Looooooong Entry...
The big topic du jour right now is health care reform. And what follows are a few of my thoughts and observations on the health care reform debate overall. I will try to avoid any pointlessly political overtones, since it's too easy, just generates anger and shock value and usually goes nowhere but to distract from real and meaningful dialogue.
The debate going on now isn't new. Even as early as the twenties and thirties there was debate in the halls of government, academia and elsewhere as to whether the United States would adopt a socialist system of government-run health care, some sort of publicly-guided cooperative system or the (at the time quite new) system of privately-directed insurance managed system of health care we see today. Obviously, as history has played out, we have the system we have today where the costs of health care are paid indirectly in that health insurance premiums are paid by most people to receive care for procedures ranging from simple check-ups with a $20 co-pay all the way to traumatic care after, say a car accident or a heart attack costing many thousands to hundreds of thousands of dollars. Some insurance will pay for all of this. Some will pay for part (as in an 80/20 co-insurance scheme), and some will pay for little. And, of course, those who have no health insurance are almost doomed to a long time of crushing debts or bankruptcy.
Like so many other things, the health care system we have is uniquely American. It was born and bred of our overall culture; a pretty much conservative, individualistic and self-determined culture based on free-market ideals peppered with some well-meaning welfare programs run by the state and serving, ideally, the least able to serve themselves. Thus, we have the best health care -- for those who can afford it as well as at least some safety net for the rest, though it full of very large holes. And the resistance to a full-fledged government-run system like in Europe, Canada or elsewhere has meant that there are several different tiers of health care in the U.S. in terms of direct cost. A few welfare-type programs exist (Medicare, Medicaid et al.) exist alongside the free-market system. The result is a system that should have the best of both worlds, but a lot of times just has the worst of both.
A few interesting facts of note (from the Wikipedia article on Health care in the United States and health care reform in the United States. I know citing Wikipedia is lazy, but I don't care.)
-The inflation in the cost of health care in the U.S. is about three times monetary inflation, now at 16% of gross domestic product. At current trends, it's expected to reach 19.5% of GDP by 2017.
-Per capita, the U.S. spends the most money on health care of all the major industrialized nations.
-Responsiveness and expenditure of health care is ranked first place in the U.S., meaning that people are more likely to get the care they need in the United States.
-The U.S. health system ranks lower in other measures of health and health care, such as 37th in overall performance and 46th for life expectancy.
-60% of all bankruptcies in the U.S. come from medical expenses as a major contributing factor.
-The U.S. pays the highest share of GDP to health care from government sources. Yes, government sources! Which means that compared to Canada, Germany or France, countries with universal-coverage and single payer government systems, a higher percentage of government money goes to health care in the United States than those other places. This fact out of all the ones I've read is the most interesting to me.
So basically, we already pay more in terms of government funds to health care and more in terms of overall GDP to health care than any other nation. And yet, our health care, as a whole, isn't better for it. Of course, measuring the whole differs from measuring individual cases. And I am sure there are plenty of horror stories right along with I-just-won-the-hospital-lottery stories out there. But I think just the very fact that we are not getting our money's worth in terms of health benefits shows that some kind of change is needed. But the real debate is how, and to what extent.
To me, the debate boils down to these arguments: Should we all have to pay so that some of the more unfortunate or perhaps more lazy and careless people get good health care coverage? Do some people deserve to be treated more effectively or extensively if they can pay for it? Is health care a right? If so, to what extent and should society share the burden of people who won't or can't pay in as much as everyone else? If not, do people deserve to die from lack of treatment or deserve to go destitute and bankrupt from treatment that they can't afford?
The health care reform debate is, in my mind, second or third to the abortion debate in terms of its lack of a solution that will please the most people. Both sides have their own sticky contentions and it is definitely a question that can't be answered easily. I can only really contribute to the dialogue what I have experienced:
I have only ever had to seek out health care a few times on my own. As a kid, I suffered injuries and hospital visits, but I nor my parents didn't have to pay directly for them. As an adult, I've sought out medical care only once or twice, but I've sought out health insurance many times, with changing jobs and situations. And each time, I was thrown into a land of confusion and bureaucratic jargon. With every health insurance policy I have ever signed up for, I have never fully understood the extent of my coverage or how much I would need to pay myself if something were to happen. I have tried to pay attention to the key factors, namely co-insurance and deductibles. And even in the five or so years I've been responsible for my own health insurance, I've noticed deductibles staying the same or going up with different companies and I've noticed co-insurance (80/20) becoming more frequent. Granted I've only sought out minimum coverage, since I am still fairly young and healthy, but I've also noticed premiums also going up. It stands to reason that if you bought a smaller chocolate bar for a greater price, you'd notice something not right here. And that is what I have noticed.
I know the system is still not quite set up for self-reliant people yet. My company doesn't provide an option for an HSA-compatible insurance. I would basically have to pay a premium on another high-deductible insurance policy to take advantage of the tax benefits of a health savings account. I wouldn't be able to save up enough in an HSA to make up on tax benefits to justify the extra cost. I'm trying to self-insure with saving up an emergency fund, but I am still not quite there yet. And a particularly vicious medical incident would cost so much that an emergency fund could be wiped out in the blink of an eye.
I also know the following: I have health insurance through my work. I pay into it and may not even ever make a claim on it for several years. But what happens if I get laid off or fired, and then three days later I get into a car wreck? What do I do then? What do I do that I've paid into the system for so long only to not be covered when I need it?
These are all conclusions I've come to on my own, before Obama was elected and before the debate on health care reform got so fervent. I know just from observation that the system is quite messed up and would do well to have some sort of change. But just what, I do not know.
