busy
haikujaguar tipped me to an interesting article which proposes alternatives to the kind of universal health care currently debated in Washington.The Whole Foods Alternative to ObamaCare
"The problem with socialism is that eventually you run out of other people's money." —Margaret Thatcher
With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people's money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.
While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:
That opening quote is hilarious, and I should point out that it's equally true of the government budget in general, which is raised from taxes.
Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).
This might be advisable, though it should be examined closely first. The main problems with HD plans is that people often buy them because they can't afford (or can't qualify for) anything else, when those plans are not suitable for them; and that people often cannot afford a savings account to cover what the policy won't cover. Before taking steps to expand HD plans, steps should be taken to address those problems. However, HD plans are very useful to people who rarely need medical attention, so should be available for that purpose.
Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.
I strongly agree with this.
Repeal all state laws which prevent insurance companies from competing across state lines.
This is probably a good idea, since the current system cuts down competition in ways that favor insurance companies over consumers. However, I'd want to investigate why those laws were created in the first place; if they're intended to stop specific problems, that needs to be addressed.
Repeal government mandates regarding what insurance companies must cover.
I disagree with this. In my experience, companies often make choices for their own benefit at the expense of their customers. I believe that removing these mandates would allow insurance companies more freedom to cheat people of medical care they need.
Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.
I'm ambivalent about this. Ruinous lawsuits are certainly a problem, and certainly contributing to high costs of health care. America's legal system is turning into about as much of a disaster as its health care system. However, it is equally true that medical mistakes injure and kill thousands of people per year; those people deserve recompense for their loss. I'm not sure whether more laws would improve this situation. Other methods might be more effective. Finally, a key reason for medical lawsuits is that some people have no other way to afford care. Removing that pressure would be more effective than new laws.
Make costs transparent so that consumers understand what health-care treatments cost.
I agree very strongly with this. It's difficult or impossible to make good decisions without accurate, complete information. I would add that we also need access to studies that show how effective (or not) various treatments are.
Enact Medicare reform.
This is probably a good idea, although I suspect we might differ on the details.
Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.
I strongly agree with this also.
There's a basic activist principle that you should team up based on common ground. Work with whomever agrees with you on a given point to promote that. Then switch partners if needed for the next round. I wish our politicians would do that, because some of these points would gain much wider support than the mass package they're currently trying to shove through. Also, it's easier to work on the hard stuff if you have several easier successes behind you.
In this regard, if there are petitions or other support options for the above points that I agree with, I'd be happy to see those. I don't actually like or trust the government, I just think that things are so terrible that even the government might manage to suck less. If some other solution could be made to work better, I would prefer that.
Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?
In fact, I believe that people have a right to food and shelter too. Why? We are guaranteed an inalienable right to life. If that does not include the basic means needed to sustain life (food, water, shelter, clothing, health care) then it is meaningless, because depriving people of those things tends to reduce or remove their life. In ancient times, people had access to territories from which to gather what they needed to survive, which cost nothing but the time and effort to gather them. Modern society no longer allows people to do that, for the most part, so it is obliged to provide an alternative minimum support. Otherwise, people suffer and die, which undermines the health of the society, impairs its function, and causes other societies to criticize it.
Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.
It would certainly be a great idea to work on prevention instead of cure, and to make people healthier. The problem is that we're unhealthy because we've designed a society and infrastructure that makes it easy to do the wrong things and hard to do the right things. People are extremely resistant to many changes that would help. Outlawing tobacco would help; the tobacco companies are rich enough to prevent that, so far. Rezoning unhealthy types of fast food to the edges of town rather than the center would help; the business sector is against that. Banning high-fructose corn syrup as a food additive would be a huge help in reducing both weight and diabetes; the food and farming industries are against that. Reducing cancer risks would be really hard, because we've surrounded ourselves with carcinogens in our foods, homes, and products of all kinds. We could start banning all sorts of known carcinogens, but almost all businesses use them and scream hysterically when even one is threatened -- as witness the recent resistance to banning bisphenols from baby bottles. Ensuring that all urban areas have sidewalks and bike paths would improve fitness; that costs money and people don't want to spend it. Urban design for walkability would have similar benefits; businesses have spent decades fleeing in the opposite direction. It is the responsibility of individuals to live as healthy a lifestyle as they can, but it is the responsibility of society to create circumstances that support this. It is unfair, stupid, and wicked of society to set up unhealthy conditions and then blame individuals when most of them become unhealthy. That's like blaming the animals in a factory farm for getting sick.
