smaller, have different cultures, and have flawed systems in their own right. Think about it. A smaller population encounters less inefficiencies and obstacles in running a social system, and is more economically homogeneous, meaning everyone pays in to a system at about the same rate. In regards to culture, we value prosperity more than community in the United States. That is not to say we don’t value community. We would just rather take care of ourselves first and our neighbors second, and not the other way around. This culture has its merits. It is what has made us so innovative and diverse in the past two centuries. And because we have a culture of prosperity, it makes it harder to turn out qualified doctors on modest salaries, and less acceptable to impose the taxes to do so.
I think the most important thing to do, which they probably haven’t done, is to first identify the fundamentals for successful healthcare, and build from there. Basic ethical decency and pragmatism are not enemies here. Ultimately we need other Americans to receive healthcare. That way we are safer from infectious disease, and have healthier contributions to society. Therefore, everyone should be covered for exams and second opinions, everyone should be covered for critical care such as congenital disease, disabilities, and corresponding medication, and everyone should be covered for emergency care.
However, most should have to pay for coverage and treatment a reasonable amount based on their income and demand. This way the system is well funded by many, for those who are sick, without bankrupting anybody. For instance, if you make $4,000 per month, you should have to pay for healthcare, but not more than $500 per month, including your premium. If you make more, your limit should be more, and if you make less, your limit should be less. This way, if you are sick then you will sacrifice but not go under. And if you are impoverished then you will get care if care is needed. But if you are healthy then these limits are not effectuated, and an affordable premium is your only obligation.
After we establish the basics, then we can return to the argument of what kind of system can best facilitate these basics. Government run or regulated healthcare could basically charge a premium in the form of taxes to assure that all Americans at different income levels pay into the system at an appropriate rate. However, our current bureaucracies have proven that a government run or regulated system would produce more forms and protocols than we have now. Remember DMV? The public option set forth in recent proposals is tricky too. If it is any good, it will drive private insurers out of business and lead to universal healthcare. If it is not any good, then…it is not any good.
Instead of the government running or funding healthcare, maybe the best way to improve healthcare is for companies and providers, for their own survival, to implement extensive coverage with reasonable limits. The government can encourage this by providing tax breaks and grants to those institutions that create competition and follow some of the basics we identified above. Government could oblige companies and private citizens who can afford insurance to pay for it. For example, they could deny businesses of any size a tax ID or incorporation if the business did not offer private health insurance to its employees. Or, similar to car insurance or homeowners insurance, the government could restrict individuals from getting their license or buying a home if they did not have private health insurance.
Whatever the solution, everyone needs to change their attitude. Healthcare will never be perfect. The true nature of the problem is too daunting. But healthcare in this country can improve without bankrupting the country if cooler heads prevail. Let us hope they do before we pass a bill contaminated by politics that no one understands.
Latest posts by Robert O'Hara (Posts)
- The dawn of Syrian conflict - August 29, 2013
- Of Russian resets and NSA leaks - August 12, 2013
- Too much news is good news for Mullah Omar - July 25, 2013
- Trayvon Martin, tragedy and injustice - July 14, 2013
- Republican hangover: it’s not the message, it’s the messenger - November 15, 2012
Print This Post
Big health insurance companies spend $641,000 a day to oppose reform because they profit by keeping the system as it is, by denying claims, raising premiums, co-pays and deductibles at will, and making health care decisions instead of our doctors. Insurance companies deny care for pre-existing conditions, pay employees to deny more care, and use our premiums to lobby against a public health insurance option. Insurance companies must be held accountable for these abuses.
It’s time for Congress to stand up to big insurance and take OUR SIDE by making the insurance companies follow fair rules, making health care more affordable for everyone, and giving all of us the choice of a strong public option if we can’t get coverage at work.
What we really need is single-payer health care that covers everybody for everything, no exclusions for theological abracadabra or holier-than-thou hypocrisy by priests who take their hands off boys’ bums long enough to demand that women be put in their place, which, to them, seems to be on their backs conceiving and delivering babies. You know what? Let’s start caring about people AFTER they are born.
At the very least, we need the public option. What is the good – what is the point – of filtering our health-care dollars through the insurance companies so that they can take their cut and then send fewer dollars to doctors, hospitals, and other health-care institutions? Thank goodness the government saw the lunacy of this in the area of student loans. It is far more vital that they see it in the area of health care.
Jeez, it’s not rocket science! If it were, insurance executives would be compensated at rocket-scientist levels, which they never would stand for.
