I am writing to urge the neo-cons who are opposing an individual health care mandate in state legislatures to reconsider, because the ONLY alternative to an individual mandate is real, actual, honest-to-God government takeover of health care.

Think about these facts:

The basic principle of insurance is shared risk. Most people will not have their houses burn down, get cancer or get into catastrophic car accidents, but if we all pay something into a pool then those few of us who experience these misfortunes can get compensated for them. That's the whole assumption behind insurance.

Most people would prefer to wait 'til their house burns down before buying homeowner's insurance or until they crash their car before buying auto insurance. That's human nature. The only way to preserve the shared risk principle is to make people buy insurance whether they want it or not. That's why states require you to buy car insurance, and mortgage companies require you to have fire insurance.

This principle is very problematic when applied to health care because there actually are early warnings that you're going to get sick -- 'pre-existing conditions'. I have high cholesterol, so I'm more likely to have heart disease, for example. Health insurance companies try not to sell health insurance to people who are already sick, e.g. have pre-existing conditions, in order to keep the costs down enough that ordinary people will buy in.

A major difference between car insurance and health insurance is this: we require hospitals to take care of people with medical emergencies whether or not they can pay. We require them to treat the heart attack or stroke, which is very expensive, but we DO NOT require them to treat the high blood pressure, which is cheap. Nobody requires the body shop to fix your car if you can't pay for it. The costs of treating these uninsured people who can’t pay are a major factor in driving up health care costs for those who can. (There are other drivers of health care costs, too.) One important way to lower health care costs for those of us who have insurance is to increase the number of insured people.

One of the very few parts of health care reform that the Democrats and the Republicans seem to agree on is the need to get rid of pre-existing condition restrictions. So if you're going to get rid of those restrictions and allow everyone to buy health insurance, how do you prevent people from buying it only after they get sick? The answer, and unfortunately the only answer, is: a mandate that everyone buy health insurance.

Now, if you really didn’t want to have an individual mandate, what other alternative is there?

A lot of people (and I'm one of them) think that the whole insurance model as a method of paying for health care is fatally flawed. For example, I've owned a house for over 30 years and I've never made a claim on my homeowner's insurance. And I almost never make a claim on my car insurance. But I make claims on my health insurance every single year. I get my mammogram and my cholesterol test every year, and I fill my Lipitor prescription religiously every month.

Since everybody needs some level of health care, these folks argue, wouldn't it be better to cut out all the administrative costs of the insurance companies, which are very significant, and devote those resources to paying for actual health care?

There are actually two ways you could do this, but there are problems with both of them:

First, you could say, OK, the routine care that everybody needs shouldn't even come to the insurance company's attention, like my car insurance doesn't pay for gas and oil. If people bought high deductible insurance policies and paid for the routine stuff out of pocket, the premiums would be a lot lower. More people could afford them. (The problem with this is that people would skip the preventative services if they had to pay for them out of pocket.)

Second, you could say, OK, health care should not be organized the way it is in this country. It should be available to everyone, more like public education is. So then you'd have the medical equivalent of public school, tax supported and theoretically available to rich and poor alike. (You might still have private medical care, like we have private schools.)

I could actually support either of these alternatives. But neither of them is politically feasible. So how do you construct a politically feasible system where everyone has the ability to get health insurance at a price they can afford?

Unfortunately, you take the unwieldy, imperfect system we now have and you tinker around the edges. You keep the inefficient insurance model, get rid of the pre-existing condition restrictions, and mandate that everybody buy it. You try to control costs by strong-arming the doctors and hospitals. Etcetera, etcetera. Every feature of the proposed legislation that the conservatives are opposing is there because of this fundamental compromise.

Senator McCain is saying, go back to the drawing boards and start over. If I thought he was acting in good faith, I would agree. But I don't believe he is. There is no reservoir of good will between the parties, and therefore no basis for negotiation.

I would hope that, AFTER the Democrats ram through this imperfect compromise that will at least allow (almost) everyone to get health insurance, they will go back and refine it. And I would hope that, after the Republicans realize that they were totally irrelevant to the most important public policy debate in several generations, they will come to the table in a constructive manner.

