The first question is of course whether or not one thinks that our system needs reform.
The second question might concern various plans proposed, or perhaps an outright prioritizing of what one thinks needs to be fixed.
It ought to be an enlightening discussion.
I believe that reform is urgent but as I have said before, contrary to many liberals, I do no longer endorse a single-payer option. I believe that open but controlled competition can be very beneficial and even superior .
It seems to me that the government needs to get involved in two areas in which it is not currently involved. The first is some form of price controlling (I have my reason for this and will be happy to discuss them if anyone disagrees.) The second is the establishment of a public option administered by the government (failing that, I would be adamant about a federal law obliging an open, completely non-exclusionary enrollment plan on all insurance companies.)
There are a lot of details, but this is enough of a start in a highly complex arena.
7 comments:
First of all, I think that the entry of government into the market is a bad idea because government is, by nature, an unfair competitor. That being said, there are a number of things that government can do, as well as not do, to help, including the following.
I agree with non-exclusionary enrollment for US citizens (we can't afford to insure the whole world and not even visitors in the country). It is stupid to insure only the healthy. Pre-existing conditions should not be a factor in obtaining insurance. As Christ said, "They that are whole need not a physician, but they that are sick."
I disagree with price controls. I think price controls have always turned out badly in the past, mostly in other countries. Competition is supposed to be price control. The problem is excessive regulation that inhibits competition. Sure, there will always be those who profit excessively, but that would happen even with price controls.
I disagree that reform is urgent. It is urgent for the Democrats for political reasons, but for the good of the nation, I think we should not rush head on into just any plan as soon as possible. Let's debate it and think it though. Nevertheless, I doubt that will happen for reasons that should be in another thread.
Also, I strongly feel that whatever plan is passed, the government should not borrow money to pay for the plan. If higher taxes is required, then so be it, but please spare us the additional debt. It would be the absolute financial ruin of the country to do so. However, considering the lack of concern for the mounting debt in all corners of Washington, I very much doubt we can pay for it without borrowing. :(
I am delighted that Alan agrees with non-exclusionary enrollment for US citizens. The absence of such open enrollment is the first and greatest weakness in our current (non)-system.
It is true that the government can be construed as an unfair competitor; this was the principle argument of George Will in one of his recent blogs that I receive on my Kindle. But I think in this case, George Will is wrong. As things are right now, it appears the the insurance companies enjoy 'control' over pricing. The entrance of the federal government into the market may really skew that in a positive way. The notion that the market is always right is a notion that I contest. I do respect the market and its healthy benefits, but it is not always the unique and best way to go about things in all arenas. This is born out by our control over public utilities as an example. Part of the reason that the banking system has been in such disarray and so detrimental to the overall economy is the fact that regulation was too absent. The same can be said of the housing market which is so controlled by the banking sector. I would argue that the market is not at all the best controller of education (a major argument in favor of school vouchers) and especially that health care is not the best arena for the free market to dominate, although it ought to be part of the overall mosaic.
I think that a public option would force a détente in escalating pricing and a pricing floor that would have to be heartily respected when insurance companies consider pricing. This would be healthy. We see this constantly in other competitive market arenas: cars for example, I know that there are certain vehicle options that I can always harken too if cars get to expensive. It is not necessarily a government produced car, but it maintains a floor to the market. As things are in health care, we have a rising ceiling with no real floor. I am not in the least apprehensive of the government competition.
Another example: in my school health care choices, I can choose between top notch Blue Cross Blue Shield or a more average HMO program. I must pay more to get the BCBS option, but I am VERY willing to pay, the same for autos, but if I were poorer, I would be very happy to at least have the option of getting an HMO. Quality is the other factor everyone considers which is why Obama would opt for the private insurance for his family. The government (public option) is to provide a minimum which does NOT exist today (well it does exist a bit in the reality of the ER and public health care clinics, but we all know that these are not really desirable options, we can do better.)
I rambled a bit, but I hope I at least made sense even if any of you disagree. I am for price controls; it is something that we already exercise with success and to the benefit of all in other areas (public utilities and public education for example). Health care is too important to leave to the fluctuations of the market.
I feel that reform is urgent. As president Obama said today, we have been giving lip service to serious reform for a long time with no appreciative improvements, it is time and it is urgent because the recession is leaving more and more people at the mercy of an inferior system.
I am open to your ideas, including price controls (but I am skeptical). Your comparison with public utilities is persuasive - except that that is not the type of system currently on the drawing board. Systems like gas and electricity are privately owned companies that are strictly regulated by local governments because they provide essential services (one could easily argue that health care is an essential service), but R&D is not being carried out by such companies. They simply maintain an infrastructure and deliver the product via the infrastructure. For the most, they do not develop new technologies. Health care, on the other hand, requires heavy R&D to deal with unresolved diseases and conditions. That is why ballyhooing big pharmaceutical company profits is very short-sighted.
I guess I am rambling as well, but if I could insist on one thing, it would be that we don't increase the debt to do this. It is simply irresponsible to continue piling on mountains of debt for our own convenience and to the detriment of future generations. It is selfishness in the extreme.
This is long....but good insight on Government controlled insurance and price controls. I picked this up from the internet. Also a note from me....I beleive the market place is more balanced...self-balanced even when you have competition and no price controls. You put price control in place...it messes with the natural balance that competition brings. There is historical proof of this all over the world, both current and anciently. Just a thought....so now you know that I am very weary of Price Controls.