Great arguments, Rob. If only the cooler heads would prevail…
Parsifal, you remind me of a Scud missile from the First Gulf War: you totally miss the writer’s point and just blow up all over the place.
Parsifal:
Not only is your indictment of the Insurance industry a steaming load of nonsense, you completely neglected to factor in anything about how they heck we are supposed to pay for your utopian scheme.
First and foremost, health care insurance is not an inalienable right. There is no guarantee in the constitution or the Bill of Rights that says we have a right to cheap, universal health care or even to cheap health care insurance.
Next, people need to get over this hatred of the health insurance providers. Health Insurance is a business, much like automotive insurance, house and life insurance too.
They do NOT exist to ease suffering, to cure the ailing or to off succor to the weak at heart. They are, first and foremost, a business and they exist to make money for the stockholders.
It is not a bunch of cackling, super villains, sitting around a darkened boardroom, dreaming of ways to make people unhappy. It is a bunch of accountants who are squeezing every last dime out of the business; their only goal is to turn a profit.
A lot of people seem to mistake an occupation in the health insurance industry for a medical avocation. They don’t take the Hippocratic oath and are not expected to do so.
That you expect them to act in YOUR best interest just shows how foolish you are! You don’t expect the automotive industry to build a Homer-mobile specifically for you, do you? Do you take up picket signs because your favorite clothes designer didn’t make the spring lineup in your size?
The only thing standing in the way of people shopping around for better (and cheaper) health insurance is the government. The Government is keeping health insurance providers locked to geographic areas, not the market. The same government you want to take control of the entire system.
This is the same government that hasn’t been able to balance its own checkbook for more years than I have been alive. And now, just to suit the whining minority, they should put us further in debt for a new, bloated bureaucracy that is bound to provide an even lower level of health care than we currently have available?
Oh yeah, that makes PERFECT sense.
I am not offering a blanket pardon for the excesses of the medical insurance industry. I would like to see some common sense regulation; some oversight to make them stand up to the letter of the contracts they sign.
All I am saying is that choosing this business as a scapegoat is not going to fix the problem, just as letting the most inefficient industry in the country (our own government) take over is not a panacea to fix all that is wrong with health care.
Precisely why we should not have insurance companies involved in providing our health care. They exist only to pay for health care for the healthy and deny it to the sick. This is efficient? Rather, it borders on the criminal. Get the insurance companies out of the way and the biggest obstacle to good health care in this country would be removed — government-provided, single payer such as they have in other advanced democracies where nearly all of the vital statistics such as longevity and infant mortality are far better than they are here. We already have one such system — Medicare — and those who are on it praise it.
Here’s the way to pay for the needed health-care reform: Pretend we’re invading another country (best to choose one that hasn’t attacked us first). We a;ways find money for that, no questions asked.
Or, we could just continue on the way we are going, the non-system that provides health care to Americans who are well-off or well-connected and lets the rest go to hell. What was it Rep. Grayson of Florida called it? Oh yeah — the Republican health-care proposal. Take an apple a day, don’t bother to call me.
Medicare… you mean the system that is so screwed up that it is almost bankrupt? The system that forces doctors and hospitals to take fractional payments and then they have pass the losses on to the rest of the non-medicare patients, jacking up costs for everyone else? The system where the payments for doctors is so messed up that we are trying to pass an emergency measure that will take ten years to fund five years of payments?
That Medicare?
Great idea! You should be the new Health Care Czar!
No wonder the deficit is so out of control.
Well, I am on Medicare, and I love it. Best health care plan in the country. All the geezers love it. Even my aging friends who hate the government, as you seem to, can’t wait to get on Medicare. Kind of hypocritical of them, I admit, but one looks past such things in friends. Medicare has been working great for nearly 45 years, yet in all that time people have been saying, as you, that it is near bankruptcy. Still waiting. With administrative costs in the range of 3 percent, it is far more efficient than private health insurance, with administrative costs anywhere from 17 percent to 20 percent. And they don’t turn you down because of pre-existing conditions or because you have an expensive illness, as private insurance does. But you know what, Medicare is not the only single-payer government-provided plan. The VA does too, with similar efficiencies of cost. Oh, and then there is government-provided health-care for the military, which my son and son-in-law, both in the military, praise to the skies.
But you’re correct in one thing: There is no “right” to health care. There is no right to police and fire protection, either. Who ever came up with those socialist enterprises? Oughta be shot.
Plus, if, as you say, Medicare forces doctors and hospitals to pass on costs to non-Medicare patients — that also applies to emergency rooms. People who are against universal health care, such as you seem to be, “explain” that people who have no health insurance — 47 million Americans — can simply go to ERs. As if that is free. No. The costs in ERs (the most inefficient and costly form of health care) get passed on to — you guessed it, people on health insurance in the form of higher premiums.
