The changing health-care debate

A few years down the road, January 2007 could be remembered as a turning point in American health care. A turn leftward, that is. This week, the groups best known for their stalwart opposition to Democratic universal health-care schemes in the 1990s announced two separate coalitions with former adversaries. This follows less-than-conservative health-care initiatives by Republican governors in California and Massachusetts within the past year. Viewed together, it looks like the political terrain on health care is shifting.

In one of this week's coalitions, America's Health Insurance Plans, whose predecessor the Health Insurance Association of America helped torpedo HillaryCare with its "Harry and Louise" ad campaign, joins Families USA, one of Sen. Hillary Clinton's favorites, among other groups, to advocate a yet-to-be-detailed "overhaul" of health care. The other coalition joins the Business Roundtable with the Service Employees International Union, among others, for a similar purpose, also short on details. Not until the coalitions elaborate on the specifics will we know where the new health-care debate is headed.

These are the key players in American health care, buttressed by the top representatives of corporate America generally: America's Health Insurance Plans, the Business Roundtable, plus the American Medical Association, the U.S. Chamber of Commerce, the American Hospital Association and others in addition to the above heavy hitters are also involved in these two coalitions. Together, this is quite nearly the entire universe of industry players -- with the important exception of the pharmaceuticals industry. All may now be signaling that they find market-based health care to be unacceptable.

If SchwarzeneggerCare is any indication, the direction is likely to be measurably to the left of previous years. Mr. Schwarzenegger's plan for universal coverage includes "pay or play," a 4 percent payroll tax and a four percent tax on doctors and...

It's going to happen one way or the other. I don't see any way out of it at this point. Too many hospitals and health departments are going broke treating the uninsured and illegals. As long as the feds require hospitals to treat everyone we will have this problem.

But it still really angers me! I belong to Kaiser, which I get through my job. I am very happy with Kaiser. However, the Kaiser hospital I go to is the ONLY hospital in town. Every person on Medicaid (Medi-Cal here in CA) can come into the hospital and be seen. I have been to the emergency room a few times and had to wait while Medi-Cal patients, WHO ARE NOT KAISER MEMBERS AND DO NOT PAY, are seen ahead of me. This is a PRIVATE hospital, not a public one, yet we still have to wait while they treat the illegals and the susidized, non-Kaiser "poor".

It's just going to get worse.

The Massachusetts plan is actually not the worst. It was supported by the Heritage Foundation. The way I understand it, is that it basically requires everybody to purchase a health insurance plan. If you can't afford one, you receive a voucher to buy one. By the measure of many economists, this may very well turn out to be cheaper in the long run.

We have laws that require emergency rooms to treat people regardless of their ability to pay. The result is, we have people treating the emergency room as their personal doctor. Who ends up paying for this? The average American, either through their health care costs of their tax money. The amount of tax money they'd pay for health care vouchers would be smaller than the amount they'd save on their own health care.

These economists could be wrong of course, and that's why it's wise for a few states to try this system out first. The only way we could have a true free market health care system would be to repeal those emergency room laws, which would never fly. This system still leaves the business of health care private, even if not all the money in it is. It has the advantages of competition and does not have disadvantages of excessive bureaucracy, neither of which would be the case with a single-payer system.

We already have "universal health care". Some people pay a great deal out of pocket for it, some pay modest (or maybe not so modest) sums into an insurance pool, and make a co-payment at time of delivery of medical services, and some are totally dependent on the kindness of strangers.

Emergency rooms have to accept incoming patients. Once the prospective patient has been put through triage, a certain degree of priority is applied to that particular situation, and it may be ten seconds, or ten hours, before directing medical attention to that individual.

The objection is that ALL medical care will be centered on crisis response, and the slow, deliberate application of good preventative medical care will become a casualty of this redirection of resources. Elective medical procedures will be allowed (or forced) to be postponed, until a crisis does occur, the fire drill response.

