Rather than something that has competed whole cloth against alternative models, our current health care system is a band-aided-all-to-hell version of a system that was inherently flawed form the start, but which conservatives have not let us meaingfully reform. So over the years, rather than evolve, our system has instead mutated sprouting arms and legs as needed to fill one more role until, in the end, we're left with an ungangly mess of appendages that NO ONE would have concieved naturally, if they just sat down one day to design a health care system with the laudable goal of providing universal care.
If someone had presented me with the following, as their initial proposal for a system, I'd ask them if they joking, and have them fired on the spot if the said, "No." This is my interpretation of what that might have looked like, given how our system has ended up looking like:
Just LOOK at this mess! FYI: The Blue Arrow represents CARE. My Doctor provides me with care. Green Arrows represent PAYMENT: I currenltly pay out to (1) my doctor, (2) my insurance comapny, (3) my employer and (4) the government, who is also paid by my employer. Doctors recieve payments from three different sources: Me, the Insurace Companies and the Governement. Insurance companies are also paid from three sources: Me, my employer and the Government. Then you have the Red Arrows. These represent RED TAPE or DA RULZ. Governement tells (in far too few cases, I might add) the insurance companies how to operate as well as any doctors, who collect medicare/medicaid payments. (And this is not even considering standards of care, regulating safety, the FDA, etc... I'm only considering the PAYMENT side of things here!) Insurance companies make the doctors jump through hoops to get paid, and also create all kinds of red tape for their customers, just to justify not paying out or not covering them in the first place. In addition, because of their involvement, my company gets to dictate all kinds of stuff to me. A couple of gems that my company madnates: We have to declare our non-use of any tobacco products or else face a $50.00 insurance surcharge. And don't think for a minute that the insurance company's are giving us non-smokers a break. (Yeah right!) Even if they were, I'm not sure the $2 a month I'm saving is worth the invasion of privacy. (And lying on this form is grounds for termination!) What's more, if you have a working spouse that qualifies for benefits under her employer's health care plan, the s/he MUST be insured with them, otherwise you'll pay an additional premium to inusre your spouse under our plan. Yes, it's already more to insure a spouse, so why the hell should it be EVEN MORE just be she'sotehrwise insurable?! Insuring a spouse ALREADY costs more! WTF?
Bottom line, you shouldn't have to pay out to (or get paid by) three or more different entities and you shouldn't have red-tape going in every direction. None of this complexity is necessary or has anything to do with providing health care. And it doesn't even WORK! We're the wealthiest nation in the world, with health care RESOURCES to spare, and yet tens thousands die (or declare bankrupcy?!) every year from lack of coverage! And even putting that aside, NO ONE, if tasked to design a health care system form the gound up, would have come up with anything like this monstrosity right form the start. No way. It's like... if you asked someone to design the perfect household pet, chances are they come up with something simple, like a dog or a cat. There's basicaly no way they'd invision something resembling some sort of land-based octopus with five mouths.
By comparison, here is the same chart, based on what I proposed with my own health care plan:
See how simple this is? The Gov't creates the policy. A UNIVERSAL health insurance policy with little or ideally no out-of-pocket expense to me. Everyone is covered the same way: Completely. They pay for it with increased taxes (from me and my employer), but the increase in taxes is offset by none of us having to pay insurance premiums or other health care costs out of pocket. They then contract and pay the insurance companies to manage it, negotiate prices with doctors, etc... Insurance companies pay the doctors and the doctors give me care. There. Done. Simple. And if you read my original post, and the few follow-up posts I think you'll see that market forces are harnessed in functional ways that keeps costs low, using good old fashioned competion, in a way that guarentees universal care, rather than promising more profit the more people get refused coverage.
Now... I'm not saying this MUST be the BEST plan EVER, but thus far I have not seen one that's really made me think, "Yeah, that could work too!" Not even truly single payer. (The laws of Microeconomic[supply and demand] guarentee that true single payer will always either have shortages or cost more than it needs to.) Based on what we have as far as resources, THIS is how I'd have it work. And depending on your POV, it's both more conservtive than single payer, or even medicare/medicaid and yet more radical that anything being proposed by congress. And it's sustainable.
But it would never pass. It just make too much sense!
Well, it's not good for healthy individuals who don't go to the doctor or have many out of pocket expenses, or at least not nearly as good for them as it is for families with children with lots of doctor appts or for unhealthy people or people who overutilize the system.
ReplyDeleteBut Soc Sec is the same way - my parents were wise with their money, even though they never were much more than middle class most of their lives. They saved money every year, even with 4 kids, 2 who they mostly put through college. Because they were good with money, and had no big crises, they would have been better off saving their Soc Sec contributions by themselves and reaping the benefits after they retired rather than giving it to the gov't to invest and then give them a stipend for life.
And then my mom died when she was 65, so they sure didn't get their money's worth on her. And on top of that, she worked part-time most of her married life, but she got more in spousal benefits rather than as an earner from Soc Sec, so all the money she put in was, in effect, wasted.
But, despite all that, my mom and my dad STILL supported Soc Sec, because they saw during the Great Depression how bad it was for the elderly, and they knew how helpful it was to many people to keep them out of poverty.
My Dad DID make pretty good money for a guy with a high school diploma. I think you work for the auto industry in a periphery job, right? My Dad worked 6 days a week in a factory that made truck transmissions and 4 wheel drive units. He never, in almost 40 years of working there, collected unemployment. They'd have layoffs, but in those early years, he'd always have just enough seniority to just be laid off for one week, then he'd get hired back. And he got paid well, great benefits too - he gets more income now than he can spend with his pension and retirement, even with a few health issues as an 84 year old man. Still drives his own car, and played golf and bowled until last year.
