Universal Health Care?
This article from the New York Times caught my attention.
The health insurance industry said Wednesday that it would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability. But in return, the industry said, Congress should require all Americans to have coverage.
The proposals, put forward by the insurers’ two main trade associations, have the potential to reshape and advance the debate over universal health insurance just as President-elect Barack Obama prepares to take office.
In separate actions, the two trade groups, America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, announced their support for guaranteed coverage for people with pre-existing medical conditions, in conjunction with an enforceable mandate for individual coverage.
In the absence of such a mandate, insurers said, many people will wait until they become sick before they buy insurance.
I can understand the insurance industry’s desire to require universal coverage. The more people who are in the pool, the lower the risk for insurers. But the big question, in my mind is: how much? The article doesn’t given any idea what prices would be charged for individuals and families, and I can tell you that buying insurance as an individual is far more expensive than in a group. But the cost of insurance probably is part of the reason people wait to get insurance until they need it. I don’t really know anyone who does this, btw. Most people I know like having insurance so that when they want to go to the doctor, it’s not a huge expense.
But having said that, many doctors give discounts to people without insurance because the doctor is saved the cost of filing paperwork. And, as I’ve noted before, doctors will even waive their fees from time to time. So, while the hospital may charge you $4,000 for an E.R. visit, you can get a break from an internist.
In many cases, people with cancer, diabetes, traumatic brain injuries or other serious afflictions have found that they cannot obtain health insurance at any price.
Research suggests that some insurers turn down 10 percent or more of applicants for individual coverage because of their pre-existing medical conditions.
It’s been my experience that insurance companies try to find reasons to either charge customers more or disqualify them for coverage, even if they are healthy. The idea that such practices would be banned would go a long way towards improving coverage. But unless that coverage is affordable, and I am not sure how we would define “affordable,” it won’t help.
Dana Pico:
The NYT article said:
OK, just how do you enforce the requirement that all Americans have health care coverage? The only institution empowered to collect from everyone is the government, in the form of taxes.
20 November 2008, 10:03 amSharon:
We’ve seen how well requiring auto insurance works, haven’t we?
20 November 2008, 10:26 amJohn:
You can’t wreck your car then buy insurance. You can’t buy home owners after your house burns down. Similarly, you can’t get low cost health insurance if you have cancer. Insurers don’t “buy” claims. If they did the rates for good risks would skyrocket. We have Medicare for the elderly, Medicade for the poor and SCHIP fo children. Perhaps we need a “high risk” pool for preexisting conditions? All I know is I’m not willing to pay for other peoples health insurance when they own cars, plasma tv’s etc. but won’t pay for their own coverage.
20 November 2008, 11:02 ammike g:
Sharon> having property casualty licensure in several states (including yours) I can tell you without a doubt that mandatory liability coverage on auto insurance helps bring down costs tremendously.
20 November 2008, 1:33 pmDana Pico:
John wrote:
You might not be willing, but that’s exactly what you are already doing. Hospitals and medical practitioners already charge good, insured, paying customers more, to make up for the loss on uncollectible care. Because of that, your health insurance premiums are higher.
And you’re paying higher taxes as well, to pay for grants and aid to hospitals, neededbecause some people don’t carry insurance.
I’ll put it very bluntly: the only way to compel people to pay for their health insurance is to use the power of government to collect — and those are things we call taxes!
The sole discipline of a free market system is that those who do not pay for something don’t get it. But since we are unwilling to let sick people who can’t pay for health care die in the street, we have eliminated that discipline.
20 November 2008, 3:10 pmJohn:
Yes, Dana we surely are all paying right now. But if we offer “free” health insurance I have no doubt it will be over used and abused by all just like every other entitlement. You are also correct about compelling people to pay being taxes. However, there is no way to compel people to pay if they already don’t pay taxes. We need to determine exactly who these uninsured are. As stated, the poor have Medicade, elderly Medicare and any kid can be covered under SCHIP. So who the hell is really uninsured? Must be people between 21 and 40 who see more value in a Corvette payment than health insurance. Hell my BC/BS costs $784 per mo. yet my car lease is $480. How about if you drive a car you must have health insurance? I’m really reaching now, aren’t I? But like you Dana, I’m frustrated by the problem. Got any ideas?
20 November 2008, 3:40 pmDana Pico:
John: Rather than write a long response, here’s what I wrote when I changed my mind about a single payer plan.
Clearly, we need to have a separate health insurance tax, structured like the Medicare payroll tax, that will get everyone who works. My preference would be for a flat rate tax, of X dollars rather than X%, where everyone would pay exctly the same for health care coverage — like they do in most employer-based systems — but I’d have to be smoking something pretty strange to think that will happen.
Yes, I know: the unemployed still won’t pay anything, and some people will cheat the system, but that’s the case with every tax we have. If we’re waiting for a perfect collection system, we’ll wait forever. I’m just hoping to get most of the free-riders to pay something.
20 November 2008, 4:37 pmPhoenician in a time of Romans:
Shorter Dana Pico: Gosh, if only there was some way to compare alternatives… Pity I can’t think of any.
