Tuesday, March 28, 2006

California Dreamin': Health Care

One of my gripes with both parties is that they don't have any really bold ideas suited to the 21st century. Most of their ideas are retreads from the past. Take Health Care. Most liberals are still pining for some kind of Canadian-style single payer health care system while most conservatives seem to think the market can solve all problems. As someone has noted there is a ton of energy on both sides to stymie the other, and meanwhile the amount of people without health insurance increases.

There is some need for bold thinking in this area and it will require both government and the market to increase the number of those insured in our country. Clive Crook writes in the April,2006 issue of the Atlantic that the answer might be health savings accounts with government subsidies for the poor. David Lesher presents serveral bold ideas in an op-ed from the San Francisco Chronicle including health care. His idea? Treat health insurance like auto insurance:

Employer-based health coverage is an anachronism in a new economy where the average job tenure is shrinking and companies compete globally.

The most promising and politically feasible route to universal coverage is to make an adequate level of health insurance mandatory, accessible and affordable for all individuals.

That means government, employers and individuals each share responsibility for extending insurance to the 7 million Californians left out today.

I think this makes sense. Instead of trying to put the private health care sector out of business, lets have government and the private sector work together towards universal health care. It makes no sense that you can't drive a car off a lot without insurance and yet we can walk around without health insurance. Governor Mitt Romney is trying to do just that in Massachusetts; making health care mandatory while offering subsidies for the poor.

As someone who has been without health care many times in my life, I know that we need to solve this problem. In the volitile economy of the 21st century, an employer-based system makes no sense. Liberals, to their credit, know this and Conservatives can't hide behind the fact that we have a one of the best health care systems in the world when a large minority aren't able to access it. However, Liberals have to acknowledge that you can't realisitically get rid of the private sector in health care (at least a third of the Canadian Health system is private), but we can steer the market to be more compassionate while being competative.

We need leaders who are willing to put down ideology for pragmatism and solve this issue. But we also need a public that demands change.


Time said...

In todays right leaning American society it's hard to get "social" legislation passed.
Some problems are so large that only a federal solution will help.
I don't have a detailed solution, but I beleive the country will have to accept a "socialist" national program of some kind to solve the health insurance problem for all Americans.

fmodo said...

Right on.

The only way to get an acceptible level of fairness in health care is through government action, and the only way to prevent the whole US health care system from becoming an echo of the Veterans' Health Administration is by maintaining market pressures for good service and cost savings.

As much as it pains me to say it, the 'managed competition' concept of the Clinton plan was not too far off the mark, in retrospect, even if their implementation was poor. Mrs Clinton did not bring the important players--insurance industry, medical professionals, hospitals--into the process of developing the plan itself, ensuring their universal opposition when it was announced. In the current environment, each party is beholden to different healthcare stakeholders.

The lesson is that any plan will have to provide all stakeholders some semblance of a feeling of participation, even if they don't get their way, if it is to succeed.

dorsano said...

Single Payer means a lot of different things

Medicare is single payer - there's one payer - the U.S. Government - it pays a standard (negotiated) fee for a given diagnosis or procedure. Since the fee is standard, the private sector providers compete on quality and service.

The administrative overhead of Medicare is 2% - 3% - 97 cents of every Medicare dollar goes into health care (contrast that to HMO's which by their own accounting is 10% - though it's more like 15%)

Canada has a regulatory component in there system called "Global Budgeting" by some - it's similar in some ways to utility company regulation.

Medicare and Medicaid spending account for over 1/3 of all the money spent on health care.

That means 1 out every 3 hospitals. doctors, nurses, surgeons is funded by Medicare.

Medicare and Medicaid have built much of our health care infrastructure.

HSA's - if they become the norm, will destory it.

dorsano said...

HSA's reward healthy people - if you don't get sick and don't use all your contributions set aside to cover the high deductible, the contributions carry over and earn interest.

Contrast that to an HMO plan where a family pays around $12,000/year whether they visit the doctor or not.
HSA's are fine and dandy - but 80% of the population is healty - the 20% that aren't can't afford to keep all our hospitals open and our health care professionals employed
HSA's don't scale - that's to say, the greater their acceptance, the poorer they will perform

But they are a great deal for healthy people right now - and an even better deal for healthy, rich people because of the tax benefits