ReplyDeleteI DO work in automotive. I'm not sure what a "periphery job" is, but I'm an engineer in saftey restraints. ;) (And if I have a bias in my thinking, that's it: I think like an engineer. I've been informed of that DERISIVELY by both conservatives AND liberals over the years, and I've only ever taken it as a point of PRIDE. LOL)
ReplyDeleteIn addition to supporting SocSec, I assume your Dad was also in a Union? (UAW?) I want to make sure before I go into a rant about how the Right seems to think he didn't deserve that pay or those beneifts. Was he in Michigan? Just curious. (I am.)
As for the whole "healthy people" argument? (Healthy people shouldn't have to buy health insurance if they don't want to?) My problem with that whole way of thinking is that we don't REALLY know who's healthy, or (more importantly) who's going to STAY healthy. A co-worker of mine DIED last week. Died. Of a series of strokes, following a pulminary embolism. He was 42 years old. I saw him the week before, and I can assure that most people (including himself, I'd wager) would have described him as "healthy." The fact is, EVERY sick person was once "healthy." And every healthy person assumes they'll always stay that way - especially the younger ones! So letting people choose in this way leads to many people making bad choices. And this drives up the cost for everyone, even if they DO stay healthy, but doubly so when some of them inevitably get sick and we end up paying for them anyway. So as much as I define CHOICE as the critical factor in all issues, I don't think it's a good idea to give people THAT choice. It ends up costing (victimizing) everybody else... Because it's not like we're really going to refuse care, or deny him bankrupcy protection!
Thanks for you comments!
It's not a good financial investment for people who won't ever have a car accident that's their fault to buy car insurance. But it's still a great idea to have that insurance.
ReplyDeleteAnd yeah, my Dad was a UAW member - still goes to retired member meetings once a month, and used to go down to the trailer park they owned in Myrtle Beach. He thought that the union in the 70's and 80's was a little greedy, but he sure always understood the value they provided too. He used to tell the story of how hard it was to fire people because of the rules the union implemented. If you had chronic attendance issues, they'd give you a day off without pay. If you continued to miss work, they'd then give you two days off without pay. Then it'd be 3 days, then a week, then 2 weeks, then a month, and only after a worker blew ALL those chances to learn a lesson would he get fired, and even then, the union could usually get him back on the job after an appeal.
The UAW also pulled the crap to enlarge their membership by granting every employee an additional 5 days off every year on top of their vacation (my Dad got 5 weeks paid vacation for a long time, got a check in May 'in lieu of vacation', so if he only took 2 weeks off, he actually made 55 weeks of payroll). You'd get a Monday and a Friday guaranteed off, as well as 3 other days, with pay, and you couldn't come in and work those days for extra pay. What did that do? Well, for every 50 people you had in your plant, the factory would have to hire one more worker to cover those manhours lost! If you had 2000 workers in your factory, you'd have to hire an additional 40 workers/UAW members, with all the benefits and additional costs - or not lay off other workers to supply the necessary manhours.
That kind of excess bugged him. He never needed help from the union, he thought they were too greedy, but he STILL goes to the union hall once a month. I worked there during summer breaks from college and in the late 70's made $7 an hour (plus shift differential and overtime pay and double time for Sundays) when McD's was paying less than $3.
My Dad worked in a plant in East Syracuse, NY that was bought by Chrysler in the late 1950's that made parts for many truck manufacturers mostly. It's since been sold a couple of times, and may get closed. It was called New Process Gear for many decades - originally someone figured out a New Process to make gears out of hardened rawhide - imagine that! Now they mostly make transfer cases for 4WD vehicles.
The first prt of your coment made something occur to me... There's so much controversey about the idea of MANDATING that people buy health insurance. I'm not crazy about the idea myself, at least under the current "for-profit" plan. But why, really, is it any different from mandating that everyone has car insurance? I know, I know... You don't HAVE to drive. But... Really? You don't? A few of us maybe don't, but I'd say for all intents and purposes, outside of the inner city and higly urban areas, driving is pretty much a necessity. And true... we only have to buy LIABILITY, not COLLISION, but still... it's a MANDATE. And we pretty much take it for granted. We recognize the inheretn good in forcing people to be responsible in that case. But when in comes to health care (and the cost to eveyone else to pay for the unisured) now we all scream "SOCIALISM!" It's kind of absurd really.
ReplyDeleteI largely agree with your Dad's judgement of the Unions. I don't consider myself a big-time, union supporter (I mean politically, I'm not IN a union myself) but I bristle (and try to keep from laughing) everytime I hear someone - and it's always someone from OUTSIDE the industry - try to blame ALL of GM, Ford, Chrysler, Detroit and Michigan's problems 100% on the Unions. That's just patently absurd. And pretty much everyone here KNOWS it. The managers at Ford and GM know what they did wrong all those years ago! They're case studies in B-School for cripes sake, and the answer is infinitely more complicated than "they shouldn't have agreed to all those union concessions!"
The Union WERE PART of the problem. Absolutely. But they were also, arguyably, the single biggest factor in building the middle class of this country. And the middle class has diminished and decayed as the Unions have faded from prominence. (Another thing to thank Ronald Reagan for!) All in all, they did a lot more good than harm, but there clearly were still some blatant abuses as well. Their situation (back then) strikes as someone taking what they can in the short term, and not considering the implications in long term. (No SUSTAINABILITY, and no PLAN FOR IT. Again: Kind of like REAGAN!) And the unions paid the price for their lack of foresight, right along with Ford and GM.
Thanks again for your comment.
Nice post. I was checking constantly this weblog and I'm inspired! Extremely helpful info particularly the closing part :) I take care of such info a lot. I used to be looking for this certain info for a very long time. Thank you and best of luck.
ReplyDeleteMy web page filing bankruptcy in florida