Issues2004: Health care
: There can be no doubt that we are living in a health-care crisis in this country:
Too many are uninsured. Costs are too high at every level: doctor, hospital, drug, insurance. Insurance companies are trying to save money by making everyone’s life so miserable it’s just easier and cheaper to die. Paperwork alone is torture. Doctors are squeezed by malpractice suits and insurance — and paperwork. Hospitals are suffering. Employees who have insurance feel trapped by the jobs. Employers who offer insurance are seeing costs grow at incredible rates (40 percent in one year at one company I know). And on and on.
All the solutions proposed so far are inadequate and don’t begin to address the fundamental flaws, inequity, and illogic of the system. I’m not for nationalizing health care. But neither am I for letting the uninsured suffer.
This post is the first in a series on Issues2004. Remember that I am not an expert in any of these areas, nor did I report on them. I’m just a voter. And that’s the point. I want to learn more about these issues and want to have the forum to help push the candidates on these issues.
My wish list on health care:
: All citizens must be insured: If a prosperous society cannot help the sick among us, then what good is the prosperity?
Basic tenant: Every citizen (yes, citizen) of this country should be covered by health insurance and a prescription drug plan.
This also means that every citizen should receive the benefits of being part of a group. The serendipity of my getting insurance with my colleagues at one rate while my neighbor, who’s self-employed, gets higher rates is unfair, unjust, illogical, stupid, harmful, wrong.
And it’s expensive: Those who cannot afford insurance people end up going to hospitals and getting care that has to be paid for with higher rates for the rest of us, which means that insurance companies and employers and thus employees and consumers end up paying for the uninsured anyway. It’s broken. The only way to fix it is with the fundamental promise that all are insured. If we’re insured to drive, we should be insured to live.
: Insurance remains private: Who should run insurance? Government or industry. I say industry. The last thing we need is another inefficient and irksome government bureacracy. We need competition. We need choice.
: But who should pay? Think about it: By what logic should should employers have to be the ones who pay for health insurance? What started as a benefit of employment has become an entitlement for many, but then the rest are left out in the cold. Offering health insurance via work makes no sense.
My hope is that we all pay according to our needs with aid for those who need it. So I get a good group rate (see above). I earn a lot of money. I pay for my insurance. If I want, I can buy the deluxe insurance. If rates are fixed, most should pay for a good share of their own insurance (instead of paying taxes or higher product costs to indirectly subsidize their insurance).
Government support comes in a few forms: Those who help supplement insurance costs for employees or the poor get tax credits; that is one form of government support. Those who earn little and pay for their insurance get tax credits; that is another form of government support. Those who cannot afford to pay anything get on Medicare and Medicaid; that is another form of government support.
Who pays for that government support? We all do, of course, in the form of business and individual taxes. But run properly, this will end up being more efficient than the present system. And — pardon my lapse into supply-side social program economics — but the less companies have to build these costs into budgets indirectly, the better salaries and prices will be in the longrun. (Debate below.)
: Who should pay for R&D?: It is similarly illogical that through high drug costs, the sick underwrite R&D for new drugs to cure other diseases they don’t have. I don’t know how this system works today but it seems logical that government should help underwrite some cost of development — and then get the benefit for all of us of lower prices for the drugs that result.
I’ll say this again later, but I will add here: I support stem-cell research. I support science.
: The paperwork torture must end: Insurance companies are managing costs via harassment, in paperwork and in “managed care.” As I understand it, one great thing Canada did was standardize paperwork and bureacracy. With the Internet, it is now possible to standardize and modernize this entire system, from doctor to hospital to pharmacy to insurance company. It reduces the costs considerably for doctors and hospitals (and that should stop some of their complaining) and it reduces the hassle for us, the sick.
: Malpractice should be limited: But the threat of malpractice must remain over the heads of incompetent practitioners. We are still consumers of health care. We reserve the right to go after bad doctors — protecting fellow consumers from them — the way we can after bad contractors. And, yes, lawyers must stop being the primary beneficiary of the malpractice system.
: We must grapple with extreme care: I don’t want anyone unplugging me and letting me starve or choke to death. No thanks. And I hate seeing old people treated like the leftovers at garage sales. But I also recognize that some care is extreme and costs everyone a great deal of money for buying little hope. Who should set and enforce the standards of what is covered and is not? I don’t know. Debate below.
: UPDATE: TB in the comments raises a good point: People who don’t take care of themselves cost the system and us. So how about higher rates for people who not only smoke but, what else?, get fat, don’t exercise, don’t get preventive tests on a set schedule….
: UPDATE: A previous post on this topic is here. It caused good discussion and I wanted to link to it … but disorganized mess that I am, I couldn’t find it. Thanks to Brett, here’s the link.