Tuesday, July 07, 2009

A Few Thoughts About Health Care Reform

Here are a few random thoughts about health care reform:

First, we absolutely require health care reform. This is not a nice to have, it's not about a long term wish list, we absolutely must have health care reform. It's the smart economic move. It's also a moral imperative.

Now let me tell you something about public health care. There's a lot of fear mongering going on these days about how bad public health care and "rationing" are. I would like to call bulls*** on that. The system we have in the US today can hardly be called a system. It's complex and it is unjust, but perhaps worst of all it's wasteful. Our system forces us to resort to all kinds of strategies for saving some money on medicines and treatment while ensuring that billions go to waste on needless administrative costs. Have you received a bill from a hospital recently? You are practically expected to haggle, much like you are in a rug store or a used car dealership.

I was born and raised in Israel, a state which offers a public health care system and in which each and every individual has health insurance. The health care in that country is no worse than the health care we get here. In fact, in many respects the health care system and the service to individuals is far superior to our experience in this country. I recently went back to visit my old homeland and had a first hand experience with the health care system. Comparing that experience to a previous visit to the emergency room in one of the top hospitals in the US, the service and quality of care we got abroad was superior. Hands down.

Last week I watched Nobel Prize winning economist Paul Krugman being interviewed by Charlie Rose on PBS. Here's an interesting statistic: according to Krugman about 60% of dollars spent on health care in this country are already spent by the government, between Medicare, Medicaid and the VA. Think about that the next time health care lobbyists try to sell you horror stories about how the country will go to the dogs if we adopt a public health care model.

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Ren said...

Clearly, what we have now has serious problems. But then, so do most other countries, though not necessarily the same problems and some may not be as serious.

However, one of the big problems we have is how much we spend on healthcare. Pointing out that 60% of our current spending is already done by the government just demonstrates that having the government take over isn't really a solution -- at least not to that portion of the problem.

My personal opinion on the matter is that most of the people with health insurance generally have too much of it. This means they pay more than they should and also results in a lack of appropriate price consciousness, helping to drive up prices.

Of course, there are many other factors as well, including over-testing, over-medicating, over-treating, etc.

Shadox said...

The fact that government spends about 60% of current health care dollars is due to the fact that Medicare patients are typically the old and frail... naturally, older and sicker patients cost more to provide health care services for.

I am not sure I follow you comment about having too much health care. We are a family of 5. My employer pays about $15K a year to cover my family. I pay an extra $5K (approx) for my portion of that coverage, and last year we had expenses of about $8K out of pocket in addition for actual medical care, prescription drugs etc. Did I add that we are a very healthy family with no chronic or serious medical conditions?

How do people with serious health problems even deal with the financial burden?

Saying that other countries also have problems - is forgive the expression - a throw away statement. Sure, everybody has problems. The fact that 46 MILLION of us are not covered is simply a travesty unmatched anywhere in the infustrialized world. We should be ashamed. Simply ashamed.

Ren said...

First, please keep in mind that I am writing these comments off the cuff, so it should come as no surprise that they may have some throw-away statements in them. Additionally, I've been lucky enough to have never had any issues with health coverage. Or, at least, I have to assume I've been lucky based on the horror stories people tell.

$20K/year for health care for a family of five sounds quite steep. I've tried to determine what my employer pays, and I think they used to tell us, but some quick searching did not reveal the answer. Our portion, which is divided between two employers, is about $1350/year for our family of four.

I don't understand how you have $8K in expenses with no chronic or serious medical conditions. My wife tore a tendon in her knee last year and yet our total medical costs for the year were still under $3K.

No doubt we have good insurance, but I actually did a search early this year and found that I could get private, high deductible coverage for something like $350/month. And the coverage was very similar to what we currently have -- a little better in fact.

My comment about many people having too much insurance is that I've talked to numerous people that feel that their health insurance should *save* them money when compared to their expected expenses. That's clearly not the role of insurance. Healthy people shouldn't expect their insurance to pay anything at all under normal circumstances, with the exception that I do think the concept of insurance paying for preventative coverage is ultimately in the best interest of the insurer as well as the insured.

You brought up the question of how people with serious health problems deal with the financial burden. Of course, this is one of the biggest issues we face, as the quality of treatments available continues to increase, along with the cost. I foresee no limit to how much could be spent in critical or chronic situations. The unfortunate truth is that there is no system were all options are affordable to everyone. I take that back, a system were there are only very limited options can have all of these limited options available to everyone. But I'm pretty sure that nobody actually wants that.

I realize that there are a large number of people in this country that do not have insurance. I even accept that a large number of those simply have no option. But I've read time and time again that the states generally do a fairly good job of providing health care to those who truly cannot afford it. The people that are truly uncovered are those that could afford it if they prioritized it high enough.

To that end, I am not automatically opposed to a system where catastrophic health coverage was mandatory. I could probably even support a scenario where a portion of our taxes went toward a generic, state-sponsored health plan, as long as you could get a credit for that amount paid toward a private plan.

My comment about other countries also having problems was really a weak reference to what I see as the looming healthcare problem of the future. As more and more treatments become available, at higher and higher real costs, people are going to want to avail themselves of these treatments to extend -- or better the quality of -- their lives. In general, people accept that only wealthy people get to live in mansions, own yachts, fly around in jets, etc., but when it comes to healthcare, most people feel that anything that medical science can possibly do should be available to them and their insurance should foot the bill. This is simply untenable.

My apologies for what I am sure is quite a rambling comment. I don't currently have the patience to re-read and edit it. I hope it isn't too bad.