Imagine if society had turned to the insurance industry in order to overcome problems of hunger. People would pay into an insurance program to buy coverage in case they become hungry. When you are hungry, you could go to a restaurant or grocery store covered by your insurance. You’d get the food you want, or maybe some plans would first require that you go through a nutritional specialist to assess your hunger needs, and they would be reimbursed by the food insurance company.
Of course, all of this would produce a lot of paperwork and bureaucracy-hence increasing the cost of the program. You’d have problems with finding grocery stores and restaurants that are covered by your insurance program. There’s also the question of how you get insurance. Would people worry about insurers pre-screening people to determine their likelihood to become hungry and consume a lot of food? What if the government decides to encourage food insurance by giving a tax credit to those with food insurance through their employment? People would worry about going hungry when they loose their jobs. Small business or those who are self-employed may not be able to buy into these food insurance programs. What happens to them?
As you can see, this is a rather absurd scenario, but how absurd is our current dependency on health insurance to meet our health care needs? Progressive Democratic blogger Matt Stoller at MyDD argues that the entire insurance based approach to health care needs to be thrown out. Consumers pay into an insurance plan expecting the insurance company to pay out when health care is needed. The insurance company, operating like any other profit driven entity, wants to take in money but find ways to prevent it from being sent out. Once the consumer’s money has entered their hands, they’ll do everything possible to send up legal roadblocks to them getting anything back.
Right-wing pundits and analysts have also come around to seeing the problems in their system. They point to our current system as insulating consumers from the real prices involved in health care decisions. Because they are often making decisions with the assumption that insurance will foot the bill, conservatives believe that consumers who are covered are more likely to over-indulge in health care spending, driving up prices for everyone and placing financial strain on the system. Insulation must end, and that means throwing out our current insurance framework.
So there are advocates on both the left and right agree in throwing out the status quo. On the left, the push is largely for greater government involvement in health care. The main point I’ve encountered in previous discussions on health care is that government centralization would vastly reduce the overhead costs found in the private sector. But I still don’t see how this will be anything more than a one time shift. At most, government efficiency would reduce health care spending by 1% of GDP, leaving it still at the astronomically high 15% of GDP. More importantly, if you shift from our pseudo-corporatist system to more government centralization, efficiency may drop the costs of health care from one year to the next. But that one time gain will, over time, be erased by the surging growth in health care spending, and I don’t see how centralization will do anything to impact the rate of growth in the health care industry.
I want to see proposals for reform that put more money into the actual health care industry, not insurance companies. I want to reconnect consumers with everyday health care decisions. The first steps to health care reform ought to focus on drugs and doctors, the two biggest expenses we face.
First, imagine a health care system in which low-cost generic drugs have a larger role in fulfilling prescription needs. How? By standing up to drug companies and their use of patents to protect them from market competition. Demand that Congress hold firm on patent expiration dates. Given the R&D money funneled through NIH and other government agencies to subsidize drug research, we ought to demand that the results of such research be made freely available, not patented and used for private profit.
Second, our health care system suffers from ancient guild-like restrictions that increase the burden on doctors. We need reform that allows nurses and other health care professionals to do more in serving patients. More pressure should be applied to medical schools to increase enrollment. America has one fewest levels of doctors per capita in the industrialized world, largely due to deliberate policies to restrict the supply of doctors and drive up individual salaries.
With a new Democratic Congress, the time has come to more forward on health care reform. But I want to see proposals that will produce positive results, not the same old ideas that activists assume will work. Our dependency on insurance needs to go, what will replace it?