Roseyland

Never before have so many known so little about so much.

I saw the line above in this article by Daniel Gross. It’s a play on a Winston Churchill quote, and I think it describes the current health care debate perfectly. A few weeks ago I was definitely in the “knows so little” category, and I probably still am, but I have made an attempt to learn more. I know that I am strongly in favor of health care reform. I discussed health care a while ago in this post, but let me summarize my general beliefs:

• Insurance companies should not be allowed to discriminate based on the health of individuals. There should be a nationalized set of standards/regulations that govern all health care sold in the United States. This does mean that health care cost is spread out over people with varying degrees of health. I am fine with this.
• Everyone who can afford health insurance should be required to purchase it.
• Caps on maximum benefits paid by insurance companies should be eliminated.
• A basic level of health care should be provided to those who can’t afford it.
• Health insurance should be decoupled from employment.

I don’t believe that we should completely reinvent the wheel. We need to adjust our health insurance business model to better align profits with benefits to society. We can not continue with a system that denies care to those who need it most and allows so many people to go bankrupt due to medical expenses. This only hurts us all whether we realize it or not.

Right about the time people started hysterically screaming about death panels, I figured that I should try to understand just what was in the currently proposed health care bills. I did some Googling, and I found the article Your Handy Health Care Cheat Sheet by Alec MacGillis in the Washington Post. This article is a great summary of the proposed health care bills. Let me summarize the summary, the health care bills currently before congress include:

• A national health insurance exchange or market place where different health care plans can be easily compared. Initially this will only be for people who do not get health care through their employers. Insurance companies are not required to put their plans on the exchange, and individuals are not required to buy on the exchange. However, anyone getting a subsidy to purchase health care can only use it on the exchange (I think). All insurance plans, whether they are on the exchange or not, will have to abide by the same regulations, such as not discriminating based on an individual’s health. For a better description of what the health care exchange might look like, check out the New York Times article A Health Insurance Exchange: The Fine Print by Anne Underwood.
• Individuals who can afford it will be required to purchase health insurance or pay a fine/tax.
• Subsidies will be provided to those who can not afford health insurance.
• Some of the bills include a public plan on the health insurance exchange and some do not. This is the most controversial item.

All in all, I’m pretty happy with the bills before congress. They mesh well with my beliefs except for the decoupling of health insurance from employment, but I could see that happening in the future if the exchanged was opened up to everyone. I’ve been back and forth on the public plan a million times. On one hand it is a good way to ensure that that all insurance plans on the exchange meet basic standards. On the other hand, I don’t think it’s completely necessary and we could always add it later. If I had to choose, I would prefer a public option, but I think it would be dumb to let this point prevent the passage of meaningful health care reform.

So what about the alternative plans? I did some searching, and the first alternative plan I came across was The Patients’ Choice Act. I read the summary, and it sounded like a decent plan to me, but then I read this analysis of the act. Apparently, the Patients’ Choice Act doesn’t require insurance companies to participate in the the health insurance exchanges that it sets up, but it only regulates the insurance plans that do participate, which makes the exchanges pretty much pointless and provides no protections for people with preexisting conditions. It looks like this plan is a lot of talk and little action. I’m going to count this as a big FAIL.

The more interesting alternative is the idea of high deductible insurance mixed with some type of health savings plan. In these plans, individuals pay for the first few thousand dollars of their health care before insurance kicks in. Often times employers that offer these plans also make contributions to their employees health savings plans to cover some of the out of pocket cost. The idea is that since individuals are spending their own money, they will make more fiscally responsible health care decisions, which will drive down cost. At the same time, individuals still have insurance for protection from large unexpected health care expenses. A big proponent of these plans is John Mackey the CEO of Whole Foods. He wrote an op-ed in the Wall Street Journal titled The Whole Foods Alternative to ObamaCare, which I consider a must read. So go read it. Other good articles advocating for these types of plans are How American Health Care Killed My Father by David Goldhill and How to Fix the Health-Care “Wedge” by Arthur B. Laffer.

There is a lot to like about these plans. I definitely know people who treat their employer provided health insurance as some type of all you can eat health care buffet. When you don’t pay the bills, there isn’t much incentive to spend responsibly. However, I ultimately feel that these plans fall short. For one, the most fiscally responsible health care decision is not necessarily the most healthy health care decision. Another issue is that, to my knowledge, no other country has tried these types of plans on a large scale, so we don’t really know how well they will work in the real world. I think some version of these plans could be work, but most of the people advocating for these plans are also asking for much less government regulation. Meaning that people with preexisting conditions will have no protections. In his op-ed, John Mackey says:

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

To be honest, I almost agree with John Mackey. I don’t really believe in intrinsic human rights, but health care isn’t about human rights. It’s about infrastructure. We have a habit of taking things like public education, national defense, transportation networks, communication networks, etc… for granted, but it’s this infrastructure that provides a stabilizing force for our communities and holds our society together. Health care should be a part of this infrastructure. It isn’t about giving anyone some sort of “entitlement”, it’s about ensuring that nobody is held down by forces out of their control. There is too much lost potential in this country, and we are all paying the price.

I think a lot of people are wondering why we need any reform at all. Most of us, me included, have excellent health care under the current system, so why change? For the answer to this question, I would refer you to the article The Most Outrageous U.S. Lies About Global Healthcare in Foreign Policy magazine. Here is an excerpt from the article:

There is one yardstick by which U.S. health care distinguishes itself: cost. The United States spends more — in total dollars, percentage of GDP, and per capita — than every other country on Earth.

On virtually every other broad metric, the claim that U.S. health care stands for global excellence is demonstrably false. The United States doesn’t take a top spot in either the World Health Organization or nonpartisan Commonwealth Fund rankings. The American health-care system is not best in terms of coverage, access, patient safety, efficiency, or cost-effectiveness. It does not produce the best outcomes for diseases such as cancer, heart disease, or diabetes; for the elderly, the middle-aged, or the young; or in terms of life expectancy, rates of chronic diseases, or obesity.

Which countries do come out on top? Often — France, Switzerland, Britain, Canada, and Japan. On the World Health Organization’s list, the United States comes out 37th.

We spend the most, and we come out 37th. I find this a little embarrassing and I’d like it fixed.

Admittedly, after reading all this, it still isn’t clear to me what the magic solution is. Of course there is no magic solution, and no system will ever be perfect. I do however find comfort in the fact that Switzerland and the Netherlands have recently moved to a health care system a lot like what is being considered by our congress. I also hear that Japan has a similar system. I’m not saying that we should just follow some other country, but these are countries with similar economies and standards of living. I think we would benefit from a few lessons learned by them.

If you were wondering what my thoughts on health care are, now you know. I think it’s abundantly clear that we need reform, and serious reform, not just a little window washing. I’m also very supportive of the plans currently before congress. They aren’t simple or easy solutions, but they are well thought out and backed up by the experiences of other industrialized countries. I hope that we don’t let political ideologies or just plan craziness stand in the way of taking a significant and much needed step forward.

Other things I wanted to include in this post but didn’t include:

• This American’s Experience of Britain’s Healthcare System <– This is a great blog post, you should read it.
• This summary of health care systems around the world at Electoral-Vote.com
• The book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care <– I haven’t read this book, but I saw the author interviewed on BBC America World News, and it sounds very interesting.
• This cartoon video gives a good and fun to watch description of why we need health care reform. It proposes a more government run solution than I think is practical for the US, but it still makes some good points.