Sunday, May 04, 2008

Don't get sick:

That seems to be the solution for health care in the United States, at least if this New York Times story is an accurate portrayal of what's going on. Some lowlights:
  • Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be ...
  • ... the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery.
  • ... the soft economy is making some insured people hesitant to get care they need ...
  • Since the recession of 2001, the employee’s average cost of an annual health care premium for family coverage has nearly doubled — to $3,300, up from $1,800 — while incomes have come nowhere close to keeping up.
  • ... for the underinsured, coverage can seem like health insurance in name only — adequate only as long as they have no medical problems.
  • “There’s a real shift in the burden of health care to people who happen to be sick”
The Times points out:
Among employers, the hardest pressed may be small businesses. Their insurance premiums tend to be proportionately higher than ones paid by large employers, because small companies have little bargaining clout with insurers.
And individuals have even less clout. Yet "individualizing" health care was what Bush called for when he debated Kerry. The logic was that, by doing so, it would result in some sort of frothy-competition which would turn health insurance into a buyer's market. Bush was explicit in the third debate (14 October 2004):
Health care costs are on the rise because the consumers are not involved in the decision-making process. Most health care costs are covered by third parties, and therefore, the actual user of health care is not the purchaser of health care. And there's no market forces involved with health care.
That's true for certain goods, like a can of peas, where the item is easy to evaluate, a mistake doesn't cost much, and all buyers are treated equally. Health care is definitely not like that.

UPDATE: Over at TNR there is an article on McCain-Care. Second paragraph:
[McCain is saying] Let's encourage people to drop their employer insurance and shop for coverage on their own, he said, since that will create a vibrant market in which people can find better bargains. And since some people will still have trouble paying for insurance, let's give them a tax credit that would help offset the cost.
From McCain's speech: (emp add)
I offer a genuinely conservative vision for health care reform, which preserves the most essential value of American lives - freedom. Conservatives believe in the pursuit of personal, political and economic freedom for everyone. We believe that free people may voluntarily unite, but cannot be compelled to do so, and that the limited government that results best protects our individual freedom. In health care, we believe in enhancing the freedom of individuals to receive necessary and desired care. We do not believe in coercion and the use of state power to mandate care, coverage or costs.
The firm conclusion from that is that McCain would like to dismantle Medicare.

CHEAP SHOT: Again, from McCain's speech:
The final important principle of reform is to rediscover our sense of personal responsibility. We must personally do everything we can to prevent expensive, chronic diseases. Our rights in this country are protected by our personal sense of responsibility for our own well being. Cases of diabetes are going up, not only in the baby boom generation, but among younger Americans obesity, diabetes and high blood pressure are all on the rise.
McCain is a three-time survivor of melanoma, the potentially deadly skin cancer. Where was the sense of personal responsibility about that? Did McCain stay indoors all day in the summer? Wear a hat? Leave Arizona for a state with fewer sunny days?


The only reason that health insurance is provided by employers is that during World War II, wage controls were in effect that prohibited companies from offering higher wages. They were allowed to offer better benefits, so offering lavish health insurance as a job benefit was one of the ways that large corporations could compete with each other for employees. That's how the health insurance companies created their special, cozy relationship with large corporations that has lasted to this day.

I don't see that health insurance is really that much different from auto insurance or home insurance. No one is suggesting that consumers would be better off if they had to purchase auto and home insurance through their employer, or pay twice the price, yet there is so much fear and angst about decoupling health insurance from employment, when the only reason it was ever coupled with employment in the first place was as an artificial end-run around a 60 year old wartime policy that has long ceased to exist.

By Anonymous jms, at 5/04/2008 7:02 AM  

There are a few differences between auto and house insurance and medical insurance.

Many states require a driver to carry auto insurance. Most mortgage holders requirer the home owner to purchase house insurance. If you don't don't need auto insurance. If you rent and don't own you don't need house insurance.

Medical insurance is a different animal. Everyone has a moral body prone to illness, disease, and accident. Everyone will need medical care at some point. Medical care does not follow the usual rules of supply and demand.
Basic medical care should be provided for's a basic necessity.

By Anonymous Rockie the Dog, at 5/04/2008 8:19 AM  

Before a recent surgery I was provided with estimates for lab work, anesthesia & the surgery itself - all three were wildly optimistic as all three billed me at least 150% over the initial estimate. Given these estimates were total fantasies, I am supposed to 'comparison shop for healthcare' how, exactly?

By Anonymous Anonymous, at 5/05/2008 8:04 AM  

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