You have to be for something


As we enter the final phase of the debate on health care reform, we seem no closer to consensus than we were in the 1980s.  I have also concluded that I could make the case for any approach from a total government program to the status quo, but that helps no one.   

If a government run program, an individual mandate, an employer mandate are all wrong, what is right?   Before you answer that question, remember that this is one big pool of money.  No matter how you slice it up we are all paying for all the health care provided in America today.  It’s like a motorcycle helmet law; some people would argue that they should not be required to wear a helmet because it is their right not to do so.  Okay, fine, but should you have an accident, be prepared to lie in the street with your brains all over the pavement until the rain washes you away because no part of society is going to be harmed by your foolishness. 

Let’s not forget too that the main reason people do not buy health insurance is because it cost too much and they would rather spend what they have on a more pleasant experience.  You can’t get a mortgage without have your home insured, you can’t drive a car in many states without having auto insurance, what’s the big deal here?  It is not your right to live in America without protection against forms of risk that result in society as a whole paying for your stupidity. 

In the process of trying to solve the health care problem you can’t be against everything.  The way all the bills in Congress are constructed at present means that people with health insurance and employers will pay more, while that is counter to the quest for “affordable” health care, let’s just tell people the truth and the consequences. 

A public plan will lead to well; eventually it will lead to forms of rationing to control costs.  That’s the simple truth and the people working on such a plan know that.  A public plan will also end up like all other such plans do, that is over budget and under funded.  You want examples of government run programs where the benefits keep exploding in successive Congresses without consideration for long term costs or the ability to pay them, Social Security and Medicare come to mind. 

An individual or employer mandate with the penalty for non-compliance so low a third grader could do the math and conclude the better deal is to pay a fine is pure nonsense.  Employers who oppose a mandate on them should think twice because they may get what they want.  Employers of any reasonable size are better off providing health coverage and other benefits than turning it over to a government agency (or even the individual).  They have more control over the expense, they can use their benefits in attracting and retaining good talent and when the distraction of medical care and bills affect worker productivity they can intervene to help solve problems.  Any employer that thinks it will have a better deal somehow by getting out of the health benefits business should think twice.  

What we need (aside from addressing the fundamental cost of health care) are better ways to spread the risk among medium and small employers, better pools and breaking down the barriers and constraints imposed by 50 different insurance commissions and we need to bar state mandates on health care benefits. 

I am not sure why we are even having a debate over a new public option.  If there is a group of Americans that will fall between the cracks of an individual or employer mandate, such as the unemployed, or the very poor, don’t we already have a public option in place that could provide coverage on an interim basis?  As I recall it is called Medicare.  The idea that a new public option with all of its added bureaucracy is needed to compete with private insurance is nuts especially when you consider the pending underwriting changes, pooling, a minimum benefits package and removing the obstacles caused by state based insurance regulation.  Unless you believe that profit has no place in health care (tell that to hospitals, doctors, and others) in any form, private insurance and self-funded employers are better positioned to both manage costs and innovate within the system.  The flaw in all this, of course, is the American people who believe that more and more costly health care is better health care and that no matter what their doctor orders it should be covered and reimbursed.  That means we simply ignore the tenants of medical necessity or reasonable and customary health care.  Is that what we want? 

So, along with the goal of understanding and managing the basic cost of health care (I am still trying to figure out why my wife’s ear infection cost over $18,000), we should focus on assuring that all Americans receive the appropriate health care, no more, no less.  Needless to say there is great disagreement on just what that may be, but one thing is for sure, we can do a lot better than we do today where the care provided is uncoordinated, often driven by perverse financial incentives or defensive medicine. 

It’s time to get everyone into the pool.

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