"Learning From Canada’s Mistakes
Closer to home, all too many Canadians are opting out of their socialized health care system and its price-controlled, budget-capped induced rationing. For instance, when Robert Bouressa, the Premier of Quebec, had to have his potentially lethal skin cancer treated, he quickly beat a path to the United States and paid for the treatment at the National Cancer Institute in Bethesda, Maryland.[21]
Less well-connected Canadians are also heading south and little wonder why. There are more doctors per capita in the United States, the medical technology is better and more widespread here and, most important if one should have a serious condition, the time spent waiting for treatment is insignificant in the United States compared to Canada because we have a competitive health care marketplace.
But those Canadians who can’t afford the fare to the United States are not so lucky. In Canada, with a population of 25 million, some 1,350,000 people are waiting for some kind of medical service, with some 177,000 of them waiting for surgery of some kind of which 45 percent report they are waiting “in pain.”[25] For example, waiting periods for health care procedures in Canada average 5.5 months for heart bypasses, 5.7 months for hernia repairs, 7.3 months for cholecystectomies, 6.4 months for hemorrhoidectomies, 8.3 months for varicose vein treatments, 3.7 months for hysterectomies, and 7.1 months for prostatectomies.[26]
For instance, in January 1990, Joel Bondy, a two-year old, could no longer wait for heart surgery, which he urgently needed, but which was repeatedly postponed by Canadian health care regulations and bureaucratic procedures. His parents decided to contact Heartbeat Windsor, an underground railroad of sorts for Canadians with heart conditions, to have their son taken to Detroit for emergency care. Only after the Canadian press broke the story did health care bureaucrats promise to move Joel to the head of the waiting list.[27]
The government authorities kept their promise, but in the best of bureaucratic style, providing the Bondy’s with a four-hour ambulance ride to a hospital that did not have an open bed, due to the shortages created by price controls. The Bondy’s spent the night in a hotel room; Joel died the next day.
Say what you will about the shortcomings of the U.S. health care market, but its operations are above-the-board and innovative. Canada’s public sector has the luxury of burying its health care costs in bureaucratic budgets far from the reach of the citizenry and the press. American hospitals, competing in open markets dependent on investors and consumers in a choice-intensive market economy, cannot. And, the American health care system is the leading source of new and better technologies in health care devices, procedures, studies, medications, etc. Canada is not.
Market efficiencies create product and service availability that can be acquired through consumer choice; distorted health care markets restrict both availability and choice. Freely priced health care markets allow consumers to find value for their health care dollars."
Another thing that is a problem is that Obama has clearly stated that he will not sign a health care bill that adds to the federal deficit. Am I the only one who sees a problem here? The health care bill will be wildly expensive no matter what form it takes. In order to remain revenue neutral, taxes would have to be raised to unimaginable heights, thus killing the economy dead in its tracks. A dead economy = far less tax revenue. As much as I think health care legislation is well intentioned, it appears to be unsustainable to me. Urgency here is the urgency of lemmings over the cliff.
Obama insists that his plan can be paid for via a variety of taxes and savings. His plan, (whoever reads these things?) claims that the health care plan will not add to the deficit, and especially not over time.
We have discussed the notion of taxing the rich, but he has been open about his intent to increase taxes on the richest 2%, he has said that we will have to pay for it via taxes on various aspects of our finances: taxing employer offered health care plans for example. It is a tax, although not an income tax. I am not against this. I never thought that it would free or without me contributing more.
Kinda laughable, but I am for some kind of soda pop and fake juice tax. We tax other things that that not essential food items (cigs and booze) without so much as a thought. I would gladly pay an extra nickel per can of pop to help finance part of the thing.
Even a national sales tax of 1% (or some percentage like that) for health care would be fine with me.
Let's reform it, let's accept our responsibility and let's pay for it! I'm very willing.
Teresa, I am not a proponent of obligatory government health care for all! I only want a government option for a variety of reasons. I do want price control, those who do not have insurance at work and who have to go out and shop for their insurance will tell you why. I have two friends who both pay over $700 a month each for their insurance. Imagine. Health care premiums for those who do not have a subsidized plan are outrageous and that is IF the insurance company even agrees to insure you. If I were to add Nick to my insurance (I may have to this fall, and thank heavens my school allows it, no public school districts allow gays to add their partners, there is no law to require it, and they don't give a crap at all and they don't allow it ), it would be (will be) $350 a month. OK, that's a bite out of my check, but it is well worth it, but we are under a plan!
Canadians would not trade their health care situation with ours. They have said so over and over. If they want to come south for health care, and they can afford it, they come! But in Canada there is health care for all and the care one gets will not cost much if anything at all. There may be waiting times (there are waiting time here too!) To the contrary of Canada, here in the USA, if you don't have insurance, you cannot always get the services you need: you don't have insurance and no money? Just try to be seen by a cardiologist! I dare you! It is a battle.
The Canadians cited in your article are opting out, good for them, but that is the point, they can opt out and go elsewhere. We will be able to as well.
However in Canada, all are covered, all get health care, all get medicine, and no one has to break their piggy bank or revert to any drastic financial measures to get care. That is not the case here.
I want our system to be superior to Canada's:
a full range of insurance companies like now, but a government public option for those who cannot get insurance any other way and price controls so that every one can afford it.
People will not flee their insurance companies just because the government plan is cheaper, unless the medical care the government plan provides is clearly superior and less expensive, but do you see that happening?
I think I kind of rewrote what I have already written on blog topic!
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