Thursday, December 3, 2009

Health care wish list

There's a lot of talk today on why health care is so expensive, and there's plenty of explanations being offered. I've heard speakers on the left say its as simple as greedy insurance companies, and speakers on the right say... well, there isn't really a consensus from the right, just a lot of talk about how our current system helps people pretty well and it would be ruined by a government plan.

I've already demolished the silly and intellectually lazy "greed" explanation, and the Republicans are confusing our health care technology with the way it's distributed. Both of these views are wrong, but still dominate the debate today. The truth is, our current system has a lot of problems and needs to be reformed.

With three weeks until the 25th, it would be a Christmas miracle if our representatives could address the following issues that drive health insurance costs up:

*Stop covering routine checkups. Insurance is about spreading the risk of a catastrophe around; a bunch of people pay a little and the ones who are unfortunate get to use it. Instead, we have health care plans that cover yearly checkups, and people have no incentive to shop around for the cheapest doctor. Instead of a restaurant model where you pay for what you take, the American health insurance system is set up like a cruise ship: Once you get your ticket and board the ship, you stuff yourself at the buffet until it hurts to eat. Stop insulating people from these costs.

*Bring higher co payments into the equation. One of the biggest problem we have with is people consuming too many health care products; resource-heavy treatments with few benefits - if any at all. Robin Hanson explains why using more drives up costs, but not health. We need a way to discourage people from taking what they don't need.

*Thwart the insurance oligarchy by allowing people to purchase health insurance from other states. Currently no states allow it, and that's why we don't have a Geico equivalent for health insurance. These silly restrictions bring costs up by blocking competition.

*End mandated coverage requirements. Special interest groups, such as chiropractors, lobby to force insurance companies to provide their services. Chiropractors are like Shriner clowns - silly on the surface, but surrounded by the hurt and writhing. I want to be able to find a health insurance plan that doesn't cover nonsense like spinal massages, magic wands or therapeutic astral projections.

*Provide "death panels." I'm sure they're rather be called triage teams, but there's nothing logical about this right-wing scare tactic against a government-run health care plan. As Milton Friedman said, "Nobody can accept the principal that an infinite value should be put on an individual life." There is a limit on how many resources should go into helping one person, be it in a life-or-death matter or something trivial. It's what the health insurance companies do now, and should continue doing.

*Tax health care benefits. Companies don't "provide" health insurance to their employees - they lower their wages and buy health insurance with the money. One of the reasons companies do this is a tax dodge - this switcheroo currently keeps people from having to pay their full share of taxes, even though health care is just as much a part of their salary as the dollar bills.

*Snag the freeloaders. I suppose it's good that we have legislation that force hospitals to treat everyone, but hospitals have little recourse for people who choose not to pay for health insurance and just head to the Emergency Room when something comes up - knowing they won't have to pay. We could install some kind of debtors prison system or work-release program. Anyone who doesn't like this solution is free to start a charity to pay for those bills.

*Cap malpractice insurance. People don't sue bad doctors for malpractice; they sue doctors they don't like. These lawsuits drive up the cost of being a doctor- even good doctors have to pay an armload to insure against it. Even if this has no impact on insurance rates, this solution comes with the added bonus of keeping money out of the hands of lazy freeloaders and black-hearted lawyers.

*Accept that price increases will not go away. Health technology is unique that instead of getting cheaper over time, like calculators and televisions, the price keeps going up. We have to realize that as we find more and more ways to improve the quality of a life, it will consume more and more resources in line with the complexity.

*Don't cherry pick the examples when talking about other government-run health care programs. There's a lot of talk about how well a government program works in another country. However, there are relevant examples of programs that failed in America. If you want to talk about the strengths of these programs, make sure you address the problems that caused similar programs to fail.

*Solve the pre-existing condition puzzle. This is the big riddle in health insurance. Poor people who already have a health problem can't get coverage for something they already have, but simply forcing health insurance to cover these costs would drive up costs. Just like letting people buy car insurance after an accident, covering pre-existing conditions would discourage people from buying insurance. That defeats the entire idea of insurance. One solution is forcing everyone to buy health insurance, but that didn't work very well in Massachusetts
. I don't know the solution to this problem.

I hope my list is enough to lay the foundation for a good understanding of what's wrong. I make no claim to have the solution to a very complicated problem, but I do believe these concerns need to be part of a real reform.

1 comment:

  1. It is true that Americans utilize too much health care treatments. I do agree with that, however, I don’t agree that raising co-payments is the answer. Co-payments are already astronomically high, even with some of the best health care coverage. This goes for premiums and deductibles, as well. My job at a hospital provides me with a very comprehensive, I am must admit, health care package. I only pay a premium of somewhere in the ballpark of less than 100.00 a month, with deductibles for major procedures of somewhere around 20 percent. I have had patients call in with insurances, though, that require THOUSANDS of dollars in deductibles, and cost somewhere in the ballpark of hundreds to close to 1000.00 a month or more. And this is through their EMPLOYERS, not just self-coverage, sometimes. Now, as for co-pays, mine are only about 20.00 a visit for most routines appointments. But multiply this by 2 or 3 times a week when you get a rotator cuff tear from filing charts at heights above your head all day for 2 years, times 6 months… This can add up to almost 200.0 a month!!! Well, I just don’t have that kind of money; luckily, I was able to find an extremely generous physical therapist who was kind enough to…shall we say…pro-rate this amount for me. Others are not so lucky.

    One solution to people consuming too much health care fare would be to more strictly limit the amounts and kinds of treatments that the people can receive. We would just need to intelligently and carefully structure and monitor the whole health care system on a needs-based level. It might not be easy, but this we could do.

    Allowing people to purchase health insurance from other states simply makes sound, logical sense. Why we are not already doing this is just bafflement to me.

    Some of your other points I won’t address, for various reasons. Don’t even get me started about death panels. I have really radical views on this one, that entail believing people should be allowed and even facilitated with ending their lives for more reasons than just what even most pro-end of lifers believe. As for a solution, well, I think you know what I would say. Health Care Reform, all the way.

    Hope you like your cheap Christmas gift. (Don't worry--you'll be getting some better ones.)