"Get your employer to pay for it" is bad policy, for a multitude of reasons. Because your employer does NOT pay for your health insurance plan, you do. By taking a lesser wage, or having the premiums deducted from your take-home pay AFTER taxes. Even if the employer pays ALL the premium, this is still a bad deal for the employee, because when the job terminates for any reason, the medical coverage disappears. Or the employer may have just done the insurance coverage shopping for you, and acquired the least-expensive source out there, with some company that is willing to accept the premiums, but may have a very poor record of paying the bills, something you do not want to discover in the middle of a major medical crisis.

Some may ask, why can't individuals just buy into the same plans that are available to most government employees? This is not the same thing at all as having the government, at whatever level, being the single-payer source, as the insurance is actually through regulated companies, that provide the coverage based on actuarial risk tables. Some people just cannot qualify for coverage under any plan, because of pre-existing health conditions, or time limitations, or some other disqualifier. Or if they do qualify for such a plan, they may be unable or unwilling to make the necessary premium payments or co-payments. These inevitably wind up as somebody's charity cases.

So to finance coverage for this pool of uninsureds, is it wise to enroll them in "compulsory" insurance? Again, this problem with triage, and overdependence on somebody else footing the bills, resulting in deferred or even inadequate delivery of health care. So, some say, slap a surtax on top of Social Security, or some kind of excise or national sales tax on goods and services, to finance. But then, it becomes a TAX, and not an insurance plan.

Problem with that, is that the tax will NOT be dedicated and segregated for that purpose and that purpose alone. The fund will be raided almost immediately, as were Social Security and Medicare, by throwing it in the general revenue fund, and "borrowing" against those funds, to run general government programs. Essentially, this program would only ADD to the national debt, as it would be funds that were to be paid out at some future time, but spent on current responsibilities, which means, there ain't anything in the bank when it comes time to pay the bills coming in.

Since the time of the New Deal, the government has been mortgaging more and more of its future by borrowing, and now, the least tremor in this cycle of always borrowing ahead, sets off tsunamis and shock waves all over the world.

Which is why GM builds such uninspired automobiles, and is soon to become the #2 automaker in the world. GM provides the biggest health insurance and pension program in the world, and exists only to continue to serve that purpose, not to build cars.

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But it still really angers me! I belong to Kaiser, which I get through my job. I am very happy with Kaiser.
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I apologize for singling you out, sir. But this statement is why FR and conservatism has not evolved a good policy response on this matter.

The truth is a lot of FR types are in traditional jobs who get group health plans through those jobs. Well, this is a HUGE problem for conservatism because what it is doing is concealing from most on FR that This Is Not The Norm.

The norm in the US is jobs as self employed people or as employees of very small business. Or employed at fewer than 40 hrs per week, and paid hourly. Add to these categories another group of Americans called "early retirees", who get an early out or simply achieve enough success to stop working before age 65.

All of those several categories can be refused individual policies for pre-existing conditions. They Can't Get Insurance. Group plans are not allowed to exclude pre-existing conditions.

I would suggest that THIS is the single key focal point that the GOP could rally around as a viable conservative position. Enforce a declaration that all people in non group plans are in total a group and constitute a group plan in and of themselves. This would prevent exclusion for pre-existing conditions and it would prevent enormous premium increases for individual plans.

It also would, in conservative fashion, keep government out of the healthcare business. Insurance companies WILL see an impact on profits from this because they are currently gouging individual plans and excluding high risks -- but a tax break for the industry could balance this and remain quintessentially conservative.

Anyway, that's my contribution to the 2008 GOP platform. :)

You seem to have given this a good deal of thought.

Let me add a bit of data regarding requiring people to buy insurance.

I'm required to be in Part D medicare and pay $38/month to do so. All of my generics are available in or out of plan for $4 ...no savings.

After the free enrollment period they changed the formulary so of 4 non-generics I need, two were dropped from the plan.

Basically, I am forced to pay for useless insurance or face extravagant penalties (1% per month). I can't drop the bad company until next November.

I understand that some folk will need less than the premiums and others more, but being locked in and having only a handful of meds even available needs addressing. I see a similar problem with forced buying of healh insurance. IMHO

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