First off, I’ve enjoyed this foray into the HoCo blog jungle. (Blog fight!) Thanks to everyone for reading, complimentary comments (the wife is not happy about the attendant ego swell: “Honey! I’m getting twenties of hits! TWENTIES!”), and keeping a fun discussion going. I wish I had joined in more on the commenting, but you guys stay up late.
HoCo Politico response here.
My response here.
HoCo Politico Response the Second here.
(After this, I’m going back to The Bachelor.)
It seems (although HCP has never come and said so directly) that we all agree health care, and the health insurance industry, need some change in the good ole U.S. of A. It seems (again, distilling here) that HCP’s recommendations are:
-Remove insurance from employer’s hands. A mechanism for this would be difficult, unless we replaced employers with the government, which I’m sure would not go over well with most of the country. I doubt the federal government would pass a law saying an employee subsidized insurance plan is illegal. Another thing ignored here is the simple fact that health insurance is not like other products. A car manufacturer gains economies of scale, and thereby lower prices, by making and selling more cars. They can expand into markets gradually, lowering prices while keeping or improving quality as they get bigger. Insurance is predicated on a large risk pool effectively soaking up those outliers who cost more. Cheaper insurance needs a bigger pool. This is why employer provided insurance is so effective -it guarantees a large risk pool- and is the thought behind the insurance exchanges proposed in current health care reform- pool all individual buyers together, rather than releasing them into a market to fend for themselves.
Wait. Let me say something. This was the best part of HCP’s last post:
“Do you have any solutions you’d like to propose? Heck, I’m throwing this out to any local bloggers (and blog commenters). HCR has made some proposals. I’ve made some. Let’s get some group think going here. Throw out some ideas!”
He’s right. We’ve been (happily) going roundy-roundy, but it would be nice to actually have some solutions, and I’m a firm believer in the hive mind. Here’s the ironic thing (for me): some changes I think are important in our status quo health care system:
-Ensure everyone (everyone!) has insurance. Yes, this would raise some health care costs for those on the right side of the bell curve, but I accept those costs in order to live in a more just society. This is easy to disagree with, and I understand that argument. It’s likely to be unbridgeable.
-Remove barriers to insurance, like exclusions for pre-existing conditions and caps to coverage
-Provide a pooling mechanism for those not covered under employer health plans. To me, this seems like a perfect place for the government to act as a single-payer, but I also see this as a bridge too far in our country. (Keep in mind I’ve been part of a huge government-run single payer system, and…it’s pretty good.)
-Since we’re not replacing the insurance companies but increasing their cost, we’re going to have get those risk pools as large as possible. In the absence of a politically unviable government-run insurance for those that can’t afford private care, we’re going to have to subsidize costs for the poor, then mandate everyone signs up.
-Hmmm, that last one is going to cost a lot of money. Let’s raise taxes (very slightly) on the top tier, tax capital gains as regular income, and sunset half of the Bush tax cuts over the next four years as we phase in this new health care plan.
What I’m getting at is the solution we’ve come to, as messy as it was…isn’t too bad. There are certainly some onerous requirements, but those can be fixed. (The Senate’s repeal of the 1099 requirement is a good example.) Heck, everyone is still so mad about it, it must be a good compromise bill.
Removing the state-to-state regulatory web is another good idea from HCP. I think this would increase competition and lower prices (although opening up the possibility of nation-wide monopolies and required federal regulation in the absent of states).
The final difficult issue is making people aware of what their health care costs. I totally agree with HCP when he reminds us that insurance companies are in the business of making money, not making you healthier (per se). Of course, that begs question, why feed more power and people into the maw of private insurance companies by mandating every buy their product, but let’s ignore that for now. The answer to consumers being abused by shadowy private corporations is generally government-mandated transparency, something lacking in the insurance industry, particularly given its largely sub-federal position. So my current suggestion…more federal regulation! Not good for conservatives, but hey, I’m open to suggestion. Let’s make costs an open book. My barber can post costs of services; can my doctor? I understand the complexity of care, and the sensitivity of “opening the cost kimono,” but still. If insurance companies stand in the way of that, we know where to target.
The wife and boy belong to Kaiser Permanente, which mandates you use their facilities and doctors, including specialists and the pharmacy. If they don’t have the specialist, they pay for it out in town. We love it. It’s simple, it’s effective, and the service is excellent. It is also the cheapest policy we were offered. This tells me the problem is not insolvable. They concentrate on efficiencies, and by bringing doctors, nurses, and pharmacists under one roof they can a lot. I don’t know how their salary structure works out for the staff, but our pediatrician is great.
Let’s end on a partisan note, because…why not? As HoCo Rising mentioned in a comment, saying health care is a right that must be ensured in a Just Society is not a platitude. It is an ethical stance that demands action. If your solutions do not meet this base requirement, they are inadequate. If you do not believe we, as a Just Society, must ensure health care is available to all, we have arrived at the proverbial sticking point. I believe conservatives in general, and the Republican Party in particular, are on the wrong side of history on this issue (among others). Reagan railed against Medicare in 1961; it’s now considered a right.
Personally, I think if you’re worried about big government, focus on one of the biggest parts: defense and security. Considered inviolable by too many, a few cuts here could go a long way toward securing health care for all. Those millions of Americans who will be covered under the new health care reform also deserve to live in a financially responsible country; this means both cutting spending and raising taxes, not one or the other. (Right now, anyway. We’re too far gone to focus on one side of the ledger sheet.) Sacred cows are not a good idea at the moment, and cutting PBS is going to do diddly squat.