Americans Get Expensive, Mediocre Health Care
Published March 17, 2006
Say what you will about national healthcare on an individual level, but on a macro level it seems to keep the population pretty healthy at reasonable cost. And it's not at all clear that waiting lists are an inevitable result of a single-payer system.
But rather than looking at the extremes, I think the more useful discussion would be "is there a combination that provides maximum choice while reducing costs appreciably?" And if we can de-link health insurance coverage from our employment status, so much the better.
I actually agree in large part with the Heritage Foundation on this, especially their assessment of the problems with the current system. We may quibble a bit on the details, but their system is workable and, with a bit of residual government involvement, equitable.
My solution would look like this:
Instead of employers providing insurance, they simply boost your pay by the current premium amount, and you go out and buy coverage yourself. Tax credits help ensure that the money is spent on healthcare, and that the very poor can afford healthcare. Future increases are left to the market: the cost of healthcare becomes just one more factor that workers consider when weighing a salary offer.
Medical costs would automatically become linked to performance, insurance products would become more closely tailored to individual needs, you wouldn't lose your insurance coverage when you lose your job (or be forced to change doctors when you switch jobs), and employers would no longer be locked into ever-higher medical premiums — eliminating a growing barrier to hiring. Small businesses — the engine of economic growth — could compete for the very best workers who might otherwise go to large companies simply for the cheaper, better health coverage.
There would still need to be some government involvement, to ensure adequate coverage for people with very expensive medical problems that a true market system, without the "group" aspect of coverage, would lock out. There might have to be a law requiring that everyone have health insurance, much like we do with car insurance. But overall you'd have better coverage and better care without a new bureaucracy deciding what each individual medical procedure is worth.
- Americans Get Expensive, Mediocre Health Care
- Published: March 17, 2006
- Type: Opinion
- Section: Culture
- Filed Under: Culture: Society, Sci/Tech: Health/Fitness, Sci/Tech: Life Sciences
- Writer: Sean Aqui
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Comments on this articleComments
Arguably, switching health-care purchasing decisions to individuals would lead to stiff competition, which would end up winnowing out many of the entities now involved in health care. So you wouldn't get single payer, but you might get a lot fewer cooks in the kitchen.
What you don't want is some version of airline deregulation, where price competition gets so cutthroat that service levels actually decline. We want to winnow out payers more than we want to winnow out providers.
Ultimately all of this screaming mediocrity comes down to the fact that doctors are limited in treating their patients by their malpractice providers.
In order for many to get discounts on coverage if they want to have access to working in hospitals, they are required to sign contracts wherein they agree to follow 'protocols' of care. The doctors in too many cases just aren't willing to take the effort to *listen* to a patient and modify a treatment to best suit that individual's need. Why make a sincere effort when it's so much easier to follow a 'jellybean trail' that reduces liability?
The problem is, these protocols created by the insurance companies are statistically generated on bell-curve averages - and God help the person that has a condition that is outside the curve - they are going to get harmed - or killed.
The real reform in healthcare will come when medicine is based on sound clinical science, not insurance generated, averaged, risk-assessed, charted, graphed 'damage control' protocols guaranteed to minimize risk for stakeholders.
Getting the insurance industry out of the equation would be the best start.
Deb.
I pay $59/month for what I consider excellent medical insurance. I don't think the system is as bad as it is made out to be.
One practical solution. For those on free government healthcare instead of providing them cocktails of high dollar diabetes, cholesterol, and blood pressure medications perhaps doctors could prescribe good old diet and exercise.
I don't think the government should be able to force people to eat certain things or exercise, but neither should those people be able to force the government to pay for their poor lifestyle choices.
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(Or ping: http://blogcritics.org/mt/tb/45107)
I'm more of the opinion that the immense number of entities involved in healthcare now is a bloated administrative nightmare. For many reasons, I'm in favor of single-payer financing, as advocated recently by Wes Clark. I think it's the most productive solution; but given differences over bureaucracy etc., I'm just happy that the subject is on the table.