And of course I expect insurance companies to operate in my interest. I expect EVERYTHING I purchase to work in my interest. Why would I want to just GIVE money to an insurance company, a car dealer, a restaurant without getting something of interest or value to me in return? Maybe you do, but that’s your money. Me, I don’t throw my money away that way.
The last time the government had a balanced budget was three years during Bill Clinton’s eight-year presidency.
Wow… your grasp on reality is tenuous at best.
The military: Since the surgeons, doctors, nurses, orderlies, pharmacists, not to mention all of the specialists are all enlisted in the military and are subject to military law; since the buildings, the land they sit on, the vehicles and medical machinery are all owned by the military; since the supplies, all expendables and medicines are bought in bulk through the military purchasing system (though this, as always, could use an overhaul), the overhead and operating costs of the military system is nothing, NOTHING like any other system out there. Using the military health care system as an example of why we should have socialized medicine is a really stupid comparison.
Unless, of course, you think that we should immediately conscript every person in the US who is involved in health care. Turn them all into soldiers, nationalize (and seize) every clinic and hospital, every ambulance and mediflight helicopter. Then, of course, we would still have to raise taxes to pay for salaries, upkeep, supplies etc etc since these new acquisitions would not have been budgeted as part of the normal operating costs of the military.
The VA is, has been, and will probably always be a joke and a massive pain in the ass for anyone who has been subjected to their tender mercies. We treat our veterans worse than we treat our homeless.
As for medicare, that the people who benefit actually like the service does not mean that it is fiscally responsible. The only reason it has not collapsed under the weight of its own mis-mangement is that we keep bailing the system out at a huge cost to the taxpayers.
Next, the federal government does not run, have control of or pay for local law enforcement and fire organizations. They are paid for out of local taxes. There are still sections of the country that do not have local fire and police departments because they cannot afford them OR because they do not want their taxes going to pay for them. My father lives in an area like this. What fire service they have is all volunteer and their equipment is either donated or paid for by local fund raising efforts.
Last, but certainly not least, that you expect the insurance companies to work to your benefit is just another example of your unrealistic expectations. You are probably someone who believes that people who signed ARM loans should not have to actually pay for their mortgages because they are not advantageous to the home owner. Have you never heard the term “Buyer beware”? Read the damn contract. Know what you are signing! Research your purchases before you buy. Stupidity should be painful and it is not the federal governments job to protect people from stupid decisions.
I am done. It is obvious that we will never reach an agreement. You live in a dream world and I am of the belief that the government has never made an industry more efficient.
The answer does not lie in making the already overburdened and bloated government larger and more intrusive. I still believe that all they have to do is allow the health care insurance industry to become competitive by removing unrealistic restrictions and to make it advantageous to provide low-cost coverage by offering tax incentives.
There are two obvious steps to improving the health care situation, both of which are elephants in the room that the administration doesn’t want to discuss:
1) There are 1,000+ insurance companies in the U.S. They all must be able to offer their services in every state, instead of, e.g., Oxford monopolizing the NY-NJ-CT tri-state area but being unavailable in CO or NV. The insurance industry itself lobbies against that, and the administration goes along with it, pretending that it’s the public option that will create competition, not removal of artificial obstacles to insurance companies’s activities on “each other’s” turf.
2) Tort reform. The malpractice suits and costs they incur are unsustainable. But, of course, the administration doesn’t want to push the trial lawyers’ lobby, a big Democrat-voting pool. While everybody is in a tizzy over how much money the doctors make, the question of who benefits the most from malpractice suits goes undiscussed. Let’s face it, any opportunity to blame and sue a doctor or a hospital for anything is found money — they tend to settle without much fight. They know they’re screwed.
Until these two issues are addressed, we’re just running up the tab of billions of dollars in hot air alone — all the arguments and deliberations cost taxpayers money in wasted time and won’t amount to anything constructive, because the whole construct is based on hypocritical refusal to fix the two things that are easiest to fix.
I am finished, too, after this: Eight of my uncles were in the Army or Army Air Forces during World War II, four of them in combat. Afterward five of them used the medical services of the VA and had nothing but good words for it. After Army service during Vietnam, and before going on Medicare, I had occasion to use VA medical services twice, and I was treated excellently. The care we received certainly was not a “pain in the ass,” nor was it “worse than the way we treat our homeless” — who, of course, are treated that way because people like you think they deserve no medical care.