Sunday, October 4, 2009

Health Care Reform (?)

Last week's news that health care reform bills featuring a public option failed to make it out of the Senate Finance Committee left me feeling that much more unsure about health care reform.

I'm a big proponent of a public option, though I'd rather we take a stronger socialist stance that would feature a single-payer plan. A lot of the arguments against the public option are that it would serve as a "Trojan Horse" that would lead to a single-payer system. Naturally, I don't see a problem with that, nor do I really follow the logic.

My figuring is that a public option would be able to provide affordable health care under reasonable conditions and rates. I think private insurance companies could compete, though they would most definitely see a drop in profits. If that means a rise in the quality of care, I'm all for it.

However, assuming private insurance companies could not compete and we actually did end up with a single-payer system, then I'm all for that too. Really all that would mean is that a privatized, profit-driven model could not provide adequate coverage and that the government could. If this scenario led to a rise in the quality of care, then where is the problem?

Still, I don't understand why public and private-run health care institutions could not coexist in a competitive marketplace. Industries like education and parcel services have existed under this model for decades and -- despite problems -- have managed to provide access to these needed services at a level that is usually acceptable. I'm not sure why health insurance would be different.

Nor do I buy into the argument that a public option or a single-payer system would put a government bureaucrat between you and your doctor. We already have insurance executives enacting that role now, so even if the mystical government bureaucrat accusation came to fruition, I don't think things would be much different than they already are.

Insurance essentially serves as a middleman, transferring money from individuals to a pool, and then to a health care provider. Ideally, all that should occur is paying a bill, but since overhead costs for private companies is usually 20 percent higher than those of public institutions, that pool isn't as large as it could be.

Despite all these setbacks to a public option, reform is apparently taking place, and the leading bill from Max Baucus might have a chance. I'm just concerned that without a public option it won't be as sweeping a reform as we need.

The Baucus alternative to a government run plan is to set up state-run exchanges to make shopping for insurance easier. I think the idea is that the people could see if they're getting screwed. My concern is that insurers could artificially inflate their prices as a trust or pool, which would still make insurance unaffordable.

The plan calls for subsidies to help lower-income families purchase insurance but does not require employers to provide insurance to employees, nor does it require individuals to purchase insurance. If these subsidies are not enough to make health care affordable to all -- and they probably aren't seeing as an estimated 25 million people will still be without insurance in 2019 -- and if people are not forced have health insurance, then why bother?

The large expense of emergency room visits will still be shouldered by taxpayers and the system could flounder. Not to mention the fact that this bill does little to provide anything resembling universal coverage. In fact, the tax proposed on high-end plans would probably encourage people to less adequately insure themselves.

The Baucus plan is essentially an extension of Medicaid, but it doesn't seem like the bill calls for enough money to enlarge Medicaid to the required extent. Also, Baucus estimates that American families will still spend roughly 13 percent of their income on health care. I'm not sure what the number is currently, but 13 percent seems high to me.

I certainly don't have the answer to all of this mess, but I do know we need money to make this thing work, and it has to come from somewhere. It seems to me that the extra 20 percent or so that private companies take for overhead and profit would be a good place to make up the difference, but the finance committee apparently doesn't see it that way.

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