Monday, September 21, 2009

Observations About Health Care Reform

The difficulty with reforming our health care system is that the whole situation is WAY too complicated. It does not fit into our shared cultural desire for a few slogans and buzzwords to sort everything out. Everything is so inter-related that it makes for bad politics. In an effort to untangle some of the confusion, I will offer a few observations:

1. Anybody who doesn't think there is a BIG problem with our current system is surely not paying for their own health insurance. As a businessman who pays for my own family plan (where I just got a notice that my premium is going up to $1880 per month!!), nothing irks me more than people with "jobs with benefits" who deny there is a problem, and claim "we have the greatest system in the world". It is especially galling when Republicans, who supposedly care about capitalism and entrepreneurship, are saying this.

2. In order for an insurance system to work, it needs a large enough pool so that risks can be spread, and prices can be fairly set. I don't have a real problem with making health insurance "mandatory" for all, and I don't think it's any different from law requiring motorcycle riders to wear helmets. Yes I know, some States don't require helmets, under the theory that "people have a right to be jerks and let the rest of us bear the risk of their medical bills". Health insurance is no different. It's pretty stupid not to have it, but many people choose not to, primarily because it's too damn expensive. Clearly, the costs have to be lower for all if everyone is required to be IN.

3. Which brings me to another point. Isn't is obvious that health care reform and immigration reform are inexorably related? When health insurance becomes mandatory, I want the 12 million newly legalized workers to be REQUIRED to pay for health insurance, or for their employers to pay for them. If this is too onerous, please leave. I am sick of paying for your health care. While I'm on the topic, I would also make "working off the books" and "paying people off the books" felonies. That's right. Not only do I want my health insurance costs lowered, I want my taxes lowered too, because I want everyone who should be paying, to PAY. Am I the only one who is ticked off about this???

4. I am amazed when people talk about "tort reform" in the context of health insurance. Yes, we could use some tort reform, but in the overall scheme of things, it's a pimple on the body of the problem. Maybe if there were universal health care, the doctors would be billing so much they could better afford their malpractice insurance premiums. Hey, wait a minute, another insurance issue at the heart of things. OK, let's fix too, this while we're at it

5. Does anybody truly think that under the present system the health insurance companies are competing with each other? Are they competing on price? Or service? Somebody show me where that happens.

6. Another good one....."If the government is involved, a bunch of bureaucrats will be making decisions about my health care". And who at the insurance companies is making those decisions now? And what standard are they using to make their determination?

7. I'm thinking that if millions more citizens have health insurance, this would be good for the doctoring and hospital business. Am I missing something? Oh, it will probably also be good for that other scourge of true health, the pharmaceutical industry.

8. I do fear that those who vocally support "universal health insurance" will be shocked when they find out they "have to pay for it" least to some extent. I don't think there can be any viable plan where the consumers are not paying some part of this. So, it really comes down to a TAX. To this I say, "fair is fair", and I think Obama has been tip-toeing around this issue. Fixing this mess will require EVERYONE to pay, another complication that doesn't generally go down too well.

9. The government is not some "otherly" entity. WE are the government. For this thing to get fixed, WE are going to be paying, one way or the other.

Sorry for ranting.
Sorry to my doctor friends.
Sorry to working people.
Sorry to people working off the books.
Sorry to people paying people to work off the books.
Sorry to Democrats.
Sorry to Republicans.
Sorry to tort reformers.

Sorry to say....I'm not really sorry about any of it. If everybody could just see that we are all in this together, we'd have a chance to make some progress.

1 comment:

jskingston said...

You make the case well...and I'm right there with you on paying monthly premiums that exceed most folks rent.

One could argue the insurance companies are just gouging us all. Then again, maybe quality healthcare is expensive, because you get what you pay for. And that's a notion which becomes frightening when you consider the cost, in our tax dollars, of paying for everyone.

There are finite resources in healthcare...both in terms of the money available to pay for it, and what's being bought -- X number of MRI machines, X number of competent cardiologists, etc. One could conclude that with universal coverage, rationing becomes inevitable.

That certainly was the case with the Canadian system when I studied it -- a system in which a months-long delay for an MRI killed the mother-in-law of one of our Kings Civil colleagues. Equal care for all may not be so wonderful if it ends up being equally bad.

I can't agree with the "we ARE the government" analysis. When I traverse red tape at the DMV, that's not me, and it's not is some folks with FAR too much job security. Health insurance company red tape will seem like a walk in the park if the government takes the helm. Never mind the DMV. Care to discuss the MTA? The TBTA? The NYC Water Board? I shudder at the thought.

I agree that the current system could use changes. There has got to be a better way than handing it all over to the government.