Wednesday, June 10, 2009

Universal Health Care

Universal health care should not cost any more than we currently pay for health care. It should end up costing less. The difference would be how we pay for it.

Currently, there are four types of people:

1. People (and their families) who are covered by employer-sponsored insurance. They get a decent deal on it because they're pooled with their co-workers, but it's still expensive. Their employer pays part or all of the cost of health insurance, and this is one of the perks of having a job at a particular company.
2. People who are covered by private individual insurance, who are not pooled with others, and therefore pay more (on average).
3. People who are covered by government-sponsored insurance (medicare, medicaid, or a state program). Depending on the program, they might pay a premium, co-pays, or other costs, but a lot of the actual cost is shouldered by the government (i.e. your taxes).
4. People who are not insured and pay directly for their health care, unless they can't afford it, and then the government or the hospital foots the bill. When the hospital pays, you can bet the cost is defrayed by increasing the bills of other patients.

In other words, all of the medical costs are being paid, either by employers, employees, patients, or the government. Insurance companies are middlemen who do worthwhile business because they pool patients and calculate risk. They make money by taking in (via premiums) more overall than they pay out.

Here's what would happen if we switched to a single-payer system:
Everyone would be covered by government-sponsored insurance.

1. Employers would not pay for health insurance for their employees, and the money they save on that would probably go to higher salaries. There would be an additional income tax for health care that would be taken out of your paycheck like social security.
2. People who were covered by private insurance would pay into the government health care fund via taxes instead of paying a private insurance company. They would benefit by being pooled with the rest of the country, and pay based on income rather than risk.
3. People who are already covered by the government would probably stay the same. If they're paying a premium, they wouldn't any longer.
4. People who are not insured now would be insured. As mentioned above, you are already paying for their medical care. You would continue to pay for their medical care.

Health care would cost less than it does now.
The cost of providing health care for the people in group 4 would be no more than it is already. In fact, it would be less, because they would be able to get preventive care, which is a lot cheaper than emergency care. Filling a cavity costs more than a routine cleaning. A baby costs more than a condom. Dialysis costs more thaninsulin shots. Get the picture?

Another benefit is the pooling of everybody: some people don't have health insurance because they don't really need it. Honestly, I don't really need health insurance. I am in good health and unless there's an unforseen accident or disease, my health care is relatively cheap, even with preventive care (4 doctor's visits a year, plus 2 dentist visits). Still, I pay almost $200/month, with a very high deductable, just in case. I can see where someone who is more of a risk-taker might save their cash and forego insurance. If these people are forced to be insured, the overall risk is lower because they need less health care than people who are currently insured. (This is the plan on the table right now, that everyone be required to have health insurance, whether it be private or government-sponsored.)

There would be no middlemen. Sure, there would still be the bureacracy of collecting the health care taxes and paying the doctors, but it would be much simpler. Your doctor wouldn't have to employ three office workers whose job is to argue with the insurance company, or keep track of which patient has which insurance, and which insurance will pay for what test/procedure. Most importantly, there would be no insurance commercials or insurance salesmen to pay. Hartford would be devastated, but the rest of the country would be happy.

Halfway isn't good enough.

The president started off talking about medical records, and getting them on computers. It astounds me that my doctor's office still uses paper files. They have a computer in each exam room, but they still have to look in a manilla folder to find out my name and age. Yeah, switching over should eliminate some of the cost and miscommunication. But there's so much more that can be done, and people are whining about how much it's going to cost.

Part of the hurdle is supposedly that people in group 1 like the insurance they have and don't want to change to Medicare. The current proposal is to add a government-sponsored health insurance as an alternative/competitor to private insurance, so that people can keep whatever coverage they have. I like my doctors. I want to keep them, and switching to a government-sponsored insurance might threaten that. But if everyone had the same health insurance, then all doctors would take that insurance, and I'd still be able to see my doctors. The fact is people don't care what insurance they have, they care who their doctors are. So while the current proposal sounds like a good compromise, you can bet that plenty of people won't be switching over, simply because everybody won't be switching over. Even if it's cheaper in the long run.

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