Wednesday, August 05, 2009

My Two Cents on Healthcare (Because that’s Its Value Now)

My own experience with health care lately has pushed me closer to the government, single-payer territory. Although I am a big supporter of the private sector, I have been wrestling with the idea of whether health care is a right that all citizens deserve from their government like the expectation of defense and justice.

To put it simply, I am all for reform and finding some way to provide health care for all who want it. I am skeptical, though, of President Obama and the Democrats of putting together a system that would work and not cause an even more economic burden.

My complaints and concerns are the same as what is prompting this push for reform. I obtained my own health insurance about 9 months after starting my job. I was a temp for the first six months and then had to wait another 3 months after officially being hired before coverage started. At first, I thought my health insurance package was fantastic. I never heard of the company before but hey, it’s not like I had a choice. What did it cost me? Absolutely nothing. My premium as a single was all paid for by my employer and this was both medical and dental. That changed at the beginning of this year when, because of rising costs, I had to start paying $10 for medical and $2 for dental with every pay period. The benefits seemed nice. $1,000 a year deductible, $25 co-pays, and 90% coverage for most in-network services. But it only looked nice on paper after I discovered how small their network actually was and what little gimmicks they pull to try and not pay out claims.

So what I liked was the excellent benefits (if applied correctly), and the low costs. What I didn’t like was the fact that I didn’t have a choice in what insurance provider I wanted unless I wanted to take a private plan which would cost hundreds of dollars a month (which in my mind, is not a choice). I also don’t like having coverage linked to my employment status. I also don't like the reality that care (or rather the payment of it) is being decided by people who have an interest in minimizing benefit payouts and maximizing profits.

What I would like is to see are multitudes of insurance companies that people can buy into that are affordable. I think the company that hires me should be able to provide me a list with insurance companies that they participate with and then I can choose a provider and a policy that works best for me. I don’t think that a person should be denied coverage for pre-existing conditions. (That’s not to suggest that they don’t have to pay higher premiums however.) I believe it should be harder for insurance companies to drop policy holders. As for the government and its involvement, I believe that it should provide health care but do so primarily as a social safety net: to bridge the gaps that occur when people lose their health insurance when they lose their jobs, or are too poor to pay for adequate health coverage, and to be called upon when something catastrophic occurs. People should not have to go into bankruptcy for health reasons.

I believe that funding a program that covers the gaps for the tens of millions without health care would be more cost effective than trying to mangle and then patch a system that already covers hundreds of millions.

1 comment:

QuakerJono said...

I think the company that hires me should be able to provide me a list with insurance companies that they participate with and then I can choose a provider and a policy that works best for me.

And after you get that, ask for a golden baby unicorn, too! Dream big or go home. :)

Truthfully, though, that will never happen because of the notion of "health insurance" itself and the concept of adverse selection. Health insurance companies make money by collecting premiums from people who specifically don't use their services. However, those are also the people less likely to buy health insurance, either via a private payer or employee sponsored. In general, people who are anticipating large medical bills are the ones who buy insurance and, thus, the insurance company loses profit.

It therefore never behooves an insurance company's business model to offer "choice" in plans a pricing structure, at least not too much. Certainly, some anticipating greater medical costs would opt for the higher-end plans, but should those costs materialize, the insurance company stands to pay out more money than they made from those high-end purchasers as well as the money they made from low-end purchasers who rarely if ever use their plans. Obama's work around on this is mandating that everyone must have coverage. This theoretically gives the insurance companies more incentive to play the numbers game. Sure, they can add high end-plans knowing they'll lose money on them, but they will have more aggressive buyers for the low end plans because, legally, everyone will have to have one. So our nation's health becomes a pure numbers game.

My problem with this, other than a profound skepticism it'll actually work, is that the health insurance company model in this nation is borked in the first place and all the current health reform bills seek to do is transpose the private sector model into public government. So instead of having a health care system that doesn't work, we'll have a federally implemented health care system that doesn't work.

However, with that said, I still support reform and Obama's plan in general. It's clear the system as it currently stands does not work. Obama's plan represents the best, most realistic effort we've had so far (or currently have at all) to try and address at least some of the issues.

Although, when you hear stories about people contacting their senators to say things like "Keep your government hands off my Medicaid", I do start to wonder if a working health care system is advisable as, clearly, some people are too stupid to live...