First, let me go on record as being a supporter of a single payer approach to medical care. I think that, in time, we will become enlightened enough to get there, but not this year.
With that said, here is what that I think is possible to attain, and it is much better than nothing. Please help me to punch holes in my approach, because this is an extremely complex subject and even I (LOL!) can not get it all correct.
First, there is the ideal and the realistically attainable. In our current political environment, the ideal is not attainable. That is just the horror of reality.
Ideally, all United States citizens (and legally admitted folks from foreign lands) should never have to worry about paying for medical care; it would be a birthright, or an acquired right by being legal. Some of the tenets that I will propose may anger progressives, but believe me, I am a progressive but I have a feel for what is possible and what is impossible. Let us concentrate on the possible first, then refine it.
As much as I would like to see medical insurance corporations be nationalized and disbanded, it will not happen in the near future. They have too much money, and are part of of the capitalist system, for good or for ill. We have to deal with them, and any thought of disbanding them is verging on foolishness. However, they need to be regulated to a very large degree, and that is not being done at present.
I also believe that what is being called the “public option” should be pursued with vigor. One of the mechanisms to reign in the insurance corporations would be to give them a run for their money. I do not intend to deny them a fair return on their investment nor their business activities, but I certainly deny their right to make obscenely high profits from essentially ripping off people.
First, and this is sort of a Republican talking point (even a stopped clock is correct twice a day), state regulations need to be eliminated and only a national standard should be adopted insofar as what the policies have to offer. State regulations and restrictions on coverage are so diverse that it is almost impossible to write policies without having separate insurance companies under the umbrella of a big one, and that by its nature increases cost. I do not advocate taking the states out entirely, and actually want them to have the lead in regulating insurance companies in their jurisdictions, but rather suggest that a consistent set of guidelines, nationwide, be adopted as a minimal standard that all insurance carriers would have to obey. If individual states want to enact more coverage, then there should be an interface with the federal authorities that makes any of those available for everyone, or rejected. This would level the field between the states, and also take away the influence of the deep pocket money on a local level.
I do not support the “make insurance coverage across state boundaries” idea. That is the Republican “free” market idea, and all that it does is let the big companies root out some smaller ones in several states. This is a transparent piece of bull, sorry, Big Corporate love that the Republicans have with Big Health.
Second, and at the risk of another Republican talking point, I do believe that there should be some mechanism to address frivolous lawsuits against good physicians and institutions. We all know that there is certain element in the legal community that says, “If we lose, you only pay my fee and the court costs, but if we win I will call you partner.” This has to end. I know for a fact (and it a current one) that medical incompetence causes a whole lot of suffering, disability, and even premature death. In no way am I averse to legal action that attempts to compensate those wrongs.
On the other hand, one sees on the Fox “news” network all types of adverts from those very “trial lawyers” who want you to hire them to get you a settlement for any number of conditions, all of which are connected to “deep pocket” defendants. This is just wrong. If anyone has actually been damaged by poor medical care I believe that legal action is a proper thing. But this has to be tempered with the pursuit of justice, not the dollar. I guess that I am agreeing with President Obama that “defensive medicine” is a very costly and poor way to treat patients. Running every test in the book just to keep the attorneys away is not good medicine, but that is the situation right now. By the way, the malpractice insurance companies are another set that need to have their wings clipped substantially. They make a fortune off of many physicians who are never brought to court. This should be a completely different piece of legislation.
Third, the medical records system needs to be revamped, but this is extremely tricky. I agree with the President that putting them online would be a good thing, but I also know about sites being hacked. Hell, even the secure military site gets hacked more often then we would like, so what evidence do we have that medical records archives would not be? None is the answer. But there is a workaround, and that is to take the profit motive out of medical care. In that case, no one would be interested in a particular person’s medical file, other than for treatment, since no money would be involved. Until the profit motive is removed from health insurance, I will continue to be extremely dubious of this idea, but it could work in future.
Forth, the concept of “pre-existing conditions” must be eliminated. This allows the big insurance companies to cherry pick their customers, taking only the relatively healthy and rejecting the ill folks, who need insurance the most. After I was discharged from my last job, I did the COBRA thing for a while, but it was too expensive. I now have a catastrophic plan, for almost $200 a month, that does not cover drugs (fortunately I need none) nor dental (I do need some attention there). All it does is cover me if a bus runs over me, but if I need get a wellness checkup, forget it. I am considering dropping it, since I am not worth anything insofar as money goes any more.
