Saturday, August 08, 2009

"Fixing" the Debate

We have two parallel and yet different discussions going forward about "Health Care Reform." One is about Health Insurance, and the other about Health Care.
Most of the debate has been about the greedy insurance bastards who are ripping us all off by reading actuarial tables and figuring out the probability of whether or not their company will still be in business in a few years. They are abetted in this scheme by the Insurance Commissioners of the several States who invent rules to control and oversee them. For instance, in the 1970s, we in Montana passed unisex laws for insurance for cars and for health. As a result, young males paid less in car insurance than young females, and more (if they bought it at all) for health insurance than they would have otherwise paid. It was a good idea at the time, but nobody reasoned it all the way out. As a result, Montanans pay more for both health and car insurance than many other states.
One of the proposals being put forward is the "public option" plan that would provide coverage to anyone without restrictions on pre-existing conditions for a reasonable cost. Seems imminently reasonable doesn't it? But what if you go with the public option and are paying only half of what you were paying before to a private insurer. You feel good about your wise decision until your wife finds a lump in her breast. You go to the doctor that you have always had, but she tells you that she won't treat your wife because the reimbursements are too low and she loses money on your insurance.
That's alright you say, there are other doctors, so you start to call around and all refuse your coverage, except for the guy who just had his license restored after being suspended for malpractice. You have health insurance, but if the doctors don't want to take it you don't have health care.
You start to realize how unfair the system is, so you start to demand that doctors accept your coverage. Unless you are willing to repeal the XIII Amendment to the Constitution, there is no way that you can force doctors to take your case. If the government puts caps on how much anyone can charge for care, you will find a large number of doctors dropping out completely and a rise in black market medicine without the necessary oversight and controls. So, that doesn't work either.
So you see, health insurance is not the same as health care. But what are we to do about it?
I have been kicking around some ideas for awhile, such as requiring doctors to post their fee schedule so that consumers can make informed choices. Doctors who are very experienced will be able to command a higher fee than less experienced ones, but it will be the patient who decides which doctor to use. Next, do away with employer provided health care coverage. If you are given something for free (ostensibly) you don't have much regard for its value. As such, you are willing to expend it on every little thing because the cost of the copay is so small. If you are someone who never goes to the doctor until ten minutes before you die, your employer was paying the same for you as someone who went every week for every little sniffle. If you are in control of where and how much money is spent on health care, you might use it only when you needed it, and not for every sniffle or cough.
Another suggestion I would like to see is to reactivate the Armed Services Medical School. This was shut down due to pressure from the AMA, but if we were to give people who wanted to be doctors a free tuition plus a GS-16 pay scale on the condition that they would have to serve for 20 years in underserved areas in the National Health Service, it would be a heck of a lot cheaper than trying to remake the health industry into Obama's image. By reducing the number of indigent who go to private practitioners and going to the above NHS doctors, doctors would no longer have to pad the bills paid for by insurance in order to cover the indigent. Win Win all the way around.

1 comment:

Anonymous said...

Great post. We have to have more facilities and doctors. Reducing non quality barriers to people to choose medical fields will be one way to do that.