You know the old expression comparing opinions to a certain part of our anatomy? The point being, everybody has one? Well, when talking about health care, this is especially true.
I recently attended a panel on health care, and my oh my, everyone in the audience had something to say about (a) what's wrong with the current system and (b) what Congress should and should not do to fix it. One health economist on the panel said privately to me that he wouldn't necessary feel comfortable speaking up at a panel on the financial crisis or Iranian conflict, but everyone -- everyone -- feels they have something of importance to say about health care.
The reason for this is obvious: We all interact with the health care system in one way or another. Sure, one could argue that we all interact with the financial system as well, but health care deals with deeply personal and emotional issues, life and death and disease and pain. Anyone who has watched someone close to him or her die knows how intense one's interaction with the health care system can become.
So when it comes to health care reform, there seems to be a lobby behind both sides of every issue people care about. There are the big players - the private insurers, the hospitals, the doctors, the drug and device companies. But there are also niche players -- like the group I spoke to for tonight's story -- who don't want Congress to cut them out of the process. Whether it's the lobby behind medical imaging technology or durable medical equipment, no one wants to be the one taking a cut.
Realistically, we're all going to have to take a cut, and I think everyone will need to internalize Obama's talk of "shared sacrifice" for health care reform to succeed. But unlike opinions, so plentiful when it comes to these issues, a willingness to sacrifice is a lot harder to come by.
Comments
Chapter 13 is nature's way of telling entities to sell off assets, downsize and sometimes cease forever further economic activity. Larger they come the more orderly is the procedure of disassembly and dissolution, the more orderly their connections in congress to use political brute strength to avoid chapter 13. Small entities and individuals are *too small to fail*. Individuals do not always have software and lawyers to help them dissolve themselves painlessly, orderly and without loss to our Beautiful America. Individuals should be protected by universal financial care from government who has probably overtaxed them into bankruptcy from the start through hidden tax etc.
Consider a world without physical disease, without doctors. Within this world bankruptcy protection could be provided for a tiny fraction of the price of medical insurance. People within such a world need bankruptcy protection but need even more financial protection in the face of doctors and hospitals. No American will be thrown out of the E-room of hospital to die on the street; but could easily be dethroned from solvency by exorbitant hospital bill. Do you see the difference? Do you see what we truly need. What they are dumping on us instead?
I totally agree with Sugrad's idea for improving the health care system. The current HSA plans could be the basis for a basic plan health insurers would have to offer to everyone, and they could not deny coverage or exclude prior conditions. Insurance companies could have multi-tier premium levels for high cost medical conditions, but these wold be limited to 3, and price would have to be justified to regulatory agency based on profit and loss figures. Govenment would pick up the tab for claims that exceed a maximum coverage limit of the underlying insurer. Government could help low income people pay for policy. Anyone who dosen't buy coverage will be billed by government for all back premiums they would have paid, plus penalty and interest. Doctor and hospital fees would be negotiated by public insurer.
Insurer high limit would be set at $5M lifetime limit, but have to increase due to inflation rate. Paperwork can be centralized with Obama's IT health plan. Extra coverage, like lower deductibles and extra coverages will be paid for by insured. I would also add that no company or business could be forced to pay for more then the basic coverage required by law, through any contract with union or employee. This would keep costs down for business. Individuals, not business would be responsible to purchase coverage, so there is no portability problem. Business can help pay for employees coverage as a negotiated benefit, but policy would be in individual name and be their policy, not a company policy that ends when employee leaves. Parents would be responsible for covering children from birth.
The fact that a number of public sector services are being contracted out to private sector companies must come from some analysis that says the private sector can perform these services more cost efficiently than the public sector. If that's true, why wouldn't we want the universal health care program run by the insurance companies rather than by the government?
The government would set up a standardized plan with a fixed set of benefits. The insurance industry would provide that plan to anyone who would be eligible and charge a premium set jointly by the insurance industry and the government. Claims against that plan would be pooled and any deficits would be subsidized by the government. The experience would be kept separate from other plans meaning other employer-paid plans continue to be separately rated and subject to increases within its own pool. It seems to me it would have to be cheaper to the taxpayer and would place the coverage and administration in the hands of people who do it for a living.
But this assumes that we're going to make available, but not require, health coverage for everyone. If we want everyone to have health coverage we can set up hospitals (similar to the VA) where people without coverage can go at no cost for certain illnesses/procedures. The covered services have to be for serious issues and the hospital can't be viewed as a clinic. There has to be an advantage to those who pay for coverage.
I think this would cover everything the government wants to do except increase the size of government.