Monday, August 10, 2009

Our Health Care Dilemma

Though I like to stay light and personal here, sometimes the political animal in me leads me astray. And as someone who has worked in the health care bureaucracy for going on 30 years, I find the present debate on health care intriguing.

From my vantage point, I can understand both sides somewhat. I’m within earshot of someone whose job it is to tell people without insurance that they are going to have to pay out-of-pocket for expensive but very necessary medical treatments. Something has to be done to made medical care more affordable. But I also realize that providing health insurance is so expensive nowadays that it is bankrupting American businesses. Imagine the costs of providing insurance to all.

Anyway, based upon the legislation that I hear most often bandied about in Washington, I have three questions:

1. If legislation mandates that pre-existing conditions be covered by insurance, what about those who do not get insurance until they are ill?

A barber in town once told me that his insurance had denied him coverage for a hernia repair. Seems that he did not buy medical insurance until he suspected that he had a hernia. Then he purchased a policy and had the surgery done. When the claims were submitted, the insurance rightfully rejected the claims as resulting from a pre-existing condition. The barber had tried to game the system but ultimately lost. Under the plans being considered now, wouldn’t he come out ahead?

Many of the young and healthy in this country see no need for spending thousands of dollars each year on personal health insurance when they have more pressing spending priorities, like a mortgage, student loans and credit card bills. What stops them from waiting until they are seriously ill to get insurance?. A $1,000 fine or something like that? They’d still come out ahead by waiting.

2. If there is a “public option”, how will private insurances compete?

Anytime there is a new treatment available, or a medical benefit that a particular group wants, insurance plans like Blue Cross/Blue Shield calculate the cost of the benefit and pass the cost along to its subscribers. That doesn’t happen with public plans like Medicare and Medicaid. And benefits with those plans are usually much more generous. For example, Medicaid pays for office visits, pharmaceuticals, surgeries and even nursing home care.

So if you had the option of subscribing to a private plan that essentially rationed your care—and most do regardless of the rhetoric you hear—or subscribing to a public plan where simple political pressure or lobbying by interest groups could provide you with better benefits, which option would you choose? This is why the insurance industry and many conservatives so strongly oppose the “public option.”

3. In any of the bills currently being considered by Congress, what will control the growing costs of health care?

Most of the bills I’ve seen discussed focus on health insurance to cover more Americans. Fine, but how will that control the escalating costs of health care? More people covered mean more people seeking services. Demand will certainly go up. So economics dictate therefore that costs don’t go down. Physicians are paid fees for services for the most part. More patients, more services, more fees. The drug industry largely supports the bills being discussed because more patients, more services mean more prescriptions. Covering those with pre-existing conditions mean insurance companies will be forced to pay for services where previously they wouldn’t. So their costs go up as well. How are the savings achieved?

Maybe I'll go to one of those town hall meetings to get some answers.

8 Comments:

Blogger Lynilu said...

If only we knew. As a person who found insurance premiums outstretching my ability to pay them, I was without for about 2 years, and breathed a sigh of relief when I became eligible for Medicare. I don't want to see this run away with us, but at the same time, I know the fear of living without coverage and hoping nothing serious happens, so I understand the need to have something available and affordable. If only we knew.

8:11 PM  
OpenID caroldee said...

THANKS Dave for this.. so many are doing without right now. I am one of them. Too costly is just what I have to say right now. Years ago I paid for B/C B/S and did for over 10 years NEVER used it.. wished I had all that money back now. I know I know.. it's insurance.. if I am covered NOTHING much happens.. it is when I am not that things do.. you can bet I am so careful these days. I have seen 3 of my friends get broken bones in the past 4 years from simple things, it scares me to death. I too will be sweating it until Medicare kicks in and then we will see if there IS ANY LEFT for us out here who are just making it to that age. Those town hall meetings are getting pretty heated.. I think people are just getting to the "boiling point" and don't know what to do. Stand near the exit okay? Things here are in such a mess.. wonder if they EVER will get fixed. : S

9:47 AM  
Blogger Carine said...

I'm one of those who'd better do whatever it takes to keep what I have-my meds are heavy duty and way up there in expense. And like other young people who feel invincible, my own daughter and son-in-law have had huge periods of no health insurance due to lack of employment.

thank goodness for the healthy kids program-which for a while, the grandkids didn't even have.

12:03 PM  
Blogger Lucy Stern said...

I don't trust Obama's plan at all, Dave. He is trying to steer us to Universal Health care and I am against it. I have relatives in England and I hear the horror stories about rationed care and long waits for services...
1) By adding millions of people to the health care rolls, where are we going to find enough doctors to service them....
2) On his plan all doctors will be paid the same, no matter what their speciality is... Why would anyone want to go into health care with this proposal...
3)To pay for this plan, they will have to ration health care...No way around it. The waits for care will be long and you will be lucky if you get the treatment you need.
4) Older people, who probably need the care the most, will get less care....It comes right out of the bill, if you have read it, you will see just what they are trying to do...They plan to revamp Medicaid and Medicare and roll all the plans into one basic plan...
Obama has out right lied when he says he is not in favor of a single payer plan, when they have him on tape saying the opposite...Sorry, but I don't trust the liberals on this.
I don't like being treated as a second class citizen by being told that if I don't agree with them that I am part of the "Mob".... I am a citizen of the United states and I have a right to express my views on health care..... Sorry, I didn't mean to rant!!lol. You asked for it, you got it...

11:57 PM  
Blogger Big Dave T said...

LYNILU--Our youngest son can no longer be under our insurance umbrella, this as he leaves to pursue his Master's Degree. But he does have coverage at the college. Being without coverage is quite scary, I'll bet.

CAROLDEE--Yeah, maybe I'll go to one of those on-line town hall meetings instead. I think the politicians are starting to prefer them anyway.

CARINE--Nearly all kids in this country seem to have coverage one way or another. It's the older people without coverage who are at most risk.

LUCY--So many people are passionate about this subject right now. I see the frustration every day on the news.

3:54 AM  
Blogger Nankin said...

Dave, I have to say that Obama's plan scares the living daylights out of me. I've read some pretty disturbing things that don't jive. And what happened to choice? I just don't think the government belongs in the health care business.

7:56 AM  
Blogger Big Dave T said...

NANKIN--Well, at least you live down there in Texas and I keep hearing they plan to secede from the U.S. Then you could do things your own way.

3:42 AM  
Blogger Merle said...

Hi Dave ~~ I think most countries are having Health Care problems and
need more nurses and doctors. I enjoyed your camping trip, glad the weather was decent. To barrack for any team of any sport means to support them and they are your favorites. It is not exclusive to cricket. Mine ia Australian Rules football team Carlton who have had some very bad years, but doing better this year and are in the "Eight" but I don't expect them to win the Premiership this year, maybe next. Take care, my friend.
Regards, Merle.
PS Do you ever hear how Trucker Bob is ?

8:30 AM  

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