20 November 2008, 4:37 pmJohn:
I read your post from Oct. 13, 2007. I also read the links and comments. The entire problem is quite interesting from an economics stand. I always vote “freedom” for any social/political problem. Yet health care has no practical trade-off I can see. We either tax all and cover all or remain in this broken system. I think it was Yorkshire who responded how odd it is that we insure our “things” yet feel it’s the duty of others to cover our health. But at this point you’ve moved me to your side, Dana. Howeer, I will continue to bounce the entire concept off my friends for other opinions. I am also forwarding your posts to them to bring them up to speed. Thanks.
20 November 2008, 5:50 pmSharon:
Similarly, you can’t get low cost health insurance if you have cancer.
Many times, you can’t get any insurance if you’ve had cancer. Unless, of course, you are covered under an employer group plan. But don’t for a moment think that you as an individual can buy insurance if you’ve had cancer.
I know this from experience. My husband had thyroid cancer, one of the most treatable forms there is (I don’t know how many times we heard the words “If you gotta get cancer, this is the kind to get”). At the time, my husband was working for a large company.
A year later, he was laid off from large employer and became a contractor. COBRA was out of the question because of the prices. So, we decided to buy insurance from Humana One. But they wouldn’t insure my husband because of the cancer. Instead, we wound up getting insurance for my children and me. But even with that, they wanted to charge me extra–not because I have health problems but because I’m overweight and they thought it would cost them more in the future.
I live in a state that has a “high risk” pool, but the cost of insurance for my husband alone was more than the insurance for the other family members.
I’m sure you’ll tell me how we weren’t “serious” because we didn’t plan on my husband having thyroid cancer or getting laid off. Or that, maybe, we should have just sold off a lot of things we’d bought when times were better because having a TV is proof that we could have afforded to buy our own insurance.
Well, I call bullshit on that. We were (and are) responsible people who happened to have a health tragedy come up. It’s not like lung cancer, which you can at least blame on your 40-year smoking habit. My husband was 35 years old when he got cancer, so, it wasn’t like he was elderly or had some other problem.
It’s easy to argue that “everybody” can afford health insurance, but the truth is, “everybody” can’t afford it or afford the insurance that’s offered. If the insurance foisted on you costs half of your monthly income, it’s not really affordable.
We’re fortunate now. My husband works for another large employer and we now have even better insurance than before. But our experience taught us that the system we have doesn’t work for consumers. At least, not the consumers who get sick.
21 November 2008, 12:34 amJohn:
Sharon, you point out another problem with our current system. Your husband did not become uninsurable he became uninsured. In reality you were only “renting” your health insurance as long as you worked for the same employer. Had the system allowed you to “own” your coverage it wouldn’t have mattered for whom you worked or in which state or even your age. It would go with you where ever as long as the premiums were paid. This is why we need a system which separates the insurance from any given employment. Instead of health insurance being a “benefit” we need to make it a product which is owned. When your husband was laid off he didn’t loose his car or his home because he owned them and was not beholden to an employer for them. So I say Sharon has a point. We need transferable ownership of our health plans which can be transferred even to a private plan without interuption of benefits, coverage or premiums.
21 November 2008, 8:53 amPhoenician in a time of Romans:
Many times, you can’t get any insurance if you’ve had cancer. Unless, of course, you are covered under an employer group plan. But don’t for a moment think that you as an individual can buy insurance if you’ve had cancer.
I can get care for cancer without insurance. I’m not covered under an employer group plan. I don’t have to buy insurance.
It’s easy to argue that “everybody” can afford health insurance, but the truth is, “everybody” can’t afford it or afford the insurance that’s offered. If the insurance foisted on you costs half of your monthly income, it’s not really affordable.
I believe what people want is health care, not health insurance. However, what corporations want is to sell you insurance not care.
So the question is - is the purpose of the health system to deliver care to people, or profits to corporations?
21 November 2008, 7:09 pmSharon:
Pho–you say you can get care for cancer. We could get care for cancer, as well. But can you get the newest, best drugs for treating cancer? The newest treatments? When you are 70, will you be able to decide if you want treatment for your cancer? Or will the government tell you that you’ve lived long enough and that treatment is only available for those under 50?
See, with or without insurance, I have never been turned down for treatment at any hospital, clinic or doctor’s office. So the idea that, somehow, using insurance limits my ability to get treatment is not true.
Socialized medicine only works (if that’s the proper word) if it rations treatment. We’ve given you numerous examples of how the rationing works, from long waits to the unavailability of new drugs and therapies. We’ve presented stories of women who had to have their children at home because the hospital was too crowded (there’s only one, you know!) and didn’t have room for them. We’ve presented stories of ambulances idling in hospital parking lots because they are not allowed to release their charges into the hospital. We’ve discussed “surgical holidays” because it takes so long to get a hip or knee replacement (or other surgery) that people are willing to fly half way around the world to get a procedure done.
And, of course, there’s the NHS which told my own grandfather that he only got one round of chemo because he’d lived long enough. Go home, get your affairs in order, cuz you get to die so you don’t use up more of the system.
The health system delivers care to people, Pho. But there’s still no such thing as a free lunch.
22 November 2008, 10:06 am