Friday, February 16, 2007

A simple fix for a our health care crisis

I'm starting another, and perhaps the last, brutal work rotation this week. I'm anticipating 14 hours days with little opportunity for breaks so posting is likely to be erratic but I'll be publishing short takes as I get a few moments starting with this piece. .

The NYT makes a good argument for a single payer system. This is simplest explanation I've seen on why a national health care system would make sense. To deconstruct it a little further, the problem is we spend twice as much as other developed countries for inferior levels of health care services because under private insurance, companies spend about 1/3 of their costs on administration, largely because they're trying to avoid insuring people who really need health care. Bad for profits.

The two main obstacles to public acceptance of national health care is perceived cost and resistance from the insurance industry. Those who wish to further privatize the system sound the alarm on taxpayer costs. And yes, taxes most probably would have to be raised to pay for the program, but what the privateers don't mention is that increased taxes would be offset by lower costs for health care and have the added benefit of providing coverage for the millions of uninsured. And those who feel they don't want their tax dollars to cover "dead beats" might consider that they already do cover those costs with ever increasing premiums as hospitals and insurers pass on the cost of covering the uninsured in the most inefficient manner, mainly hospital ERs, onto policy holders.

The second biggest hurdle is the insurance lobby which of course will fight tooth and nail against anything that threatens their profit making machinery. The author suggests a solution.
The first step is to acknowledge that insurance companies are not evil, that they invested in good faith under tax laws that favored employer-provided private health insurance. To put them out of business with an overnight switch would be unjust.

Even so, they are not entitled to a permanent license to operate a system that has become economically unsustainable. The move to a single-payer plan would save far more than enough to compensate insurance companies for lost profits. Compensation for losses could start at 100 percent, then be gradually phased out as companies shifted investments elsewhere.
I have a little problem myself with the notion that insurance companies aren't inherently so greedy that it rises to the level of evil but nonetheless this seems to me to be a practical and equitable solution.

I would note in addition that I have had a lot of medical practitioners of various stripes in my life and am well aquainted with how the system works. Doctors spend countless hours filling out paperwork for the multitude of plans. Often the cost of preparing the paperwork exceeds the reimbursement and the hospital or practice will eat the cost but the overall expense is passed on to the consumer in raised costs and the quality of the services provided is diminished because time spent on paperwork is time that won't be spent with patients.

Further doctors must weigh reimbursement in ordering treatments so to some extent insurers are dictating medical practices by reimbursing more for some procedures than others. Thus our health care becomes more driven by a business model rather than best medical practices. A single payer system wouldn't eliminate that entirely but it would certainly simplify the process and free the doctors to practice their profession rather than their bookkeeping skills.

Nothing is perfect but we can't afford to simply allow the status quo to perpetuate forever. A single payer national health plan is the best and simplest solution to a complicated problem.
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Anonymous Anonymous said...

I was originally opposed to national health insurance, but the more I see and hear, the more I realize that corporate greed is absolutely forcing us into this type of coverage. Since I left the nursing profession over a year ago now to do real estate full time along with hubby, I have been looking for an affordable policy for ER and hospitalization only. They don't exist. Every salesman I've been in contact with wants to sell me a full health policy with crap in house coverage. Harry and I are relatively healthy and can handle our own outpt expenses, but if one of us ends up having a heart attack or needing cancer treatment,I don't want to have to worry about it. There is now a new group of uninsured emerging; as people take early retirement packages, they are finding their health benefits cut or the cost going up to prohibitive levels. The biggest problem in the health industry is the "for profit" health facilities which have been allowed to operate. I've worked for both non profit and for profit facilities and I can tell you the non profit places were far superior in employee benefits and patient care. I am thoroughly disgusted with the whole process and we are now exploring a way to build up an account in stocks or something for paying large health care expenses.As more of mainstream America finds itself in our position, I think you will be seeing more favorable responses to national health care.

12:27:00 PM  
Blogger Libby Spencer said...

I'm also caught in the self-employed, self-insured trap. The bloody coverage costs almost as much as my rent. I could have bought a house with what it cost me and the hell of is, you don't want to use the services cause then they bang you with a huge increase in the next renewal.

What you're doing with building some kind of "health savings" plan is what Bush is proposing be mandated, but the problem is there's 40 million Americans at least who can't do that and the bottom line is you have to have a pretty huge nest egg to cover a castastrophic illness. I forget the percentage but I think the majority of bankrupticies are attributable to just that. My friend's chemo for instance, runs $35,000 a month for the treatments. He's lucky he's covered from a previous job.

There's got to be a better way.

4:28:00 PM  

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