What are the Candidates saying about health care reform? Here is a quick and dirty primer. I appologize about the graphic in advance. I have been working for 2 weeks to get this to work on this forum.
The presidential candidates propose a variety of systems which sound to me like a band-aid for a hemorrhage. In other words, they are likely to keep the overarching and very flawed system we already have and try to tweak it into something the American people will at least accept without mutiny. This is a short list of the options proposed and the candidates who propose them:
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Universality—Everyone in the United States is covered and can get access to some sort of medical care. This is one of the things that Americans should demand from there health care! After all it is high time the United States stepped up to the going standard in the Third world. There are some pitfalls here. What is universal? Are mental health and dental health covered? How about drugs? I can’t tell you how many times a person on Medicaid comes to see me because their insurance pays for me but the medication that I prescribe they do not take because they can not afford it.
Mental Health—When Reagan was Governor of California he proposed that instead of housing the mentally ill in large state hospitals like the one in "One Flew over the Coocoo’s Nest" we should put them in smaller half-way houses where they would get better care. I was all for that. However, after the funding for the state run institutions was discontinued he failed to fund any of these half-way houses. The state was rapidly overrun with homeless and decompensating mentally ill patients. We are still stuck in that mode today. This is nothing but a shameful human tragedy. Our communities would be much better off if the mentally ill were adequately cared for and not left to fend for themselves on the streets!
Dental—None of the candidates are backing this. I once knew a man who for a brief time was unemployed. During that time he got a tooth abscess. Since he could not afford any care, the infection spread and one night in desperation he broke off his teeth one by one with a pair of pliers. Did you know that poor dental health increases your risk of heart disease? And preterm labor? Well now you do. Dental health is a part of adequate health care.
Pooling—Most of us get our insurance through our employer. This means that the "pool" of money to draw from if one of your coworkers gets sick is relatively small unless you work at a large firm. If you work for a small employer, that means you pay higher rates. If insurance was offered to you so that you were part of a larger pool, say everyone with that insurance in the state or the nation, in theory because the risk of you personally getting sick is smaller, then your rates should be smaller. Additionally, when you switch jobs you can take your insurance with you. In other words you would negotiate directly with the insurance companies instead of someone at your company negotiating for you. This may indeed drive cost down and be more competitive but be ready to read the fine print because when you get denied service or have a huge co-pay there is no one to blame but yourself. Also, if you are in a pool that has fairly cheap rates you could see your rates rise as the insurance firm takes on risky clients.
Employer mandate—Every employer in the country would have to insure every one of their employees. This has a huge number of problems. First, work discrimination. What employer would want to hire someone with diabetes if they knew they were going to have to pay more in health insurance to hire them? Small employers will struggle with this cost. Also, what incentive is there for lower health care cost if the insurance companies know by law you have to buy it? This has not created low insurance for auto insurance. Almost all of us pay more than we will ever use in our lives for auto insurance.
Patient mandate—You the consumer are required by law to get insurance. Same argument as above. What would drive the sky rocketing cost of health care back down to European levels? Nothing. Additionally, what if the state calculates that you can pay your own insurance but they do not take into account some debts that you have that you feel you need to pay, i.e. putting your kids through college? Are you going to be backed into a corner by this law?
Federal subsidies—Our tax dollars given to insurance agencies for the poor who could not otherwise purchase insurance. In shorter words tax money to insurance companies. Anyone suggesting this should be scratched from your list of possible candidates immediately. We know that insurance wastes 31 cents of every dollar given to it. So you will convert the healthcare system for the poor from a system that wastes 5% (Medicaid) to one that wastes 31%. And the extra money the tax payer spends goes directly into the insurance company’s pocket. Corporate welfare. How will this decrease the amount the rest of us pay in insurance? Some candidates included in this group want state taxes to cover the poor instead of federal. Same idea.
Tax deduction to pay for insurance—Again, when the federal government gives aide to students to borrow more money for college, the price of college went up 200%. What do you think will happen with this idea?
Regulation of insurance industry—This is something that is done in many European countries where the insurance industry plays a far smaller role in health care. We would still have insurance companies but they would be regulated by the Congressmen that are holding their hands out for campaign contributions from these same companies. Hmmm. This could improve things for a while until the insurance companies find the loop holes but it is unlikely to bring things up to the standard that other industrialized nations enjoy.
State control—Passing the buck to the States.
Medicare Buy-In—In this scenario you can buy regular insurance or you can purchase a product run by the federal government. This could work to decrease the overall cost of health care in the US as private companies compete with the Feds, but it has many potential pitfalls. Again the insurance industry will try to cherry pick the most well and financially well off patients. They will advertise their product with glitzy ads and brochures. You had better be able to read the fine print because they may not lie to you with these ads but giving you the wrong impression is fine with them. The federal health care system, unless very competitive, will attract all of the patients denied by the commercial insurance industry, i.e. the poor and people with expensive and chronic problems. This would create a 2 tiered health system. One for the rich and one for the poor. Exactly what we have now!
Healthcare Saving Account—Oddly enough I like this idea but only if the insurance industry is not allowed to play. A health care savings account means that you can put money away pretax for your health care. The current problem with this is that the insurance industry gets to say when you can use it and for what. They only allow you to put a very small amount away at a time. The average person is projected to spend $7500 a year in medical insurance. If you started when you were 20 and put that much away every year you could pay for a lot of medical care by the time you were old enough to need it. This in conjunction with a fee for service system that excludes insurance companies all together might actually fix this problem.
Electronic Records—I think this is classic political red herring. There is a push to go to paperless records and billing. The argument goes that since 31% of the dollar spent on medical care is wasted on "paper charges" we will reduce the paper and save money. The truth is that those "paper charges" include paying the CEO’s of the insurance industry more than $30 million a year, paying for a fleet of people to deny you coverage and paying for another fleet of people to deny physicians payment. The actual paper is only at fault for a very small percentage of the cost. This is unlikely to save anyone money except the insurance agencies.
Prevention—Our system actually discourages prevention. It encourages dramatic last minute life saving therapy and interventions. There is virtually no money to be made to get an obese patient thinner or a smoker to stop smoking. All the evidence from other countries shows us that a system focused on prevention is cheaper and results in happier, healthier populations. I gave credit to any candidate who mentioned prevention as part of their system any where that I could document even if they did not tell me how they were going to change the system to control obesity before it turns into diabetes.
For Profit—Someone will make in excess of $1 million off of this idea.
Single Payer—Abolish the insurance companies and only the government or some other entity pays for the health care. This is what Canada and England have. It is the system proposed that is most likely to work and least likely to happen.
Campaign Contribution--This is the dollar amount that the healthcare industry contributed to this person’s campaign in the first quarter of this year. This is to give you some idea how responsive that person would be to your needs as compared to the insurance industry.