March 24, 2010

Random thoughts on healthcare

I haven't fully digested the bill yet, but I'll post a few random thoughts.

For one thing, anyone who says "the current system is the best in the world and doesn't need to change" hasn't been paying attention. We spend the most per capita, yet we have lower life expectancy and higher infant mortality than many other "Western" countries (not by a huge amount, but for as much as we're spending we should be the best in all these categories, and we're not!)

Part of that is lifestyle, certainly, and changes should be made there, but it's NOT as simple as "so lose weight and go out and buy insurance" like I hear so many people saying. In this country, under the "current" system, it's legal for insurance companies to deny coverage for conditions that are unavoidable. For example, in a pure free market system, no sane insurer is going to cover a Type 1 Diabetic (and KNOWING how much I cost them, I couldn't blame them -- but THAT'S the problem, profit shouldn't be the motivating factor when it comes to people's LIVES). I'm fortunate enough to live in a state that requires coverage of "pre-existing" conditions (after a one-year waiting period -- if I let it lapse, ever, the clock starts ticking again and I'm paying for everything out of pocket) for an employer who provides coverage (companies are NOT required to sell to me as an individual, and even if they did the rates would be astronomical -- thus preventing me from ever taking the risk of opening up a gamer-friendly tea shop)

Some states don't require coverage of diabetes supplies at all. That kind of INCONSISTENCY needs to change.

So, require insurance companies to cover preexisting conditions? Fine, but that opens a DIFFERENT can of worms - people who choose to not have insurance, then get sick and buy it. This completely changes the dynamic of insurance companies' intake vs output, and would bankrupt them in short order. Thus the need to require everyone have it -- that measure is for the insurance companies' BENEFIT, but I don't have a problem with it.

The new rules AREN'T socialized medicine. People who say "now we're trusting the government to make our health care decisions instead of us and our doctors making them for ourselves" are forgetting that in many cases, we ALREADY don't make our own decisions. If you have insurnace, then the insurance company can and will dictate what it covers (again, I know this all to well from experience, having had to fight for almost a year to get coverage for my continuous glucose meter), and if you DON'T have insurance then the decision is based on your budget.

I have concerns and questions about the new rules -- what's it REALLY going to cost, will it REALLY improve coverage, etc., but SOMETHING had to be done, at least now we're talking about it.


Paul Moravec said...

I agree to some extent but believe it is certainly a step towards more socialized medicine. Frankly the government already significantly impacts the healthcare industry due to Medicaid and Medicare as the reimbursements for procedures that insurance companies use are often based off what the government pays. This gives government more control over healthcare, now with enforcement ability straight from your paycheck through the IRS, and just like they do with highway funding they will use reimbursements as a club to insure states do what the federal government wants.

The other major issue with the bill is that, no matter what people may want to believe, it does NOT just impact those that are now getting covered for the first time and those with pre-existing conditions. It will impact all of us. You can not add 30+ million people to the equation of available hospital and doctor time and not think it will result in delays for the rest of us in receiving care and seeing our costs go up. The number of doctors is relatively fixed. Allegedly costs (read payments to doctors) will decrease so where's the motivation for more people to go through med school? There isn't. Doctors in most demand will move away from accepting insurance (many already only accept cash and force the patient to deal with getting reimbursed) and they will raise prices wherever they can to cover the relatively low reimbursement from those covered by these newly created plans. Guess who will see higher rates, yep those of us with employer sponsored plans.

Additionally, employers that are forced now to provide insurance to all employees will either have to raise their prices to cover the additional outlay (consumers covering the increased costs), reduce numbers of employees, refrain from hiring additional staff, and/or put up with decreased profit/income (not likely to happen). Some employers that currently offer insurance to employees at a higher level than what the government will enable through their exchanges may well step back from their plans resulting in employees with less coverage than before.

Then, as you mention, there's the question of how much this will really cost us. No one knows and I don't think for a second that their estimates of how much they'll "save" are accurate. They first assume that the rate of increase they've seen recently continues on into the future and then make a bunch of assumptions about how much what they've written into law will decrease costs. Neither of these assumptions are likely to be valid as insurers, employers, and citizens will find loopholes in the law. Additionally, since this is a phased approach to control, we will see insurance companies increase rates in the short term to try to cover what they forecast their losses to be under this plan in the future. So, sure there are some benefits to this bill but there are a lot more negatives, in my opinion, than positives.

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