Sunday, July 26, 2009

Healthcare Reform - What/For Whom, Etc.?

In following some of the recent Healthcare Reform debate and conflict I find much of what I hear often inane and shortsighted. I come back over and over again to a basic point: "What is the goal?"

A simple example of this is looking at proposed ideas and how they seemingly will or won't do what they are intended to do.

IF, for example we are looking at saving money and cutting the costs of healthcare or limiting the increases in costs then we need to look at Why healthcare in the U.S. is so expensive. Besides the issues of excessive uses of various testing equipment and the fears of malpractice and and such the basic costs of most prescription drugs is a significant issue related to the costs of healthcare. Simply pushing a public option healthcare plan will in no way help bridge the gap between drug costs in the U.S. and elsewhere. The simple facts that drug companies "own" the system now in the US and we pay dramatically higher costs for most drugs must be dealt with if we are to "compete" with Canada and other more progressive countries.

If, we focus upon "competition" and "choice" within a reformed system (which seems idiotic to me, but is often done), we should consider what will allow competition and real choice. Clearly, where I'm given choices of paying roughly $190-350/month for family coverage and others are facing choices of $800-1500/month for similar coverage, if they can get insurance at all, we don't have a truly competitive market. Where our health coverage is heavily subsidized and many others' isn't, the market they are a part of is likely to be exceedingly expensive and difficult to navigate through.

Besides the simple issue of subsidizing the costs of those whose incomes aren't very high and whose insurance isn't subsidized, we need to look at Why insurance costs will be high. One obvious factor is where the risk for the carrier exists. It would seem logical, for example, to consider creating more of an "open market" for health insurance options, if "competition" and "choice" are important.

To do this over time would seem to me to need creating less of a separation between "subsidized" and "unsubsidized" coverage. Taxing subsidized benefits is one way of doing this, but not the only way. Unsubsidized health plans could have a "free" or "low cost" assistance from the federal government in covering them for catastrophic costs. If, for example, such plans had no liability for health care costs over $10,000/year, the federal government would take on a Huge Liability, while the insurance industry would have an opportunity to offer a lot more healthcare options, not risking losing huge amounts of money on enrollees in their plans.

We definitely need to get away from the seeming naivete that healthcare reform is going to be "affordable" or "inexpensive". We also need to recognize that if we say that options such as single payer are off the table (as is said now), that it removes or makes much harder many areas of significant cost savings. Simply having a public option available to most, if not all, will not, in of itself lower healthcare costs and there rapid inflationary increases year by year.

We need, for a change, to look seriously at the options that we, as a country face. We need to look at the costs and benefits of these options. We also need to get away from the scare tactics and rhetoric where "socialism" and "free choice" and similar are used to avoid dealing with the real problems that we face.

I'm Not optimistic, because the desires for consensus and the short-sightedness of most of our congressional leadership will likely lead us to a "political solution" which at best will be marginally better than what we now have, and may be worse in some ways. As is common politically, the Democrats again will stick their foots in their mouths if they mess up, as was done in the early Clinton era.

The problem with Hillary and Bill Clinton's plans weren't with "the details" but rather with their total naivete in taking on the insurance industry and allied forces head on, without having any comparable force that had any chance at countering the lies and deceptions of those who would have lost their massive profits then. Our issues aren't that different today!

I hope that I will be proven wrong! We shall see!



Gregg's Health Insurance News said...

Profit motive would need to be taken away from the industry to control costs, and I don't see this happening with this new legislation. It seems that there will be a reduction in care, not costs. You may receive a minor reduction in costs, but choice of care is going to get stifled and overall, its a losing situation for consumers. You may pay less, but your care will be exponentially worse than any cost savings could account for.

Curtis Faville said...
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