I am for universal health-care, meaning everyone is covered and the primary determinant of quality of care is not determined by dollars but by need. The primary vehicle to achieve this, as is done in virtually the entirety of the rest of the industrialized world is with a single-payer plan. This has many forms, from England's complete nationalized care where doctors, etc. are government employees to Switzerland where private companies do exist but they are heavily, heavily regulated (far beyond anything seen or contemplated in this country). Given the already existing structure in this country, the smartest way to achieve this would by extending Medicare to include everybody. A public option, along with increased regulation, may also achieve most of this, and I am willing to accept it as a compromise.
As a CPA, the single payer is the solution that makes the most economic sense. Private health insurance add 30% or more overhead to the cost of health-care, Medicare overhead can be as low as 3%. Who pays for that difference? You do, through increased premiums and increased tax dollars. It's not just evil or greed that motivates private insurers. They are obligated to increase the profits to their shareholders - it is their mandate and reason for existence. They do this by trying to limit their risk, taking greater premiums while minimizing claims.
As a Christian, I feel it is my responsibility, a moral requirement of my faith, to do everything in my power to make sure everyone is covered. There are other faiths and philosophies that will lead to this same conclusion. It is immoral to watch while people die because they cannot afford adequate health-care. It is unconscionable to stand by while people go broke because they get sick. To me, a society is without morals who let people get denied care because of pre-existing conditions. "Let them go to the emergency room" Who are we? Marie Antoinette? Do we have individual responsibility to help? ABSOLUTELY! Do we have a societal responsibility to help as well? ABSOLUTELY, POSTIVELY YES. There is room for caring people to differ on how this to be accomplished. What we cannot disagree on is that it must be accomplished.
Unlike some, I did not come to this conclusion by some horrific personal stories. I got bothered when my first job in accounting did not offer health insurance, and could not get my first wife covered by any one at any cost because of a pre-existing conditioning. I tried to engage the help of our conservative Christian congressman, who basically told me it was not his problem (this moralistic angel later wound up in prison for financing the building of his house with laundered drug money). This was over twenty-five years ago, and the so-called pre-existing condition has not cost anyone one dime to this day.
I have watched people tied to jobs they did not like in order to maintain coverage. I have seen people presumably well covered by health insurance struggle for months and years to get covered bills paid. In one place Alison and I came to work, we made acquiring health care insurance an essential condition of our employment. This also helped cover a woman who had worked for him for many years. He was notorious in not timely paying his bills. He fell behind in paying the insurance at the same time that the woman who had given so much of her life to him had been diagnosed with breast cancer. We had to force him to pay those premiums at practically the point of a gun.
I see canisters in convenience stores where families are desperate to get a child or loved one the needed care or operation just to survive. I know of countless barbecues and fundraisers that just break my heart that this, this is where we concentrate our efforts.
Please don't talk to me about socialized medicine. I care not a whit. We already have socialized medicine. No one gets completely turned away (I hope). We just do it in an inefficient, costly, and morally irresponsible manner.
How much will it cost you? How much money will it cost you if we don't? We already spend some $6,000 more per person than any other country, and with less effective results. Overall, the system with single payer or public option would cost less. Would you personally break even? It's hard to make changes and guarantee that everyone will be in the same position. But the odds are very, very good and I think it's more than worth the risk.
How much will it cost? How much will it cost our soul, individually and as a nation if we do nothing? I'm afraid it would cost more than we can measure.
Every single one of my friends is a good, caring person. But we have lived in a world inundated in the Reagan philosophy of hating government so long, it is almost impossible for some of us to get out of the box to think any differently. I see the government as just one tool in a box of tools to fix something. It just makes no sense to me, to take one of those tools and say oh no,no,no,you can't ever use that one. And I've stated elsewhere, I'm a big checks 'n' balance guy. I don't care what the solution is, it's not going to work without them.
If you have other ideas about how to achieve true universal health-care, please let me know. I may strongly disagree with you, but then again, at least on some elements of it, I may surprise you.
Thanks,
Tom Strait
Tom,
ReplyDeleteI agree that we need health care reform. I don't agree that expanding Medicare/caid is the way to go. Let me give you an example: 2 people go to the hospital for the same trouble - let's say for the sake of this example, a heart attack. Both people recieve the exact same treatment from exactly the same doctors and are admitted and released at the same time. Their bills are identical (ok, probably not completely realistic but bare with me). One patient has Medicare one patient has private insurance. One of the charges on the bill is for an echo cardigram. Hospital charges $3000 for this procedure. Medicare says that they will only pay $300. Hosiptal is forced to accept that payment from them. The hospital in an attempt to make enough money to cover the treatment, collects the whole $3000 from the private insurance (when in acuality the procedure probably only cost the hospital $1500). This happens every day at every hospital. What is going to happen to hospitals and the quality of care that we receive there if we are all on a Medicare-type insurance program?
BTW, while my figures may be off, this is a true example relayed to me by a friend who works in the finance department of the hospital.
:)
Thanks for your comment. I must say that you are talking about one of the few legitmate concerns that I've heard regarding health care reform, and that is the uneveness and inadequacy of some medicare reimbursement rates. Some Blue dog Democrats from rural states are concerned because smaller population states don't get reimbursed at the rate of larger states.
ReplyDeleteI see this as a problem that needs to be addressed in the broader context of health reform. It is easier to fix the rates so that the discrepancies aren't so great than it is to eliminate something as vital as the public option.
The Senate is considering now a bill that will help doctors with medicare reimbursement rates.
In my own experience with medical and health related businesses, I find a much larger problem with private insurers than with medicare/medicaid. A lot of my experience has been in the collectibilty area, and to that medicare/medicaid is vastly superior. Some of my clients have to routinely write off over half of their private insurance collectibles. Aging analysis shows that vrtually all the receivables over three months old are privete insurance related. All the hassles and calls, lawsuits to collect, etc, come from the private side.
When private insurers have to face true competition, both from the public option and the elimination of the anti-trust exemption, I believe that will drive reimbursements to a more even keel.
It is important to clarify what one means when one says health care reform. To me it means universal health care, with everyone having access and no one left out. I mean no more medical bankruptcies, no more pre-existing conditions, no more losing a job means you lose your insurance. What do you mean when you say health care reform?
Thanks for visiting the strait line!