Does ShortWoman have the answers?

My blog buddy ShortWoman writes a post that is by turns depressing and then (somewhat) hope-inducing. [Yes, I'd be grateful to anyone that could tell me what word I really want to use...since somehow today my brain can't get past "hope-inducing."]

She begins with a series of links to articles confirming just how broken our current health care system is. But wait, you think, I reall already knew that. You think you know it, but seeing the compendium of reasons listed all at once is still a sobering confirmation.

And then she lists:

Some things we can do to fix the system

Mix and match from this smorgasbord of possibilities:

1.  Make insurance companies work as mutuals or not-for-profit companies in order to provide health insurance.   

2. Encourage the existence of major medical policies. Not everybody needs common cold insurance; everybody needs hit by a truck insurance.

3. Remove barriers to individuals purchasing their own health insurance, including additional paperwork, higher fees, requiring proof of existing insurance, and "pre-existing conditions" rules. Not only does this eliminate a middleman, it reduces prices by allowing individuals to seek lower rates.

4. Require insurance companies to treat all insureds in a given geographical area (such as zip code or county) as a group for rate setting purposes.

5.  Change the IRS rules to allow anybody to deduct their health insurance and healthcare costs.

6.  More doctors "opting out" of the system, thus removing the dysfunctional middlemen.

7.  More states following Michigan's lead and requiring hospitals to be non-profits. 

And if all else fails...

8. Universal single payer healthcare. Basic coverage for everybody, plenty of room to make money in the supplemental insurance business.

So, what do you think? Are these the answers?

My thoughts are in the extended entry...

The one I'm really not sure about is #4. If I recall correctly this is exactly what is true in New York, and it results in an avergaging out of health care premium costs, true, but it then sucks to be young and healthy. And I think states don't want to discourage young and healthy people from living in their states. (I mean, who's going to take care of the old and infirm after all?)

I also notice a lot of "musts" for hospitals and insurance companies (#1 and #7), but only "encouragement" for the idea that everyone should have major medical (#2). Why just encouragement? Why not requirement? Somehow we've managed to pull off making it illegal not to carry a minimum amount of car insurance.

Who does this protect? Why has this so easily been done? It strikes me that it really doesn't save insurance companies in aggregate from covering the costs of accidents. If a solo driver had an accident and smashed their stuff up, and they had no money, no inusrance? No one would care much. They'd abandon the car and be on public transportation until better days came. Rather mandatory car insurance seems designed to make sure that when there is some blame or accountability in a car accident, an individual's insurance company will have to step up, and that then that individual can be held accountable by rates that rise insanely for that individual. [Oh and in the meantime it represents a nice total addition to the income of insurance copmanies, obviously.]

Overly simplistic? I'm sure it is. But basically, isn't it true?

Then there's #6 . I see the point there. Doctors end up feeling that they're as screwed as the patients when it comes to most insurance carriers. ShortWoman's husband is a doctor, and he eventually opted out of regular practice into a more elective procedure line of work. So I'm sure she speaks from first-hand knowledge on this subject.

Still, if the doctors are going to start a movement there will have to be some way to get patients as a partner in that. Otherwise we'll have three medical tiers:

1. The folks with medical insurance of some kind...who feel trapped to go only to on-plan providers and pay carrier-defined prices. (Can doctors out on there own save such patients money and still make more than they do working with carriers? If so there's a major marketing message that would need to get out there.)

2. Lower income folks without medical insurance. (Are any of the opting-out doctors going to focus on being the doctor to these folks? letting them pay cash or in installments for quailty care?)

3. Higher income folks who eschew traditional medical insurance, because they can afford to pay for the best care without it. (Yes, I can see many an opting-out doctor shooting fo this market.)

Since I know there's a healthy amount of the "life isn't fair" and "it's not a right, it's a privelege" crowd out there, who tend to imply that those without coverage got that way because they deserve it, I always focus on the patient that draws the problem in starker relief: the child.

Surely we can all admit it's not a child's "fault" that their parents are successful?  We can't look down on them for their parents' lack of ambition, education, intelligence, skills, etc. Can we?

And what I want to ask ShortWoman, and all the people thinking about the solutions to our broken health care system: do any of these solutions ensure that a rich person's kid get as much of an opportunity to get well as a poor person's?

Comments

[Mollie]

My husband is a doctor too, so it's encouraging to see posts like this. We need to talk about the solutions instead of simply complaining about the problems.

As for equality in quality of health care, I recall seeing (somewhere) a study that found money doesn't guarantee better quality. Americans pay more and get less across the board, according to the study (and I wish I could remember where I saw it.)

[Steve Gorman]

Based on my extensive professional and personal experience with health insurance, I have seen and heard all types of suggestions and complaints about health insurance in America . As a result, I have formulated some ideas on how the system can be made substantially better.

I have been a health insurance agent for more than twenty years and my wife recently passed away after a three-year battle with breast cancer, with medical bills (covered by insurance) of close to $1,000,000, so I can speak to the issues better than most.

I oppose a government run single payer health plan for many reasons. The idea of having the government deciding what medical procedures I can have is not what I want, and I believe that most Americans would not enjoy that aspect of a government run health plan.

Another very significant reason I oppose such a plan is that it will result in health care rationing. Many people point to the Canadian system in advocating a universal single payer health plan. Right now, many Canadians are forced to wait and wait for various procedures. Those who can afford it, come to the U.S. and pay for their treatment.

There are three significant, but not that difficult or costly, things that can be done to significantly improve the situation:

1) Allow health insurers to offer their programs nationally and agents to sell across state lines. There is already legislation that has been introduced in the House and Senate to do this. The result would be more options for all Americans and more competitive pricing on health insurance policies.

2) Create an "assigned risk" system that requires each health insurer to take their fair share of high risk individuals with a ceiling on how much more they can charge these people over their preferred and standard rates. Spreading that risk equally between all insurers in the market would enable those people who can not now get individual health insurance to do so and could be done without making the cost of health insurance for healthier people that much more expensive.

3) For those who can afford to obtain health insurance and choose not to, make it impossible for them to discharge their medical bills through bankruptcy or statutes of limitations. This would create the incentive for everybody to purchase health insurance and would result in lower costs for everyone.

I am sure there would be some fine tuning required on the above ideas to make everything work, but this sure beats more costly, bureaucratic program that would limit our choices and truly result in rationed health care.

There is a lot of health insurance rhetoric out there, but there are solutions other than getting the government more involved in our private lives. While I agree that some government intervention and mandates are necessary to fix our healthcare system, a socialized program is not the answer.

Thank you for taking the time to consider my suggestions.

Sincerely,

Steve Gorman

President

Alternative Health Insurance Services

[Elisa Camahort]

Thanks for sharing your story and your suggestions, some of which I think are very good indeed.

I do, however, tend to dismiss this "government making medical decisions" argument as fearmongering. The fact is that Medicare is an example of a "government-run" medical insurance system, and I don't think it suffers the problems you mention.

Also, I wonder how we'll end up defining who "can afford" health insurance and what penalties they'll end up suffering. Of course, this was an issue with my own suggestions above too.

[Steve Gorman]

While Medicare has some good aspects, I do believe that as millions of "baby boomers" hit Medicare eligibility age one fact will become evident: there will not be enough money to meet the demands, and rationing will result for those who can not afford to purchase additional supplemental policies.

Decisions will need to be made regarding how to use available funds to pay for ever increasing high technologies and new, expensive medications, including who should be given some of this care.

It's a complicated problem with no simple solution. Ultimately, I believe that both the government and the private health insurers need to be involved in the solution.

Thank you for putting some good thoughts out there which will stimulate more discussion on these issues.