Wednesday, 22 July 2009

From The Holy Texts

From Kevin Drum:
...[T]wo-thirds of the country already has health insurance through their employer and another big chunk are on Medicare. If these aren't going to be touched, then why should they care about healthcare reform? In particular why should they be willing to pay higher taxes for something that won't help them out in any way?... [T]he selling point of national healthcare is freedom from the endlessly gnawing problems of our current jury rigged system. For example: HMOs that make it hard to see a specialist. High and rising copayments. Fear of losing coverage if you lose your job. Long waits for non-urgent care. New (and usually worse) healthcare coverage every time your HR department is told to find a cheaper plan.
Let us now turn to our Sorkin, Chapter 4, Verse 12:

The specifics are always different, but the basic shape remains the same. If the powerful want to make an gesture that helps the poor, or those in other countries, or struggling minorities, or whatever, they need to make damn sure voters realise the exact reason there's something in it for them as well. I'm not particularly happy about that, but there you go. We've heard some things already about those people who think they're insured only to find the rug pulled from under their feet at the worst possible time [1], but it feels like the White House is spending too much time reassuring people they can still have their BS bastard-run money-pit pseudo insurances if that's what they want, whilst insisting the new health care proposals are for the benefit of the nebulous "other".

Of course, they might just not want to pick a fight with the insurance companies, but that fight has already begun, and it has to happen some time, and if it really is that the Democrats can't even be bothered to suit up, they may as well just give up on making a difference, ever.

Update: Publius briefly explains (amongst other things) why constantly reassuring people they can keep the potential stinking pile of shit they have is important; it's how the Republicans beat Clinton on the issue. It's a fair point, though it doesn't change my belief that there are serious message-balancing issues to be addressed.

[1] In a civilised society one would hope that there would never be a line of business with a vested interest in letting people sicken and die. The fact that the US not only has one, but it's actually the business designed to keep people healthy and alive, never ceases to make me mad.

1 comment:

Senior Spielbergo said...

You see to me this is a classic example of both sides having completely the wrong idea. Both sides are trapped in the notion that the Insurance model is the solution to providing healthcare, when insurance (by which I mean commercially motivated and underwritten insurance) is completely unsuited to the task at hand.

Insurance operates well when you are trying to insure against the unexpected catastrophe, the low frequency, high severity incidents. It can also be used successfully for the higher frequency low severity events, although largely only as a form of budgeting, and is normally better suited to self insurance. Where it completely falls down is in the prospect of high frequency and high severity events which is basically what the modern health care system represents. Maybe 75 years ago you might never set foot in a hospital in your life, and if you did it would largely be as a result of a one off incident like breaking your leg, that is not the case today. Today healthcare is about long term care and treatment for a whole variety of ailments that simply were not understood back then. Today you are virtually guaranteed of spending time in the healthcare system, and for at least most people this will include a period of long term care.

You’ve also got the obvious moral clash that occurs when commercial underwriting attempts to operate on health care. African Americans are more prone to heat issues and blood pressure problems, therefore from an underwriting view black people should be charged more. Poor people have a poorer diet, and are more prone to risks from violence etc therefore should be charged more. Old people are more likely to need long term care, so should be charged more. People already sick clearly are going to result in more long term costs and are ore likely to get other illnesses, therefore you should charge them more. Given that the system is essentially a replacement for taxation (people pay their health insurance premiums presumably instead of paying the relevant tax for the government to provide it) and I’m reasonably confident that a tax plan that proposed having increased taxes on those who are black, poor, old, or infirm would be shot down into tiny, tiny little pieces, It’s fairly easy to see that passing the buck onto Underwriters who are there to make such commercial decisions is not exactly taking the moral high ground. And this is before we get into the whole kettle of worms concerning an Insurers desire (and duty) to minimise their exposure through the use of policy warranties and exclusions.

This is the very definition of a fundamental risk, and one that can only realistically be provided for through a universal plan. Assuming you accept the fact that everyone should receive healthcare (and I think most people can get behind that) the only realistic modern solution is for a universal coverage plan to be provided by the government and funded through whatever tax system your citizens perceive as fair. Insurance companies can take on the less fundamental risks by providing cover for “better” private treatment, but the core cover realistically needs to be provided by a universal government funded plan.

Of course you’ll have to figure out what to do with all those Health Insurance employees who will lose their jobs, but at the very least they won’t lose their health cover if they do.