We need health care reform. Not just "health insurance" reform. Actual health-care reform.
First, for all his talk, Obama is really showing his lack of leadership ability, here. His proposed "health care reform" is nothing but a showcase for how to let lobbyists write legislation.
The problem is that health insurance is too expensive. So, the Democrats' solution: force people to buy it or face fines. Nice job, Barack. Logic only a Democrat could love.
Of course, the Democrats are saying that they watered down the bill to get Republican support. Never mind that nobody in their right minds thought that the Republicans were going to support this. That gives us one of two possible conclusions: that everybody in the country is smarter than a Democrat, or the Democrats wanted to sell us out but wanted to blame somebody else for it.
I've seen the Republicans do some pretty crappy things over the years, but I've never seen them blame the Democrats for it.
The Democrats have a reputation of being unaccountable and unable to lead. Their performance on the health insurance reform initiative pretty much solidifies that reputation.
We need an overhaul of the system from the ground-up. I just had a very minor surgical procedure. I am still amazed that medical records are kept using technology developed in the 17th century. I fill out a form listing all my current meds. A nurse then interviews me, asking for all my current meds. I fill out another form with all my current meds. Then another form with all my current meds. Then another nurse interviews me about my current meds. You get the picture. And I'm only shortening that story because reading the same two sentences over and over for 3 paragraphs gets a little old.
Anybody who can spell the word "doctor" knows that it is physically impossible to include the words "customer service" in the same sentence without a word like, "not" somewhere in there.
Any business that operated like a doctor's office would be bankrupt very quickly. Unfortunately, most people are not repeat customers of doctors and there is no need for doctors to improve customer service at all. Especially since most people don't actually choose a doctor. They find the list of their insurance company's network and generally go with the closest guy.
If that doesn't work out, chances are you don't need to see a doctor in a while. In the few cases where you change doctors, you do so after several years.
They just don't care. Their current ways are inefficient and expensive, but they don't have the same competitive pressures that make the free market work. So, they just pass the cost on to you. End of story. They'll complain that their medicare reimbursement rates are too low, but it never occurs to them that collecting 15 pieces of paper with the same information on it wastes both time and money. Or that the nurses who had to ask you the same questions over and over and over again aren't working for free.
Another example? I had surgery yesterday. I feel pretty good, but not good enough to want to talk to people on the telephone. I had to make a follow-up appointment.
We finally got settled on the date and time and the person on the phone said, "and what is your insurance?"
ARE YOU ****ING KIDDING ME? I have already been to your office. Made sure you photocopied my insurance card. You took it from me no less than 3 times that visit. I hand-corrected where you still managed to get it wrong on my paperwork... AND YOUR DOCTOR JUST OPERATED ON ME YESTERDAY???!!!
YOU DON'T HAVE MY INSURANCE INFORMATION WRITTEN DOWN SOMEWHERE???!!!
Honest to god. Again, any real business would have changed this... oh... 20 years ago. Not the medical industry.
I wish I could say this was an isolated case of bad service, but it isn't. Anybody who has had to deal with health care knows exactly what I'm talking about.
Yet, nobody, but nobody does anything about it.
Yeah, the government is big and beaureaucratic and not the most efficient bunch of people on the planet. But compared to the medical industry, the government is a bunch of Wall Street stockbrokers.
Finally, there's a huge problem with health insurance. It can't be fixed. That's the problem. It just can't be fixed.
Why? Because people aren't all created equal in regards to health.
With your car, you are grouped in a risk pool. You are grouped with drivers who, the insurance company estimates, are about the same risk as you are to need to file a claim.
If you're a careful driver, meaning the ones who pay premiums for 50 years and never file a claim, the insurance company wants you to be their customer. So, they charge you the lowest premiums to attract you. After all, you will pay them thousands, upon thousands, upon thousands of dollars, and all you'll actually get in return is a piece of paper with some writing on it.
A driver like me with a ticket or two pays a slightly higher premium.
Drunk drivers? People who are just plain crappy drivers? They pay a huge premium. In fact, their risk pool is so bad that many of them simply can't afford insurance.
Health is done a bit differently, though.
If you're in good health, you can probably get a relatively affordable policy.
However, if you're a woman of child-bearing age and want pregnancy covered, you're going to pay more.
If you have a pre-existing condition, if it's expensive enough, you're in a risk pool so expensive that you can't afford it. It's not that the insurance company wants to deny you insurance. It's that they know you can't afford it. So, they're not going to bother selling it.
If you have a health condition that costs you $10,000 a year, then, well, you're going to pay more than $10,000 a year for coverage. In fact, administrative costs usually add up to about 30%, so you're going to be paying a minimum of $13,000... not to mention a few more thousand for the occassional unforseen event.
Which gives us our current problem: you can get health insurance easily if you don't need it. Trouble is, you don't need it.
The insurance companies need those healthy people. They throw them into risk pools with unhealthy people and voila, premiums go down for the average policy holder... until the healthy people realize they've paid thousands... and all they got was pieces of paper with some writing on it, and they decide to drop their insurance or move to a cheaper pool, preferrably with only healthy people in it.
