Health Care- We Are All Screwed No Matter What Happens

I have been putting this off for awhile. The article has re written itself in my head multiple times and while I am not completely satisfied with its content today is as good of a day as any. This is going to be sort of a hodge podge of theories, potential solutions, the problem with them and different examples.

A good friend who is otherwise pro limited government is for a single payer Canadian style plan. Insurance has been recockulous for his family and the Canadian style plan might have some benefits for him. All principle aside I thought a lot about this and he has something of a point. For a person with some relatively main stream but consistent medical problems which require regular hospital visits this could be a good thing.

The main problem with that sort of an idea as I see it is that unless you are constantly having needs that can get addressed by an ER doc or a GP you will need to see an expert, possibly more than one expert. In a government run single payer system the chances of seeing an expert in a timely manner is about as likely as the sloppy drunk random who comes home with you from the bar being truthful when she says 'I've never done anything like this before'.

My friend Maggy and I have talked about this pretty directly. She is for a single payer plan because she has seen them work first hand in other countries and also for the practical reason that right now there is no way she can afford health insurance (though thankfully boy has it through Ex-hole). Since she has a lower income and no current coverage she would fare reasonably well under this sort of plan EXCEPT that it will hurt our economy. The people who would take the real financial hit for this sort of thing are the ones who would likely employ her (as an individual or in a small business) or be regular patrons of the sort of service/ disposable income kind of places she would likely work. So odds are that even though this would not cost her money directly it would likely take money out of her pocket one way or another.

Wifey and I had an interesting discussion about this. Her Dad has a real good job and makes what I would consider a lot of money. Not top 1% or anything but a hell of a lot more than average. He is high up in the company he works for and if laid off it is unlikely he could find another job at that same income. Little Sister in Law has a complex medical condition. She probably goes to 6 or 7 different experts and has a multiple doctors appointments every month. She is also on Human Growth Hormone (her and Mark McGuire:). There is no way in hell they could get private insurance with her complex pre existing condition. At face value a single payer plan might be a good thing for them. No worries about job loss or pre existing conditions excluding you from being able to buy coverage. Except the problem with this is that she currently has Cadillac health care. In a single payer system (true in the best ones and very true in the less good ones) care in managed to keep costs in line. Her far cheaper care would be much more Chevy or Daewoo style and would not be effective for filling her medical needs and having high quuality of life.

My best theory of how to make our system better has been as follows. Simply put insurance needs to go back to what it is meant for, occasional unlikely extreme circumstances. We all have car insurance but of we get a blown tire or need an oil change that is out of pocket. Insurance is or at least should be for when you wrap your car around a tree or get into a collision with someone else. Health insurance should work the same way. Pay for regular visits and occasional trips to the doc with a bad cold or even a broken arm with cash and have catastrophic healthcare insurance for genuine emergencies. Have a catastrophic insurance plan (between $1,000 and $10,000 depending on your income and needs) coupled with a solid emergency fund and a lot of people are good to go.

There are two real problems with this plan. First it will only work for basically healthy people who really don't use their insurance much and only have it in case something suprising happens so they aren't financially ruined. Those who need regular care (not yearly checkups and such) and or have multiple perscriptions would often not be well suited by a plan like this.

The second problem is that insurance works reasonably (yeah that can be debated but we'll get there later) because most people who have it are basically healthy. For every 70 year old with 6 perscriptions and all sorts of doctor visits and medical costs there need to be several 20 somethings who have insurance and don't cost the company a dime. Lets say everyone pays $250 a month (yeah people pay more than that and not everyone pays the same, I got it) and Mrs Johnson costs the company $1,000 a month. That means that without even factoring in administrative costs and profit (we will revisit this one) there need to be 3 people who don't so much as go to the doctor once to even out the costs of her being insured. So if every healthy person got catastrophic insurance and paid a far lower premium insurance companies would have some real problems.

I do however have a real problem with many conservatives who think our medical system is working just great. To be blunt I don't think our current system is working well at all for anyone except the very rich and a few who currently have really awesome insurance plans. Even for those who have 'good' insurance premiums are getting higher and they are buying less and less as services get worse while deductibles go up. I have seen this through my Mom's insurance over the last decade or so. Loose a job and you are screwed by 'pre existing conditions'. The current system we have jacks up the prices of everything so much that you basically need insurance.

We the functional people pay insane amounts for services (and by default insurance) because illegal immigrants and assorted poor people go to the ER because it is cheaper than buying some bandaids or cold medicine at Rite Aid. I am not advocating that people aren't treated for genuine life threatening emergencies. Don't think any sane person would do that. Imagine Joe Middle Class looses his job and thus his families insurance. Since they're broke the family is cooking hot dogs around a small bonfire, little Timmy slips and falls face first into the blaze. Joe pulls him out getting some pretty good burns on his hands. The Mrs gets you both into the SUV and drives to the hospital like it is the Indy 500. You get there and they immediately ask for pre payment, cash or major credit card only and it is going to cost $10,000. You don't have that in the checking account and the limit on your AMEX is 5k. They say fuck you and to get out of line till you can provide payment. That is more or less how it is right now in China and I don't think even the most heartless liberterian wants that here.

As for the talk about how we will save $1,200 because Homeless Joe or Illegal Jose will have insurance instead of just getting care and us eating the cost I am not so sure. Sort of seems like us the tax payers giving these people free or very cheap insurance 'saving' us money may be Enron style accounting but me is not an expert on that.

A single payer system will be good for the currently uninsured particularly those with low incomes at least if taken at face value. Everyone having the same access to medical care certainly fits some egalitarian points of view. One real benefit it would have is that it would effectively de couple having decent insurance that doesn't exclude anyone who has ever had anything wrong with them from getting reasonably priced insurance. For those who want to work for themselves, do some consulting or maybe underground work this might not be a horrible thing.

When it comes to insurance people far too often forget (mainly because insurance is so intertwined in our lives) that insurance companies exist to make a profit from providing a service. They want to get as much money from people as possible and manage to exclude as many expensive treatments and conditions as possible. Their desire to make a profit might just be better than a single payer system which just doesn't give a fuck. They light cigars with $100's and when those run out they just get more from the government which means us. So we loose either way.

So a single payer system sucks because at the end of the day they ration care and their is absolutely no incentive for the monolithic state health aparatus to be efficient, timely or generally do anything well. Our current system is rapidly going from bad to worse.

While I do have a few ideas on how to make things better (streamline real tort reform, refuse to pay more for meds than other countries, crack down on various fraud/ waste/ abuse, and a couple others) these are sort of like the lady argueing over getting 12 cents off peas and 87 cents off tortillas when she has $200 in groceries in the cart. They will not really change the overall financial situation of the thing.

For every possible plan there are strengths and weaknesses. I suppose finding a plan that is most tolerable to as many people as possible and completely intolerable to as few as possible is the best we can possibly hope for.

Lets look at this like an 'Adult Novelty' store. There are many different products some of which are fairly mild (r rated birthday cards, playboy, etc) and others are very extreme with everything in between. The common denominator of every product in the store is that in some way or another (if only symbolically) someone definitely gets fucked.

So basically we are all screwed.