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.