February 05, 2011

How Do We Provide Health Care to All Americans?

A recent decision by a federal judge to invalidate a portion of the new health care mandate has re-opened the discussion about the US being the only advanced country that leaves so many of its people without proper medical care while spending the most as part of its GDP.

The government requires that everybody gets insurance, most of us from a private insurance company, otherwise there are penalties. It is this provision of mandatory insurance that is the problem. Many Americans cannot afford to buy insurance, and some others will take the penalty instead since buying insurance costs a lot more. 

Health care insurance, coverage, and accessibility may be a bit complicated, but the underlying principles are simple. Should a wealthy liberal democracy give quality health care to all its people? I don't see this as any different that national defense. As a matter of fact, more Americans have died due to lack of health care than from attacks from our enemies.

Like defense, the federal budget should provide everyone with health care coverage, and everybody pays into the system through taxes and, perhaps, a small premium (a deductible?) to control the cost for the little expenses. Same with other insurance policies.

Speaking of costs, the US is probably the most expensive country when it comes to medical costs. This has to change. Why do the Japanese pay $150 for an MRI whereas we pay $2,000? Same with medicine. The pharma lobby successfully prevents the government from negotiating better prices for bulk purchases. 

Bureaucracy has to be controlled. Up to 1/3 of hospital expenses go to deal with the complex, litigious, adversarial, and inefficient system. Legal reform also has to be introduced into the system. Of course, quality controls, regulation, and oversight have to be in place, but lawsuits and the very high insurance premiums for doctors have to be checked. 

Some tough decisions also have to be made, like when should we spend and to what end.

Having a public option, whereas the system is non-for-profit makes a lot of sense. Perhaps we can start by allowing people to buy into Medicare, or, my choice, to extend Medicare to all. Those who may want additional benefits, or a suite during their hospital stay, they can purchase additional coverage.

How can we claim to have the best health care system in the world when it is not available to all, and, if present trends continue, it will become even less affordable due to the rapid cost increases. 

Ah, politics! This year is the staging area for the next presidential race due to commence in January of 2012. How knows, maybe some states would jump ahead and hold their primaries/caucuses this year!  Is health care and immigration something the president and the Dems would like to debate? We'll see...

1 comment:

ghassan karam said...

I do not think that many people will disagree with the proposition that the US health care system, as it stands, is expensive and needs to be brought under control. The failure to do so would be disasterous. So where is the problem? It is the lack of a unanimity in what to do in order to address these shortcomings.
May I suggest one simple obvious truth that no politician seems to be willing to address. Health care is ultimately about rationing. No nation can afford to make all medical procedures available to all its citizens. Once we agree on a set of standards that must be offered to all then calculating the cost and affordability should follow.
Another issue in health care, just like in all other goods, is the superflous level of service that is to be expected? Should medical doctors be wealthy? Why should an insurance company foot the bill for private birthing rooms?If a hospital charges an insurance company $200 for an MRI then why should it charge a private individual $2000.00?Who should be the final judge in determining when to stop active intervention? And finally and arguably the most important question: Is Health care a public good?