I guess that my point is that the insurance companies tend to maximize profit, and if it costs the health of the insured, well, so what. This is why we really need a public option, to take those capitalists out of the equation. The public option would be a zero profit firm, using the incoming payments to support the staff and pay the claims, whereas the current system gives the shareholders lots of profit, and the executives millions of dollars per year.
Fifth, this is both a moral and a fiscal issue. On the moral level, why should anyone other than the actual providers (I mean the physicians, nurses, hospital employees, and some funds to maintain and improve the hospital) get any money from you or me being ill? But the insurance companies profit off of it all the time, and want us to keep out of medical treatment, ill or well, because it widens their profit margins. Those on the top of the food chain make millions of dollars per year in salary, and get whopping stock options as well, usually more than their salaries.
The fiscal issue is even more important. Health “care”, actually “ill care”, costs us in the United States around 17% of our GDP. In all other industrialized nations, is is around half that. Why is that? Well, it is pretty easy to figure.
In the first place, the overhead for publicly run health care systems is around 7%. That is not unreasonable, because the folks working there need to get paid. Most charities would be singing a 7% administrative charge from the rooftops as being the most efficient known.
Well, in the United States, the overhead for medical insurance corporations is more like 30%. So only 70 cents on the dollar, not the near 93%, goes to medical care. Where does the rest go? It goes to the corrupt executives of the health insurance companies, and to the shareholders. Oh, it goes to several members of the Congress as well. Check out the contributions to Max Baucus, for example. Although he purports to be a Democrat, and is the chief Senator writing that version of the health care bill, he has received over the past five years $3,973,485 in campaign funds from the health care industry. We need better Democrats. Do you suppose that some of that money might have come from the 30% overhead? You be the judge.
In summary, the health insurance companies need to be severely regulated, and the days of protection be gone. I advocate doing away with them all together, but that is not possible at present. Their profits should be restricted, and excess profits plowed into a public plan. Then, over the years, the government should acquire their assets so as not to screw up retirement plans for many citizens who have invested in them. Complicated? Very much, but we can crack this nut. Any suggestions are welcome, and should also be sent to your Congressional agents.
To post on Dailykos.com when I awaken tomorrow and after I buy groceries and do some chores.
a sensible approach to this problem?
…the other day, I found that the total cost of medical care use in the U.S. in latest figures (2008, I think, maybe 2007) works out to a rounded:
$3750 per person for all U.S. citizens, legal aliens and illegal aliens in-country during the year.
All medical care received by the uninsured – which is now estimated to be 51 million in 2009, NOT the 30 million Obama mentioned in his speech on Wednesday – works out to a rounded:
$1,250 per uninsured person. IOW, the uninsured are a health care costs bargain.
These figures and accompanying information tells me some things…
1. The uninsured use far less medical care than the insured. This makes them a highly desirable pool of “new customers” if they can be forced to purchase for-profit insurance, especially with government paying a portion of the premiums.
2. The government is going to keep picking up the full tab for the elderly (greatest costs, least uninsured), the seriously compromised via Medicaid, and the impoverished young (SCHIP). So for-profit insurers are still left with a relatively healthy pool.
3. Poverty is increasing during this depression much faster than state Medicaid/SCHIP programs can keep up with. Many or most of the newly impoverished used to have good jobs and insurance. They are also a desirable pool for the for-profit sector, even those families with a child who has asthma or some other pre-existing condition. They make money off the rest of the family, and the government pays the premiums.
Now, why do you suppose the government – including the legislators – would want to overpay for-profits to cover health care that in reality costs a mere (relatively speaking) $3750 per person in this country all added up?
See, even junk insurance policies will cost at least $10,000 to $12,000 per year. That’s the insurance overhead for all those spreadsheet murderers plus bonuses and outlandish salaries at the top. Why would anybody in their right mind pay a thousand dollars a month for what costs in reality $317 a month all told? That it’s the most expensive and least effective medical care in the civilized world is a whole other issue. Deal is, if we just paid the actual costs – via graduated taxes on the rich for this purpose to cover subsidies for the poor and those in the middle just paying their share – we’d have universal care covered 100% right now.
Everything about this debate looks to me to be smoke and mirrors.