Sunday, March 14, 2010

The Goals of Reform-- Part 5 of The Itch for Healthcare Reform

  
     The Itch for Healthcare Reform has already addressed the whys and why nots of the issue, provided statistics that demonstrate that other nations in the world have successfully implemented more affordable healthcare with better results, and given examples of how a few of those systems worked. Now, in part five, I will address what I believe the goals of healthcare reform should be.
     The first goal of any healthcare system should be simple: to provide good quality healthcare, at all levels and stages of life, regardless of ability to pay, to everyone. However, as nice as this goal sounds, and for as many people who would certainly agree with it, the US is not prepared, at least not now, to see it through.
     In the meantime, there are a few things we can accomplish that will help. There seem to be two problems with our current system: affordability and access.  While the US has some of the best doctors and hospitals in the world, the results of our healthcare system don't reflect that. That is largely because millions of Americans can't afford health insurance, or are under-insured, and therefore unable to visit our excellent doctors and hospitals. Sometimes they can't even afford regular physicals, vaccinations, and other routine care.
     So, our first step is to bring down costs and increase access to good healthcare without eliminating the profits of the insurance companies. This is a difficult task, because any way the crisis is solved, the approximately 46 million people who currently aren't getting care are going to need it, and someone will have to pay for it. While the insurance companies, hospitals and doctors don't want their profits to be reduced, and many don't want a public option that will provide insurance without a profit and therefore be less expensive, extending insurance to those who can't afford it will have to come from government subsidies.
     Does anyone see the irony in this? While the government could provide a public option, which still may be subsidized but should cost less because no profit is necessary, people oppose it; but they are less likely to oppose government subsidies going to private health insurers, part of which would be profit for the companies, and cost the tax payer even more than a single-payer or a public option.
     The government subsidies will improve access to health insurance for those who can't afford it, but that is not enough. We also must eliminate the ability of insurance companies to cancel policies when an insured needs care. We have all heard the horror stories of someone who has paid for insurance for fifteen years and hardly used it, but when they develop a serious medical problem, the insurance company cancels the policy for some strange reason, like an inaccuracy in the fifteen year old application. So, they knew about the problem all along, took fifteen years worth of premiums, and then deny coverage when it is really needed.
     Next, we need to eliminate the insurance companies ability to deny coverage to people based on pre-existing conditions. There are too many horror stories about that, too: someone loses a job or their health insurance for some reason and can't get coverage, even though they can otherwise afford it, because they are a bad risk.
     Finally (maybe not finally, but finally for the purposes of this post) we need to eliminate the ability of the insurance companies to set limits (known as lifetime maximum benefits) to policies, which are often as low as $1,000,000.  While it seems like a lot of money to most of us, it can be reached quickly, and a family who had financial security is left in ruin because of healthcare costs. My wife is a nurse on a unit that deals with chronically ill patients, and has several times witnessed patients meet their maximum policy benefit and be left with nothing, while still being reliant on medical care to live.

     In part four of The Itch for Healthcare Reform, the healthcare systems of Canada, the United Kingdom, Germany, and Japan were briefly reviewed. There are other countries with similarly effective programs, including France. Switzerland, Thailand, and more. While these systems all operate a little differently from one another, there are some significant similarities, and four that deserve attention.First, they all see to it that everyone is covered--through a single-payer, a mandate to have insurance, or an ability to pay for healthcare without insurance.
     Next, they all have health insurers or payers who are not for profit. In the single-payer systems of Canada and the UK, those payers are the government, and there is no profit. In the other countries, where there are private insurance companies, the companies are, by law, not for profit.
     The third similarity is that all the countries reviewed had some type of strict price controls. In Canada and the UK, the government, as the payer, sets how and what they'll pay, which is similar to the US Medicare model. In Germany, the insurance companies negotiate regionally with care providers to set prices. And in Japan, although the insurance companies and hospitals are private, the government sets the prices for each and every aspect of medical care.
     Finally, in each of the countries reviewed, doctors earn significantly less money than doctors in the US-- sometimes less than half. But, they usually have free or near-free medical school, and so carry no debt as they enter their profession. They also have little or no malpractice insurance to pay for.
     Each of these differences would have huge hurdles in the US. Although it is unconscionable to me, there are those that would not have everyone insured because of the cost of subsidizing those who can't afford it. Of course the insurance companies would fight hard to protect their $12 billion per year profits, and many would be opposed to government price controls. Finally, doctors, like everyone else, would not likely volunteer to make half of their current earnings! (Oddly, this last hurdle may be the easiest to overcome, since doctors retire and are replaced with new ones who do not know any differently, and because I am hopeful that most doctors get into the profession to help people. As long as they were paid a fair and livable wage, they should be OK with it.)

     There are things we can do to improve healthcare in the US. But will it be enough? I don't think so, and in part six of The Itch for Healthcare Reform I'll present my solution for the health-care crisis.

1 comment:

Cliff said...

Great job with this series. My favorite point in this post is where the public is opposed to the public option but ok with subsidizing the insurance companies. It makes no sense. This week will be interesting, the vote is going to take place. It better pass!