We need more than health care reform, really. We need social reform -- and most people simply do not want to do that, and fight against it.
On a related note, I've observed that many people arguing against "socialized medicine" do not ackowledge (or perhaps realize) that we already have multiple versions of it in play. Congress has a lovely health care plan paid for by taxpayers. Elders have Medicare. Military personnel have medical services through the military both during active service and afterwards through the VA. For those people who oppose a health care system that provides for everyone: Are you also against the socialized medicine systems we already have? If so, what would you do to replace them? If not, why is socialized medicine okay for some people but not for everyone?
August 12 2009, 19:46:50 UTC 11 years ago
Seriously, when the Democrats leave power and the Republicans come back (as is inevitable with our system swinging back and forth), do you want them in charge of making your health care decisions? Somehow I doubt it.
I've been wanting to do something about health care for years, so it's not like this is a one-party issue. I'm all for tort reform particularly because of my studies about what it was doing to doctors. And I'd want to take health care reform one idea at a time... not just throw a ton of ideas into the pot and have some mishmash result that I couldn't figure out what was responsible for what.
Hmm...
August 12 2009, 20:46:35 UTC 11 years ago
I hadn't heard that point raised before. Let's see ...
Top 10 countries by population:
China
India
United States
Indonesia
Brazil
Pakistan
Bangladesh
Nigeria
Russia
Japan
The first major European country is Germany, in fourteenth place.
http://en.wikipedia.org/wiki/List_of_countries_by_population
Of those top 10 countries, China, India, are Brazil described in some detail regarding their universal health care systems. Pakistan, Russia, and Japan are also mentioned as having universal health care, but not cited.
http://en.wikipedia.org/wiki/Universal_health_care
None of those are countries commonly cited for having a terrific health care system. I'd consider China, India, Pakistan, and Russia as having actively bad reputations for health care. (But then, America is developing a bad reputation now.) Brazil is eye-catching in this context because that country has been making dramatic headway in some regards, moving towards a more sustainable future. Plus they're only two steps down from us in population. The health system is described as underfunded but rapidly improving. So I'd consider Brazil to be a relevant comparison and worthy of further investigation.
http://en.wikipedia.org/wiki/Health_care_in_Brazil
The description of American health, particularly in comparison to other developed nations, is not flattering:
http://en.wikipedia.org/wiki/United_States#Health
So there seems to be a correlation between "developed" and "smallish," and "underdeveloped" and "large." If national population is a serious factor in quality of health care, we need to deal with that. I don't think people would go for shrinking the country, even if it could be proven prudent. What we have now, with insurance companies holding down near-monopolies within corporations, cities, and states is not working. What about something in-between, like dividing along regional lines and creating several universal plans that would be big enough to bargain effectively, but small enough to function efficiently? I don't think anyone has explored that possibility yet.
>>They can barely manage anything else. <<
I agree with that. It's an indication of the insurance industry's epic fail that I suspect the government might exceed their performance.
>>Have you talked to any doctors? <<
Yes. Mine favors a single-payer plan, and says that his colleagues do likewise. As I have heard a variety of other opinions coming from various health care providers, I believe that they are no more unified than the rest of the nation, but are broken into clusters based on their experiences and what they believe would work best for them in their practice.
Re: Hmm...
August 12 2009, 20:47:12 UTC 11 years ago
No. I want to be in charge of that. But I'm not, and under the current system, can't be. I have no health insurance, so anything above trivial cost is simply unavailable to me; the system would blithely stand by and watch me die. I was told that quite bluntly once. If I were to be able to afford insurance, decisions would then be made by the insurance company, not me or my doctor; I've had that experience also.
I am so extremely displeased with these two options that I am willing to give the government -- which I do not trust either, but which does a fine job of providing socialized health care to politicians and an adequate job of providing it for seniors -- to make an attempt. I do not anticipate the government would be excellent at providing health care to everyone, but I suspect that it would be at least a marginal improvement over what is available now. If I had decent health care, I would be more reluctant to let the government try. If the government tries and fails to provide decent care, I will feel free to criticize that too and demand something more competent.
