In this audience, it is probably pretty obvious that the Obama health care plan makes more sense. The question we need to ask ourselves is do the conclusions that both McCain and Obama have come to make sense and what should we do about it.
I work on the fringes of the health care industry and my argument is that our national self-identity might be preventing a real substantive look at how we really need to change the health care system.
The Problem Today
The current health care system has many problems that may or may not be immediately obvious. I'm going to quickly bullet these - feel free to add your own.
1. Out of Control Premiums: The amount that individuals and those under corporate plans need to pay has risen and continues to rise to astronomical levels - largely because the cost of health care services are on the rise.
2. Businesses can't afford to buy insurance for their employees: We've heard the statement many times - pay for insurance or stay in business.
3. Unable to obtain insurance: Individuals at ever increasing levels are being rejected due to lifestyle reasons or because of pre-existing conditions. Insurance companies simply don't want to have these people as a drag on their books.
Where do these problems come from:
These three problems systematically come from the same source. It's all about the money folks. The true cost of health care has been on the rise for years. This is not tied to increased bureaucracy (entirely). Each year new techniques, medical devices, and pharmaceuticals are invented that revolutionize the survivability for certain procedures. This is a good thing if you want to live longer with, in many cases, a higher quality of life.
However, it often takes years and years of research to develop these products and the companies will try to derive as much profit off of these products prior to the expiration of their patents.
So from a public health standpoint we should be in great shape - right? We have research helping solve many problems - but the costs are very high. So high that the average American cannot go without health care.
The Insurance Companies Come In - with actuarial tables in tow
Insurance companies are in a precarious position. They are a business and deserve to make a profit, but the least profitable customers are the people who need the most help. Grouping people into the largest possible blocks that balance between the older and presumably infirmed and the young is how employers have traditionally mediated these high premiums at the top.
As an employer, you are much better off with a young energetic workforce than an older one - from a premiums perspective.
The insurance companies (being a business and in competition with others) want to make their premiums look as affordable as possible. The way they have done this is by shaving off goods and services that are covered or not covered. Therefore, you're doctor prescribes xyz, but your plan doesn't cover xyz because it is too expensive - so you either pay full price OR your doctor has to change the course of treatment.
So why the long explanation of the health care industry?
I needed to explain how I see the industry so its possible to deconstruct the problems.
First, competition doesn't really benefit the consumers here. In the insurance space, consumers benefit from large groups because it balances the costs for the older with the younger. From a utility standpoint is like having one of those bills where the electric company lets you play the same in the winter as you do in the spring by averaging the cost out over the years. In health care, instead of paying nothing as a 25 year old and paying astronomical amounts in your 60s, the rate is leveled off. It would seem that having the largest pool possible would have the most benefit.
Second, everyone dies. I just want you to remember that. From an insurance standpoint, their best customer is someone who never gets sick for 40 or 50 years and then dies suddenly. In today's technological world, that is becoming less and less likely. People still die from first heart attacks, but at much lower rates than in the past. Those people will need health care at a higher level for the rest of their life. The insurance company would rather not have them on the books, but once they are there it is difficult to drop them. So, if everyone eventually gets sick and dies AND we are able to help people live longer - doesn't this become a lose-lose from an insurance perspective?
What can we do about this?
We need to take a hard look at what health care means in this country. What it allows us as a nation to do. Do we need healthy citizens that live to increasing old, vital age or is that just not important? If everyone dies and everyone needs health care, shouldn't we look at a way to make this a national utility.
Some things just need to be highly regulated with little or no competition like electricity and water. Attempts to deregulate the electrical utilities had pretty disastrous results - to a point where most efforts in that regard were pulled back.
It seems like health care is quickly approaching the point where for the health of our nation and economy, we need to turn health care into a public utility.
It might sound like socialized medicine - but we have many other socialized structures in the US - and this ones time might be right now.