Sunday, April 11, 2010

Healthcare Insurance System Reform

When a lot of people talk about the healthcare reform Congress just passed, it's some form of the question, "What exactly just happened?" There are a lot of details, but the two headliners are that insurance coverage can no longer be denied for pre-existing conditions, and everyone has to have health insurance.

For some, passing this bill is so distasteful as to somehow be associated with "Armageddon" (per minority leader Boehner). But when I step away from the hyperbole and fear-mongering (Glenn Beck, I'm looking at you), my short thoughts are: this is a good thing, it could have been a better thing, more is yet to be done. As to the title of the post, the reform that was passed was mainly a change in how we pay for healthcare rather than addressing the problems with the medical system itself, and I do believe it will have a positive net impact on us as a country. However, the most fundamental problem with how we finance health care has not been addressed, and that is that nobody--from the patient to the various team of healthcare providers--knows how much anything costs.

Maybe it's an extension of the obfuscated costs of healthcare, but discussions of healthcare as a "right" and the inevitability of "rationing" all stem from some absurd idea that the resources for healthcare follow a set of unique existential laws separate from all else we consume. Somehow many people seem to believe that nobody has a right to tell anyone when to pull the plug on Granny, but are hard pressed to explain who should pay for these expensive benefits Granny et al can't afford. The fact is, it's all expensive--very very expensive. And unlike everything else in my life that costs a lot of money, I'm prevented from doing cost research, taking advantages of sales and price breaks, or any of a zillion economic tricks that have kept my family living comfortably on a resident salary for years. But, it hardly matters when the bills are paid by the borg--some collective of University, government, insurance company, and hospital resources that combine to take care of things in a manner that recycles all the very real costs into a smattering of undetectable accounting tweaks that make me feel like I'm not really paying for it at all. It's an employment "benefit". Woop-dee-doo.

Anyway, all that is to say that in my view the real problem with the medical system is that people have not been allowed to understand the value of their care--how much it really costs. And until we are given that, other cost cutting measures are stop gaps that will only put bandaids on the severed arteries of our economy. This bill didn't address that fundamental aspect of cutting medical costs, and, somewhat understandably, that made a lot of people oppose it. I ignore the deficiencies in what the bill could have been in favor of appreciating what it did do.

As a nation, we've decided basic healthcare is a right. It's already done. That is to say, if someone shows up at the ER bleeding to death, we don't check their insurance status before saving their life. If they can't pay, we all pay for them. One can make the argument that this should change, but I don't see that as politically feasible, moral, or consistent with my own values. So, I accept as a given that everyone consumes healthcare in this country whether they pay for it directly or not. For healthy young people, the consumption is of the obviated risk of unfinanced catastrophic injury rather than direct medical care, but the consumed benefit is real just the same. Since everyone receives this benefit, it's only fair that everyone should be made to pay rather than freeload. And that's why I personally support mandated health insurance as an appropriate intrusion into our personal freedoms.

Detractors have many arguments against the reform, but the ones I hear most frequently are these:
- mandates are unconstitutional
- healthy individuals should not be made to pay for the benefits of the unhealthy
- those whose behaviors make their care more expensive should not be subsidized by their more personally responsible counterparts
- the government can't be trusted to do something this big correctly

I bit off more than I could chew by starting this post, because I realize to do it justice will take a lot longer than I have right now. But, add to my list of detractor arguments in the comments and I'll try to write more later. Thoughts?


Daisy said...

I agree that some reform is necessary and that much more should be done to really make change. I still feel like some issues were ignored with the insurance reform... It's funny how we're fine with everyone paying when we realize we're getting a better deal, but if we think some of our dollars are going to someone else, it's suddenly ridiculous. Though there are many good elements, I still look at it and wonder how sustainable our system is, and for how long...

Mrs. Donut said...

I am writing from a state that went wild when this passed. I heard a lot of, "Well, it was nice being part of the United States while it lasted. Welcome to the United Socialist States of America!" Not to mention all the chatter of succession! Yay, Texas! I am divided on the issue. As a consumer, I want to get quality health care. As a citizen, I want everyone to get what they need / deserve. And you are correct when you say that people just don't KNOW. So, I'd like to do more reading and thinking before I make up my mind for sure. My question is, and who really knows the answer, when will we as a nation begin to see and feel evidence of this change? Personally, when will I feel it? P.S. If Texas succeeds, I am moving . . .

Rachel said...

THANK YOU, Shane, for taking the time to post all of that!!!! I would love to hear more of your thoughts!

sph2 said...

Thanks, Shane. This week at work we had a representative of our health insurance provider (United Health) come to show us all that is available to us on line at "myuhc". One of the things that really interested me is a section where we can put in a procedure that we could be anticipating, options of who would do it and where it could be done, and receive probable costs, in advance. He told us of having put in a knee procedure to be done, I think in a north-east state. It showed the costs at two hospitals, one at twice the price of the other. And he said that the cheaper was the one most acclaimed as a great hospital. He said they want people to know their options and to be able to "comparison shop" even in medical care. It sounds good, if it isn't all hype.
Love, Mom H.

Mrs. Donut said...

I am mortified by my spelling mistake. Just, um, pretend like I am smart and treat me the way you might treat a smart preson and stuff . . . Wow, and I teach English and all that! Anyway, still, we won't sit around to watch Texas become its own nation, no, no we won't!

Harvey said...

Accountability is more important than cost transparency.

Cost transparency will aid those few already inclined to make better choices. High deductible insurance plans will increase the size of the group inclined to make better choices.

Princess Gerty said...

Cool to hear from your perspective. I have found there are opportunities for cutting costs. When I pay a provider cash out of pocket, they usually charge me a lot less and share ways of saving money. Also, there is a health discount program we have used in Arizona that has been better than insurance.