plan to fix health care, part deux

http://www.nypost.com/seven/09062007/news/nationalnews/obama__clinton_health_plan_was.htm

I like it when the media makes up attack ads for them. Just what we need, more combative political system. At this point however, I would be willing to simply set each side's candidates in a dirt arena, equip them with simple tools or weapons and have at it. It's certainly a more productive and entertaining way to select a presidency than the series of pointless beauty pageants interspersed with a series of 'vicious' attacks.

As to Obama's actual suggestion, I appreciate that he wants to have an open forum debate on health care. However I suspect that allowing the ill-suited public to make the call on who pays for their medicines and surgeries is folly. Economics should dictate our response to this issue, simple and cold as it is. There are elements and problems with how the free market has handled itself, particularly over the past few years. I'll deal with those instead of simply screaming and running around demanding the government pay for my checkups and emergency health needs. If Obama wants to have public forums, then hold them on fuzzier matters like race relations or religious extremism.

1) Cost run-up. There's generally two reasons costs run high. Supply is low and demand is high; it's really that simple. We can't increase the supply of doctors very easily. But there are several ways people are trying. Doc-in-a-box clinic setups are popping up in places like Wal-Mart or pharmacy drug stores. They treat simple stuff like coughs that emergency rooms are too overwhelmed to have time for anyway. That would cut down things immediately and for much of that type of stuff, a simple medication or a quick consultation suffice. A real disease might require more specialized care, but to be fair, doctors have no idea how to treat and cure viruses anyway. Go home and rest is about all they can tell you, so quit wasting your/their time.

A secondary problem with supply is that the manner of money crops it's ugly head in doctor's training. It's simply so expensive to go to medical school that the traditional doctor we might think of from old days has gone by the wayside. 'Everyone' now is some sort of specialized care giver. That's great if we need something for our heart condition or cancer treatments, or surgery to fix a bone or ligament. But it's not much help for everyday life, which appears to be precisely the condition that is causing most Americans the most harm. Moore and other's publicly spectacular works have shed some light into the differences with other countries. Their prescription however is rather dubious. I look at the situation and see that the primary difference is the ratio of primary care doctors to specialized ones, not that the public pays for it by way of taxes or by way of pockets. When there are more 'trusted and learned friends', as I like to think of primary care, I suspect the arts of medicine are dispensed more generally, more cheaply, and more effectively over the long term. Our doctors are looked upon as gods of health, and what they say we must do, we must labor towards. But when that doctor only cares about maximum heart function, they're not much of a god. More personal care and attention given at a general level would likely give some of us less of a demand for health care. That's actually a good thing, simply because we'd like to be in control enough over our bodies that we'd be learning how to manage our health and how we effect it every day.

2) How to pay for it. There's basically two ways we as Americans pay for health care. One is our employer gives us a perk in the form of health care coverage and we do not have any private incentives to care about cost. We pay our deductibles and get our tests and so forth run. All of the care on cost is then in the hands of either the hospital or the insurance company, who will battle freely over how much and who pays for what. Not a good thing.

The second manner is privately, which also devolves into two methods. The first is through private insurance and the second is out of pocket. Private insurance usually works just as the employer-paid method except we ourselves pay for our insurance out of pocket without subsidy, so there is some incentive of cost, except for two things. First, the cost of care is usually a negiotiated rate by the insurance company, but not something the insured person ever really sees; doctors do not have menus for their treatments and care. It also means if there is no insurance, it's a very considerable rip-off, either for the person trying to pay for it, or for the hospital trying to collect money from those who won't ever pay such outrageous bills. Second, the person paying for their own insurance sees how much monthly is going by the wayside and will feel compelled to make use of those dollars. General rules of money will tell us that a dollar which is not ours is spent very quickly. So instead of only seeing a specialized doctor with a real and specific problem and sometimes checking in with our general care doc, we'd go all the time. When there's a commercial on TV for a new drug or a TV special on some disease that 50 people a year get, when we read symptoms for some illness and presume ourselves to have it, et cetera. Not only is that really annoying for the doctor, but it also encourages the health industry as a whole to run more such ads and our viewing public who becomes ever more paranoid about health and safety, to watch more carefully. That's great for the few thousand people a year who catch something (or the few million men who must have penis-related problems), but I don't know it does much good for anybody else.

At the moment, the only private sector response to this that makes any economic sense is medical savings plans, or more effective still, health savings plans (I have no idea why they have two different names that mean the same thing, damn lawyers). A savings plan specifically for health care is mostly our own dollars at work (getting past Friedman's observation). The best of these plans work by providing a high deductible coverage on catastrophic care and a seperate savings component which is used to pay the deductible or to earn interest for later use. That means if a person gets cancer or tears a knee ligament, they're still covered by the insurance company. Nobody in any sector of our lives wants to pay many thousands of dollars for unforeseen events, be it a car accident or a debilitating disease, that's precisely why insurance exists in the first place. Just as those types of insurance are not designed for our continuous use for every little thing, such as a ball breaking a window somehow requiring a call to our homeowner's insurance, so too with health care. These types of plans recognize the fundamental economic purpose of insurance and harness it for health care, with some tax benefits and private ownership (rather than dependency on our employer's plans, making us dependent on our employer). I fail to see why this cannot be widely embraced if it is properly explained because such plans fulfill several practical objectives.

First, the cost is reduced, both by having a negotiated group buying power of insurance involved but also by removing needless insurance paperwork for smaller claims. Hassle factors on doctors being removed so they can instead focus on seeing patients who are stuck in those little rooms with the deli wrap paper would be a nice bonus. Second, the onus of paying for care is privately held and determined. Each person would be able to exercise some choice over how much coverage to purchase or what types of coverage they might need simply by only filing for insurance when they actually need it, and paying 'out of pocket' the rest of the time.

Thirdly, a plan can be designed with certain realities involved, such as older women not needing prenatal care anymore. I've heard the horror stories of over-regulated insurance boards demanding that an insurance policy for women include whatever built-in surcharges for prenatal care heedless of age. It should be based on calculated risks just as any other insurance should be (I won't get into car insurance and that that often isn't based this way either, another time). The chance for older women getting pregnant is low, they have other health problems and risks which rise accordingly. Most of the problems revolving around installing a nationalized plan regard this issue; what sort of coverages are needed.

And finally, the cost is relatively lowered for most of the Americans without coverage and without access to Medicare/caid. Most such people are of working age still and many such people were like myself for some time, choosing to be uninsured. A calculated risk on the part of the consumer that they would not get dread diseases or some other fortune breaking condition besetting their lifestyles is not the wisest course of action here either. Access to an affordable coverage that actually works and provides that precise type of coverage that is needed by such people is perfectly fine alternative to taxing everyone to pay for these people's oversights or outright ignorance.