Sunday, July 26, 2009

What can be considered health care reform a success

Last week, President Obama gave another prime time press conference, this time to talk about Health Care.

As my wife pointed out, if you've been following the discussion, he didn't seem to really add anything to the table. And if you weren't paying attention in the first place, I have the feeling that what he was talking about didn't make sense.

Part of the problem is that the health care debate is just complex. Just what *exactly* is the US Health Care system going to be like? Nobody really knows, because it's a huge problem.

You have 50 million people without health care. Some because they're just too poor to afford it, some because they don't think they need it (unless they get into an accident, fall off a tree, and then you'd bet they need health care). You have others that have it, but then either get denied health care for "preexisting conditions". Others who want it but can't get it because an insurance company isn't going to take on someone who's *already* sick, or someone else who had it up until they lost their job.

It's a huge complex stinking mess that, if you haven't read over the 100 years of history of health care in America to understand *why* it's so complex, it just seems like a bunch of nonsense that shouldn't be this hard.

It is a hard problem, though. It's hard because you have people who want health care, but don't want to pay anything for it. You have insurance companies who want to make money, which means (as per the capitalistic system) you provide the most care for the least amount of money - and that means if someone is already sick of cancer or some other very expensive illness, you're not going to add them on. And it's hard because there's a history of employer based health care for so many Americans, and which means once you change or lose your job (something that's happening a lot in this economy), you find yourself without health insurance even though you spent all that money on premiums for so many years.

I'm not going to go into the history here. It's long, sorted, full of lobbyists and stupidity and inaction. So instead, I'm going to list what I'd consider the basic health care plan needs to have in order to be considered "successful." Some of the things I list here are both what I'd like to see, and how I consider the country to pay for it.

No More Preexisting Condition

One comment I see a lot is "The market can solve the whole healthcare issue. Just get the government out of the way, and things will become cheaper!"

Amazingly, it hasn't worked for all these years. Unless by "get the government out of the way," you mean "don't allow health care lawsuits when doctors/hospitals screw up, don't enforce basic health care rules and regulations so people don't get defrauded out of real health care, etc, etc, etc."

The problem is that the insurance companies have already rigged themselves so they're above the fair market system. If I went to buy a car for $20,000, and the second I drove it off the lot it broke down, some people *would* say "Well, caveat emptor - let the buyer beware! Now you'll know better than to buy a car from that dealership/manufacturer again! Next time you'll spend your money more wisely!"

It's a nice thought in an Ayn Rand dominated dream world, maybe that would work. Problem is, if I just spent $20,000 on a car that I'm not going to get back, I'm just going to go out and blow it again on another car right away. I can't afford it. Maybe I can't even go to work anymore if I don't have a car. Now I can't even make another $20,000 for another car.

People realized this, and that's why we have Lemon Laws and other things to prevent people from defrauded in this country. Sure, to a certain extent, it's still "let the buyer beware", but if you offer a car and promise it can go 50,000 miles on a warranty, you have to fulfill that promise.

Right now, health insurance companies have this big escape hatch. If you get sick, and if they can prove you had a "preexisting condition", then they can deny you care. Sometimes that "preexisting condition" means things like "had a yeast infection and now that you have cervical cancer we can deny you care." Or other "reasonable" (hah!) excuses.

So that's got to be the first thing to go. If we expect people to have health care, then insurance companies can no longer be allowed to pull the "get out of paying free" card and say "Oh, um, you had a preexisting condition, we don't have to pay any more!" If you get sick, your insurance company has to pay for it.

And on top of that, health insurance companies are no longer to be allowed to refuse people to sign up for their health insurance program either. Doesn't matter who you are or what your health care issue is, if you want health care insurance, they have to give it to you.

Wait. There's a problem here. This can get expensive real quick for insurance companies. And let's face it, it isn't fair that suddenly they get hordes of sick people signing onto their lists. The way insurance is suppose to work is a kind of a bet. You're putting your money in because you're betting that sooner or later, you're going to need some help. Your $200 a month will go to pay for people who have their spot of bad luck. Or to pool resources so my $200 a month can go to pay a doctor's salary that can see a set of people, or pay for equipment so everyone pooling their $200 a month can use. If you start adding on just sick people, then you're going to have overworked doctors and have to buy new equipment all the time.

So we need a way to pay for it. And there's one way to make it fair.

EveryOne Must Get Health Insurance

Everyone. Every single person must get health insurance. No exceptions. Many states have laws on the books saying that they to drive, everyone must have car insurance, because when even the safest driver has an accident, someone has to pay for it.

If we're going to demand that insurance companies fulfill their obligation to give everyone the care they need, then we have to make sure that every single person is covered. There are two ways of going this - either the government pays, or individuals pay. What we're really doing is saying "insurance companies, here's another 50,000,000 people who are going to pay you money every month. Of that 50,000,000 people, odds are the majority are perfectly healthy and only need annual checkups. In return, you have to give them coverage."

There are going to be some people who are too poor to be covered, and that's where the taxpayers will have to step in. But for the majority, they can pay for it.

It all comes down to this: either individuals pay a tax to the US government who then pay the insurance companies, or individuals pay the insurance companies. If someone is unable to because of income, then people can step in. Maybe that means we take some money out of the defense budget (oh, noes - no more F-22 fighters that have never flown and don't do any good!), or maybe a 1% tax on people making more than $280,000 a year, which would hit 5% of the population (oh, noes, if I make $290,000 a year, then I have to pay 40% tax on $10,000 - I'll be ruined to go from paying $3,900 to $4,000 in taxes!).
I think you can sense my sarcasm.

You still have employers who offer employees health insurance, but now the US government can offer tax breaks to those who do. Those who already have health insurance keep it.

Just the Starting Point

If we start with these two elements, then you provide care to people, and prevent insurance companies from getting around the market system by playing the "oh, preexisting condition" game.

This is a good starting point. Now, I haven't gone into how we deal with people changing insurance companies or employers, or what we hold as a "basic" level of care. I'll cover that in another post, since this one has gone on long enough. More later.

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