Can this proposal be improved? Oh, yes. And maybe that will be the subject of my next email. Your thoughts are most welcome.

I agree- this is not about who is right or wrong- it's about us taking care of each other- and we seem to be the last industrialized country to get this- which I personally find shameful as we can certainly afford it.

If it bothers you that much, move.

Tax, that is harsh.

You raise many good points.
But, why should people that take good care of themselves or are otherwise poor risks pay the same as people that don't?
For example, people with bad driving records pay a more for insurance or are declined.

Medical insurance should have never been designed for preventitive medicine or prescritions.
If people had to pay out of pocket for this, prices would plummet because "price" would become a consumer issue and medical care costs, like everything else in this country would be looked at from a true "value" basis.

The fact that most people have to pay for their own dental work out of pocket keeps prices in line because of real competition. Dentists run ads with coupons,when was the last time a general practitioner did that? Never

While auto insurance doesn't pay for an oil change. Prudent people do get their oil changed and cars looked after every now and then, becuase insurance is not going to pay for a new engine or new car if there's stops running.

Imagine a world where people cared how much one pediatrican charged compared to another. We might get to know how much Dr's charge for diagnosis and prescribe a soltuion for our child's ear ache. Have we ever seen a list of prices that doctors charge for basic services? Nope. You do for dentists. A better example is anything not covered by medical insurance, chiroprator, lasix, plastic surgury, etc. These all are consumer driven, competitive services where prices and services need to compete for our business.

Let's start by:
Insure only for the big ticket medical issues (no more Dr. co-pays). We want our doctor to post his prices - consumerism will force prices down. Wouldn't it be great is doctors had to compete based on price for basic services like every other service providing business. Dr. expenses will also drop as they won't have to have three people assigned to handle all the medical insurance paperwork. Much less paperwork for insurance companies would also lower their costs tremendously.

Don't except non-emergency people in the ER's. Have a nurse as a gatekeeper. Ask any nurse or dr. and they will tell you that a small percentage of people in ER's actually need emergency care.

Allow insurance companies to offer insurance across state line - more competition lowers prices

Tort Reform - make the plantiff pay the legal fees if they lose (now there's no risk to suing anytime since there is no cost to sue) - also have more resonable caps


This is where I would start.

quote:

Originally posted by GE Mom:
We require them to treat the heart attack or stroke, which is very expensive, but we DO NOT require them to treat the high blood pressure, which is cheap.

I disagree with you here. I'm mid thirties and now on cholesterol meds and will, presumably, be on them until the day I kick it. But meds or not, yearly checkups with an expensive cardiologist or not, it's pretty likely that I'll still die of heart disease. It's practically a law in our family. Whether I die 10 years from now (same age as dear old Dad), 20 years from now (dear old uncle), or 30 years from now (dear old grandfather), I have a tough time seeing as it'll be cheaper for society. And meanwhile I'll be dropping $90 on my end (who knows how much of Blue Cross' money) per month.

quote:

But meds or not, yearly checkups with an expensive cardiologist or not, it's pretty likely that I'll still die of heart disease.

The reason we treat high cholesterol is that there is research that shows it does reduce heart attacks. If not, what would be the point in taking the medications?

True anecdote #1, more to follow.

A good friend has excellent health insurance. Just about any drug at retail costs him $10. He is also a very aware consumer and makes sure he knows what the real prices of prescripton drugs are.

He is a member of CostCo.

His daughter needed some pricey antibiotics. Full retail price at Walgreens - less than a mile from his home - was $125. Same exact prescription at CostCo - about 12 miles from his house - was $80.

His out-of-pocket is $10 no matter where he goes. He went to Walgreens. I can still hear him saying: "Why should I drive 11 miles to save my insurance company $45?"

I can also hear him following on with something like - "There is something VERY wrong with this picture."

I agree.

quote:

Originally posted by GE Mom:
If not, what would be the point in taking the medications?

Longer life. But it still has to end in some fashion.