A Weblog of Centrist Voices in American Politics
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A Weblog of Centrist Voices in American Politics | |
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January 29, 2005Health Care: The 800-lb GorillaWhile the Democrats work overtime to shoot down a Social Security reform plan that hasn't even been proposed or detailed yet, there's another crisis waiting in the wings to explode. And for this one, there's no cushion of lead time. Tax-Exempt Hospitals' Practices Challenged As the cost of medical care continues to increase faster than economic growth, even the institutions that are supposed to help are taking a very hard line indeed on collecting bills from the uninsured--and charging them more to boot. While insurors negotiate steep price breaks on services, the uninsured are dunned for full "list" price, sometimes as much as six times what an insured patient's bill would be. In times past, the poor's charges would be written off as charity. Now even the non-profits are sending the bill collectors to dun minimum-wage workers for bills they can't possibly pay. Malpractice suits, insurance companies, high drug costs, boutique clinics, corporate medicine--the list of things and people to blame is endless. But the bottom line is that the system is out of control, and rapidly becoming unaffordable to even those in the middle rungs of the ladder. Health insurance for a family of four has already passed the $10,000 a year mark, and that's NOT including deductibles and co-pays. By far the #1 cause of bankruptcy in America today is medical bills. Social Security reform, while not cheap, is not complicated. The choices are fairly clear, the finances not all that ambiguous. If we act soon, it can be brought under control without the system imploding. But Medicare isn't running out of tax revenue in 2018. It's running out of revenue NOW, and the overall cost of the program in constant-dollar terms is expected to more than quadruple in the coming years. And that may be an optimistic estimate. One conclusion is inescapable--Medicare can not be reformed without reforming the overall health care system. In the meantime, fewer and fewer employers are picking up the full tab for medical insurance. And even fewer pay anything at all for the employee's dependents--that's extra. The cost of insurance is severely retarding wage growth, and is the #1 factor cited in "outsourcing" decisions by employers. Many defenders of the American health care system like to say that we have the finest health-care system in the world. And it's true that American health-care innovation is unrivaled, in drug and technology and treatment development. But outcomes are lagging, as large portions of the populace simply can't afford to access these innovations. We do indeed have the finest for-profit health care system in the world. It's the absolute finest at producing profits. But it's rapidly becoming second-rate at producing outcomes. I have no easy answers. But I'd love to hear suggestions. How do we cage the 800-lb gorilla? And how can we afford to feed it? Posted by Tully at January 29, 2005 12:16 PMComments
The SS question is easy compared to this one. Looking at the waiting time for people in Canada to get treatment makes their system look like a failure. However since my brother is a cancer surviver with no insurance I think their system looks pretty darn good about now. I despise big government, but I just don't see how we can avoid nationalizing the system. It may take another decade to come to a head, but this is still a democracy. You can't distract the voters with war and gay marriage forever. One logically easy solution is to allow Medicare to negotiate for lower drug prices. The politics of adding that provision to the Medicare reform bill was a sad day for this country. In its most nebulous form the question is: Where is the money going and how can we stop it from going there. 1)Drugs (negotiate national prices)
As someone who recently retired from a career in health, this is an issue I have put a lot of thought in to. I cannot see any easy answers. My personal opinion is that some sort of national health insurance, with basic coverage for everyone, will be the ultimate choice. Right now that is politically unfeasable. So... 1. Reform of drug prices has to come first. I like the idea of not allowing advertisements plus refusing to allow the drug companies to sell their drugs overseas for less than they charge here. 2. Actually, I liked the outlines of the Kerry plan for catastrophic bills being covered by the government. I have personal experience of what happened to a relatively small group plan (300 families) when two employees needed very expensive treatment (1 cancer and 1 heart surgery). I believe a lot of small business would be better able to offer coverage if they didn't have to worry about the expense of a catastrophic illness. 3. Address the uninsured. They show up in the emergency room and by law you have to treat them. Later the charges are written off as bad debt. Not sure how to do this either, but if we could get groups that offered low cost, high deductible policies for say the whole state, where young singles with jobs could get inexpensive policies it might help.
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