I am further severely disturbed by the fact that the insurance industry has killed health care reform five times in a row, using nearly identical tactics and making nearly identical promises; and every time, the promises have failed to materialize and the situation has gotten worse while corporations and executives got richer. This makes me feel that America is being fleeced and that the current system needs to be replaced. Is there any evidence to support that we should believe the insurance and drug companies that this time they really will fix the problems and deliver on their promises even though they did not do so any of the previous times they promised to fix the system?
>>I've been wanting to do something about health care for years, so it's not like this is a one-party issue.<<
I've been aware of the problems for years. Only recently have I been driven by utter desperation to involve myself in a topic that I usually expend energy to avoid.
>> I'm all for tort reform particularly because of my studies about what it was doing to doctors.<<
I'm flexible on tort reform. The legal system is a mess too. If this could be done without harming people or allowing incompetent health care workers to go unpunished, I'd be in favor. So I think it has potential.
>> And I'd want to take health care reform one idea at a time... not just throw a ton of ideas into the pot and have some mishmash result that I couldn't figure out what was responsible for what.<<
Well, an incomprehensible tangle is what we have now, and almost all health care providers complain about that. I do think that taking health care reform one item at a time would yield better results than what we have now, which is an endless repetitive argument that nobody ever seems to win. And I'd start by looking for points that had a high level of agreement. Transparency, for instance, has many people and health care providers supporting it; pretty much the only opponents are drug companies and some insurance companies. Most people think that prevention is a good idea, though it breaks down when they look at what that would actually require; but maybe some aspects could be found that would be highly agreeable. So I've been looking more towards isolated aspects, because it looks like the morass in Washington is going to drown this reform again.
Anyhow, thanks for this article, it had some salient ideas. And thanks for pointing out the population divergence between U.S. and the countries with the most effective public health systems; that will have to be accounted for one way or another.
Hmm...
August 12 2009, 21:10:01 UTC 11 years ago
You and I seem to agree that the patient and the doctor should make the decisions about a person's health, right?
One current argument (valid or not) against a government-run health plan of any kind is that government bureaucrats would make those decisions instead of patients and doctors. Yet a widespread complaint voiced by many patients and doctors regarding the current system is that insurance company bureaucrats (or for that matter, hospital bureaucrats, if you owe the hospital money) wind up making those decisions. I believe the underlying complaint is the same: medical decisions ought not to be made by people without appropriate medical training who are not placing their own bodies at risk.
Given that many people feel the current system does not reliably place choice where it belongs, and many people feel a government-run system would not either, what else could we do? Is there a way to break the conflict of interest between an organization spending money on a sick person vs. pocketing that money? Has this topic come up among your relatives/friends in the health care industry, and if so, what are their thoughts about it? Or are they working in a part of the field where it's not a prominent issue?
So far the only idea I've had along these lines is nonprofit care, which consistently outperforms both for-profit and government versions. But that definitely has a size problem. Nonprofits tend to be small, and it's hard to make them work on a large scale. I'm not sure they could be made big enough, or made numerous enough and networked, to solve this problem. But it's the closest I've come, so I'm still collecting data.
Re: Hmm...
August 12 2009, 22:37:21 UTC 11 years ago
August 12 2009, 22:41:41 UTC 11 years ago
I'd like to hear the articulate reasons, and weigh them against the reasons for leaving people without any access to health care at all.
August 12 2009, 22:44:14 UTC 11 years ago
I think this is barking down the wrong tree, and I'll continue to say so. I want a weaker federal government, not a stronger one.
August 12 2009, 22:48:02 UTC 11 years ago
August 12 2009, 22:50:09 UTC 11 years ago
August 13 2009, 17:19:53 UTC 11 years ago
August 12 2009, 23:19:23 UTC 11 years ago
1. It's a choice. If it's not a good choice, companies can still use the incentive of a *better* choice to attract employees.
2. Doctors, nurses, etc? They're still independently employed. I know a doctor who won't accept medicaid because of the paperwork headaches attached to it. She'll treat patients for free & ask them to write to Congress about it. This could still happen under this system.
3. The nature of insurance (whether provided by the government as in a single payer system or provided by private companies) is such that someone is always making decisions about your health care other than you & your doctors. What's covered? How long is it covered? Can I even afford the co-pay?
4. Current solutions are untenable. As a healthy 20-something, it cost me nearly $400 per month to maintain coverage under COBRA while I was unemployed. Private insurance was nearly as much for even less coverage.
I'm very much in favor of tort reform, as long as it's done carefully. But we're working on having no OB/GYNs as their malpractice insurance costs keep going up & up.