Roseyland

Now that health care reform is done, settled, and assured to never be an issue again (#sarcasm), I’m writing one last health care reform post. This debate has taken a toll on me. There are a few people out there whom I thought I would always hold in highest regard, and well, now I don’t. They probably feel the same way about me. Oh well, that’s life.

This is my problem. I love systems. I love to analyze systems. I like to break them down into parts, understand how the parts interact, and look for potential improvements. Few things make me happier than a clean elegant design. Not so simple as to be ineffective, and not so complex as to be inefficient. I don’t care who comes up with it, when I see a well designed system, I get excited.

Nothing excites me about the United States health care system. It’s ridiculously complex. Look at the chart above. The U.S. spends 45% more on health care than any other country. Our health care is not 45% better. No, seriously, it’s not. Don’t get me wrong, the U.S. has world class health care capabilities, but our distribution system sucks.

Most people in the U.S. get some form of group insurance from their employer. I contend that this is “socialized” health care, because everyone in the group pays the same rate regardless of their sex, age, or state of health. If you leave your job, you can continue your health care for up to 18 month under COBRA. If you are self employed or your employer doesn’t offer a group plan, you can buy an individual insurance plan. This will probably cost you more for less coverage, and if you have a pre-existing condition, you will likely be denied coverage. If you are over 65, you can get Medicare, which is a government run single payer system. If you are poor or have certain disabilities, you might be able to get Medicaid, which is a system run by individual state governments. There are a number of different insurance companies, and a number of different health care providers. Every employer negotiates it’s own rates with insurance companies, and every insurance company negotiates it’s own rates with health care providers. In addition, every state has a unique set of regulations that insurance plans must abide by. To summarize, in the United States, we have employer provided group insurance plans, individual insurance plans, COBRA, Medicare, Medicaid, and a big giant patchwork of regulations.

Do you know what the U.K. has? The National Health Service (NHS). None of this one plan for you, another plan for you, or one rate for this insurance company at this provider, and another for another. They have the NHS, and that’s it. It doesn’t matter how old you are, who you work for, or what health conditions you have, you are covered by the NHS. I am sure the U.K.’s system isn’t perfect, no system is, and I do not think the U.K.’s system would be a good model for the U.S., but…. You have to admit, the U.K.’s system is exponentially simpler than the U.S. system, and it essentially produces the same results. This is a big reason the U.K. bar on the chart above is nearly half the size of the U.S. bar.

If I were King of the World, and I should be, I would transition the U.S. away from employer provided health insurance. Employer provided group insurance plans are by far the best health care options in the U.S. I love the insurance my employer provides, and I feel very grateful to have a job I enjoy with an employer that can provide me with said insurance. Still, I would rather not have my health insurance tied to my employer, and I don’t think the fact that I work for a fairly large company means I deserve better insurance than someone who is self employed or works for a small business. We should work towards taking the structure and benefits of employer provided group insurance plans and extending them to the country as one big group. To me, this is by far the most rational and “common sense” approach. It keeps the best aspects of our current system and simplifies it at the same time.

The recently passed Health Care Reform Bill isn’t perfect by any stretch of the imagination, but at least it’s a step in a direction, which is actually pretty amazing at this point. I can’t say that it does much to simplify the current system, but it does fix the pre-existing condition issue and I am hopeful that the national insurance exchange will lead to nation wide group insurance plans similar to what large employers provide today.

The thing that’s frustrating about all this is that I get the feeling nobody really cares about anything I just said. Few people want to analyze our system, compare it to other systems, think of potential improvements, and evaluate the pros and cons. Most people just want to agree with the people around them. People are tribal, they perceive themselves as being members of a particular team, and that membership comes with a whole host of emotional entanglements. People love drama. People don’t make decisions based on a sincere attempt to understand reality, they just do what feels good. I realize that ranting about irrational and imaginary fears brings about certain emotional rewards, but those rewards have very real costs. I’m tired of paying those costs.

Okay, end rant. I’m never discussing healthcare again.