Wednesday, October 01, 2003

As the news out this week reported the Census Bureau's report of the number of Americans without health insurance has increased by 2.4 million people (or 14.6 percent) to a total of 43.6 million or 15.2 percent of the population of the United States. This is accompanied by a decrease to 61 percent of persons covered by health insurance at work. I wish everyone could become insured not only for the altruistic reasons, but because I do enough work for free as it is. While one can debate the scope of the numbers or how many of these millions are ininsured by choice, something is going to come of this I hope (or fear)
Everybody has a solution for the problem, but the Checkhov quote on Dr. Smith's main page hits the nail right on the head. No solution is going to make everyone happy. I think that two aspects of the problem are:
Health insurance is too expensive
Patients are insulated too well from the cost
This is why fewer businesses are offering coverage, it's eating up too much of the bottom line. Insurance is forced to be all things to all people, driving up the cost. I am of the opinion that health insurance should be like insurance for your car or house, available for unforseen emergencies, but not used for routine maintinance. Here is my simple plan for fixing things:
1. Disassociate health coverage from employment. Individuals should be able to purchase insurance themselves, and take it from job to job. They should get the tax benefits that companies get now on the premiums.
2. Individualize plans. Why should a young, healthy twentysomething have a plan with drug coverage? One reason why plans are so expensive is that they all have to include coverage for things that a person may never need.
3. Require some level of basic coverage to be purchased. This applies to auto insurance in my state, and will help spread the risk pool.
Simple plan from a simple man. I'm sure a "Fisking" will poke quite a few holes in my master plan. (What about those who can't pay for a basic plan....what about the elderly) But other plans have their faults too...

Medicare and Medicaid are caught between a rock and a hard place. They are underfunded and in the case of Medicare are going to have solvency problems in the future. They pay so poorly that physician participation is decreasing, and those covered by those plans are going to have a harder time finding a physician. So just saying "Medicaid for everyone" a'la Howard Dean won't work.

The single payer advocates seem to think that by eliminating the insurace companies they can come up with enough money to provide coverage for everyone. Physicians for a National Health Program want a system where everyone has the same coverage, and it is all funded by taxes. No co-pays or deductibles. You have to put some responsibility on the patient to ensure that resources are appropriately used. Even with seniors having to pay 20 percent, they are milking Medicare for all its' worth. A system such as this would either go bankrupt, or become like Canada's or Great Britian's with the waiting lists. It would be difficult to initiate co-pays after you have been giving it away. The lack of a private insurance market is also a problem. Americans are not going to take lightly being told that they can't get private insurance, especially if the national system is facing cutbacks. But won't that create a two-tiered system? you ask. I reply: is the goal to provide everyone with insurance, or to provide everyone with the same insurance? (I posted some comments on the PNHP report in August but Blogger seems to have lost them).

While I don't like always dividing people into two groups over an issue there are two camps with reasons for supporting universal coverage: the idealists who view it as society's job to insure coverage for all concerned, and the pragmatists who view the loss of productivity caused by sick people who can't get insurance. Or as put in Lawrence of Arabia :
With Major Lawrence, mercy is a passion. With me, it is merely good manners. You may judge which motive is the more reliable.
Back to work.
Weblog Commenting and Trackback by HaloScan.com

This page is powered by Blogger. Isn't yours?