The way it works with individual policies, is that they then assign you to a brand-new risk pool. They raise the premiums the 2nd year because healthy people (who need insurance less) drop out, and sick people (who need insurance more) stay in. Eventually, everybody either keeps moving to new risk pools if they are healthy, or they get classified with a pre-existing condition if they're not.
So, basically, individual policies only work if you're healthy. If you ever really need them, they just don't exist for you. Eventually, anybody whose health costs are lower than yours will leave the pool and only you and other high-cost policyholders will be left. The pool will be crazy expensive and you'll either drop out or pay your entire income to afford health insurance.
If you work for a large company, you're in a little better shape. Your risk pool is generally the entire company. So, the odds of your premium increasing by 25% in a year (like an individual policy) are remote. They'll just go up at 2 or 3 times the normal inflation rate so that they double every 10 or 12 years, your copays shoot through the roof, your covered services dwindle every day, and your pay raise fails to keep pace with inflation because your employer is paying through the ying-yang for your health insurance.
Now, the only 2 things the Obama plan does is it precludes insurance companies from denying coverage based on pre-existing conditions.
That means the cost of those risk pools will skyrocket. They'll have no choice but to raise premiums unless they can get enough healthy people (meaning, "people who will not file claims") to offset the cost.
Thus, othter thing is the need to FORCE everybody to buy health insurance. Not just inexpensive catastrophic-only policies, either.
Now, I know there is a social problem with people who chose to be uninsured, but I chose to be uninsured for about 6 years after I got out of the Army. Why? Because crappy health insurance cost about $150 a month, and that was a lot of money for a guy who, literally, might consume about $100 a year in total health care costs.
What the Obama plan does is forces people in that boat to pay their $2,000 a year for a cheap personal policy, even though they'll only use about $100 a year in medical services, in order to contribute the other $1,900 to lower the cost of the risk pool, overall.
It'll be a benefit if that young person gets into an accident. If not, it amounts to an insane tax on the young and healthy in order to benefit those with higher health care costs.
The other reason health insurance doesn't work, other than the fact that people are born with different health-care needs, that they cannot help, is that people also make lifestyle choices that impact their total health care spend.
I think some element of fundamental fairness should dictate that just because a person was born with a condition that they had no control over, that they should not have to live their life in poverty, paying only for their health care, with the only other option being to die. People don't chose to be born with type 1 diabetes, or other heredetary diseases.
Unfortunately, once you know somebody has that problem, how will you price their risk? If you're a for-profit insurer, you need to recoup every penny that person will cost, plus money for your overhead and profit.
The single payer system is probably most fair in this regard. Everybody is entitled to the same health care services from cradle to grave. Your risk pool is simply universal. I could have had a child with multiple sclorosis just as easily as I had one who is perfectly healthy.
By assigning everybody to the risk pool BEFORE we know if they're sickly or not, we level the playing field. Sort of like if you sold insurance policies, but KNEW whose house was going to burn down. You'd end up only selling to the folks whose houses wouldn't burn. And you'd charge the folks whose houses were going to burn down enough to cover the cost of their house, plus your overhead and profit.
Same with health insurance. Since, in so many cases, they can tell who is going to need a lot of care, they only want to insure folks who won't. And they charge the folks who will need a lot of care enough to cover the cost of a home, plus overhead and profit.
The lifestyle choices get a little trickier:
If you smoke? You'll need more health care. If you drink? You'll need more health care. If you were buying a life-insurance policy all those factors would be taken into account.
If you don't exercise? You need more health care. If you overeat, you need more health care.
Is it fair for people who make good lifestyle choices to have to pay what amounts to an additional tax to pay for people who do not?
No. It isn't.
But should I not be allowed to ride a motorcycle? To rock climb? What if the parachuting accident that caused me a lifetime of extensive hospital bills was from an accident in the Army, not from recreational parachuting?
Tough one, there. On the other hand, our private health insurance solution is no better at fixing that problem than a public solution would be.
Other cute things that happen in our current system? Drug manufacturers, hospitals and networks want to entice insurance companies to use them. So, they offer "discounts". Problem is, those aren't discounts at all. All they do is jack up the sticker price to twice what it should be, and "discount" it down to the reasonable price that they charge to insurance companies.
No harm, no foul, right? Unless of course, you're uninsured and need to buy medicine or check into a hospital. If you aren't destitute enough to be on medicaid, you have to pay sticker price. Yep, the people least able to pay for medical care since they have no coverage at all, are charged twice what everybody else pays.
The system is just flat out broken. It doesn't need repair. It needs to be scrapped and replaced.
Unfortunately, the market forces that can take care of so many aspects of our lives absolutely can't fix this problem.
Only a single-payer system can possibly address the problems in our current system. If not a single-payer system, then at least a very, very strong public option. The current Obama plan provides for neither.
Obama is proving to be a weak and inneffectual leader trying to wrangle a bunch of special-interest whores. What he intitially proposed as a real solution is now watered down to yet another government giveaway to private industry. He's proving himself to be our generation's Jimmy Carter. A well-intentioned, brilliant man who is being made a laughing stock by his inability to lead his own party.
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