If one were tasked to design a health care delivery and financing system, with the goals of maximizing overall costs and minimizing efficiency, inserting as many layers as possible between the provider and patient, maximizing expense for those least able to pay, completely denying protection for those who need it most, and completely excluding over 15% of the population—while maximizing the power of, and the profits extracted by inert middlemen, who play no role in treatment of disease of injury—it would be difficult to improve upon the system we have today in The United States.
If the exclusion of millions of our citizens from health insurance coverage were necessary to maintain an economically efficient overall system, it would still be ethically unacceptable, but might be justified from a purely economic morally indifferent perspective.
Fortunately, we don’t face that conundrum. The same dynamics in our system which make coverage unavailable to millions of Americans, and prohibitively expensive for millions more, also add tremendously to the overall costs to our society.
We don’t even need to invent a solution from scratch. We are surrounded by countries with systems that work – societies that have advanced beyond letting for-profit health insurance companies pick the pockets of their citizens. None of these countries pay anywhere near what we do for coverage, none discriminates against low-income workers, small businesses and entrepreneurs, or the unemployed; and thirty-seven of them have broadly superior public health outcomes. Many of these other systems give consumers a much wider range of choices than most Americans enjoy. And none has anywhere near the US bankruptcy rate, the vast plurality of cases of which result from uncovered medical expenses.
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Questions ...
ReplyDelete- Why doesn't the "for-profit" motive work in the case of health insurance in the USA? In other words, if health insurance companies really are picking our pockets, then why doesn't someone start an insurance company that doesn't do that (and thereby only make a "fair" profit)?
- Which of the 37 countries with broadly superior public health outcomes do you want the USA to be like? And what is it about their system-that-works that you like? And why hasn't that happened in the USA "naturally"?
One theme seems to be "cut out the middleman" ... who doesn't want to do that (besides the middlemen)? Perhaps that is happening "naturally" ... and this current national debate is what that looks like ...
Doesn't this issue quickly boil down to "freedo"? It seems if what's needed is something that's not being provided by our for-profit system, then what will happen is forcing someone with money to use that money for the benefit of someone without money. I'm all for "doing the right thing" ... but I'd like to think that enough people would choose to do the right thing (rather than being forced to do the right thing) that we don't have to sacrifice much, if any, freedom.
Keep on posting your thoughts, Michael ... you're making the USA better!
Unfortunately I don't have time to compose a long post. But one of my concerns about the proposals on the table follows. I'll try to find time to post other concerns.
ReplyDeleteMost people with insurance are insulated from the cost of their healthcare by their insurance. Part of the reason insurance costs are rising is that the cost of health care is rising. Doug and I have catastophic coverage which means that we pay for all of our healthcare up to a hefty deductable. It makes us consider the $5 antibiotic instead of the $105 antibiotic; because my risk factors are low, I get a mammogram only once every 2 years; I don't take my kids to see their doctor when they exhibit flu-like symptoms, nor do I get a prescription for Tamiflu when one of us has those flu like symptoms; etc. When we just had a copay for all of our medical costs, I had no idea how much our appointments, treatments or prescription drugs cost and no reason to consider a lower cost treatment, or drug, or going without treatment. The proposals for reforming health reform do not address making medical costs visible to consumers. I have a hard time supporting a system that provides no information, much less incentives for people to consider various treatments which come at various costs.
Another concern - some of those healthcare systems in those 37 other countries you mention are going bankrupt. (France for one is closing rural hospitals due to the huge deficits it is running - source Wall Street Journal). Medicare is going bankrupt. Other government run systems, the post office, Amtrak, are also going bankrupt. I cannot support another inefficiently run government system.
ReplyDeleteHey Tonya,
ReplyDeleteI found that WSJ article
http://online.wsj.com/article/SB124958049241511735.html
interesting, but came away with a different conclusion than you (there's a surprise, eh?). Early in the article, the writer compares costs (11% of GDP in France to 17% in the US), and—qualitatively at least—outcomes. I checked the figures for his infant mortality example from the 2009 CIA Factbook; France 0.33% - 8th place worldwide, US 0.626% - 45th place WW. While the author asserts correctly that France’s Assurance Maladie is running 10% deficits, he doesn’t follow the math through. If they increased spending enough to balance that, they’d still only be just over 12% of GDP – still well below our spending – without the adverse health effects and financial ruin that result from inadequate individual coverage.
Rural France is facing some of the same issues we are here. The cost/benefit to providing care there doesn’t compare well to more densely populated areas. They blame the government; some people here choose to blame lawyers. Basic economics is the primary driver in both places. I feel that adequately funded rural clinics and hospitals are one of the best selling points for a more comprehensive health-care financing program than we have here. And note that the closing of that hospital is occurring under the Sarkosy regime, which is trying to move to a more market model. The best answer to healthcare doesn’t lie at either polar end—either fully private, or fully public—but somewhere in between. I think your ‘high deductable’ approach has merit for many people, but is a trap for folks on limited budgets, who may opt to not get important preventative care due to the expense. Sliding-scale co-payments might achieve a similar benefit without that risk. Don’t know.
I’m going to start a separate string on US Medicare. It’s a whole new fresh can of worms.