I'd like to get yours-all opinions and input on this, even if it's something as overly quaint as "keep the gubmint out of my Medicare."
The debate going on now isn't new. Even as early as the twenties and thirties there was debate in the halls of government, academia and elsewhere as to whether the United States would adopt a socialist system of government-run health care, some sort of publicly-guided cooperative system or the (at the time quite new) system of privately-directed insurance managed system of health care we see today. Obviously, as history has played out, we have the system we have today where the costs of health care are paid indirectly in that health insurance premiums are paid by most people to receive care for procedures ranging from simple check-ups with a $20 co-pay all the way to traumatic care after, say a car accident or a heart attack costing many thousands to hundreds of thousands of dollars. Some insurance will pay for all of this. Some will pay for part (as in an 80/20 co-insurance scheme), and some will pay for little. And, of course, those who have no health insurance are almost doomed to a long time of crushing debts or bankruptcy.
Like so many other things, the health care system we have is uniquely American. It was born and bred of our overall culture; a pretty much conservative, individualistic and self-determined culture based on free-market ideals peppered with some well-meaning welfare programs run by the state and serving, ideally, the least able to serve themselves. Thus, we have the best health care -- for those who can afford it as well as at least some safety net for the rest, though it full of very large holes. And the resistance to a full-fledged government-run system like in Europe, Canada or elsewhere has meant that there are several different tiers of health care in the U.S. in terms of direct cost. A few welfare-type programs exist (Medicare, Medicaid et al.) exist alongside the free-market system. The result is a system that should have the best of both worlds, but a lot of times just has the worst of both.
A few interesting facts of note (from the Wikipedia article on Health care in the United States and health care reform in the United States. I know citing Wikipedia is lazy, but I don't care.)
-The inflation in the cost of health care in the U.S. is about three times monetary inflation, now at 16% of gross domestic product. At current trends, it's expected to reach 19.5% of GDP by 2017.
-Per capita, the U.S. spends the most money on health care of all the major industrialized nations.
-Responsiveness and expenditure of health care is ranked first place in the U.S., meaning that people are more likely to get the care they need in the United States.
-The U.S. health system ranks lower in other measures of health and health care, such as 37th in overall performance and 46th for life expectancy.
-60% of all bankruptcies in the U.S. come from medical expenses as a major contributing factor.
-The U.S. pays the highest share of GDP to health care from government sources. Yes, government sources! Which means that compared to Canada, Germany or France, countries with universal-coverage and single payer government systems, a higher percentage of government money goes to health care in the United States than those other places. This fact out of all the ones I've read is the most interesting to me.
So basically, we already pay more in terms of government funds to health care and more in terms of overall GDP to health care than any other nation. And yet, our health care, as a whole, isn't better for it. Of course, measuring the whole differs from measuring individual cases. And I am sure there are plenty of horror stories right along with I-just-won-the-hospital-lottery stories out there. But I think just the very fact that we are not getting our money's worth in terms of health benefits shows that some kind of change is needed. But the real debate is how, and to what extent.
To me, the debate boils down to these arguments: Should we all have to pay so that some of the more unfortunate or perhaps more lazy and careless people get good health care coverage? Do some people deserve to be treated more effectively or extensively if they can pay for it? Is health care a right? If so, to what extent and should society share the burden of people who won't or can't pay in as much as everyone else? If not, do people deserve to die from lack of treatment or deserve to go destitute and bankrupt from treatment that they can't afford?
The health care reform debate is, in my mind, second or third to the abortion debate in terms of its lack of a solution that will please the most people. Both sides have their own sticky contentions and it is definitely a question that can't be answered easily. I can only really contribute to the dialogue what I have experienced:
I have only ever had to seek out health care a few times on my own. As a kid, I suffered injuries and hospital visits, but I nor my parents didn't have to pay directly for them. As an adult, I've sought out medical care only once or twice, but I've sought out health insurance many times, with changing jobs and situations. And each time, I was thrown into a land of confusion and bureaucratic jargon. With every health insurance policy I have ever signed up for, I have never fully understood the extent of my coverage or how much I would need to pay myself if something were to happen. I have tried to pay attention to the key factors, namely co-insurance and deductibles. And even in the five or so years I've been responsible for my own health insurance, I've noticed deductibles staying the same or going up with different companies and I've noticed co-insurance (80/20) becoming more frequent. Granted I've only sought out minimum coverage, since I am still fairly young and healthy, but I've also noticed premiums also going up. It stands to reason that if you bought a smaller chocolate bar for a greater price, you'd notice something not right here. And that is what I have noticed.
I know the system is still not quite set up for self-reliant people yet. My company doesn't provide an option for an HSA-compatible insurance. I would basically have to pay a premium on another high-deductible insurance policy to take advantage of the tax benefits of a health savings account. I wouldn't be able to save up enough in an HSA to make up on tax benefits to justify the extra cost. I'm trying to self-insure with saving up an emergency fund, but I am still not quite there yet. And a particularly vicious medical incident would cost so much that an emergency fund could be wiped out in the blink of an eye.
I also know the following: I have health insurance through my work. I pay into it and may not even ever make a claim on it for several years. But what happens if I get laid off or fired, and then three days later I get into a car wreck? What do I do then? What do I do that I've paid into the system for so long only to not be covered when I need it?
These are all conclusions I've come to on my own, before Obama was elected and before the debate on health care reform got so fervent. I know just from observation that the system is quite messed up and would do well to have some sort of change. But just what, I do not know.
I'd like to get yours-all opinions and input on this, even if it's something as overly quaint as "keep the gubmint out of my Medicare."