Wednesday, July 18, 2012

Caring about Health Care

  3 weeks ago, the Supreme Court voted 5 to 4 to allow the national health care reform law (‘ObamaCare’) to stand. Most parts of the system weren’t very controversial to consumers of the health care system: removing caps on benefits, allowing children up to the age of 26 to be on parent’s policies, and preventing insurance companies from dropping or excluding people who are or get sick. The most controversial part of the system is the requirement of everyone to either purchase insurance or pay a penalty. After all, someone has to pay for the new uncapped benefits and the insurance payouts for sick people… The so-called individual mandate was the main challenge to ObamaCare, but the Supreme Court ruled that since it was a tax and not really a mandate, the law was constitutional. I think it makes sense to let the health reform law stand. If enough people object to it, they can elect politicians to repeal the law just as it was enacted by Democrats when they were elected with a large majority in 2008.

  I’m conservative by nature but I like the idea of having health care coverage if I lose my job. The whole idea of having your health care benefits tied to your job is tied to the idea that people would spend their entire career with a single employer and a job change was a rarity. When I worked as a contractor in 2008-2010, I had to get an individual health care plan for my family and my insurance came with exclusion; because I had torn cartilage in my knee fixed in 2004, NONE of my joints would be covered. I called the insurance company and asked if I would be covered if I accidentally slammed my car door on my finger and broke a knuckle and I was told no. I asked if I would get a discount for not having my joints covered and I was told I would not. I have joint-inclusive insurance through my workplace now, but when I had the individual coverage I knew that if anyone in my family had come up with a costly illness, our coverage would be dropped because of some other piece of arcane health trivia that was omitted from the application that the insurance companies knew about when they assigned the policy in the first place. This is called rescission and when you are rescissioned you don’t get your premiums back even though you were never covered to the extent you were promised by the insurance companies. If I had the protections of this new law I could have continued to work as a contractor and had decent health coverage.

  The health insurance companies are exactly why government sponsored health care coverage is needed for people who don’t have the protection of a company health care plan. Capitalists point out about how the private sector can handle things better than the public sector and that the free market will take care of everything, but the free market has long ago realized that when people are sick they will do or pay anything to restore their health and the prices for all things health-related are priced accordingly. Whether it’s called a tax or a mandate or a penalty, the fact remains that health care is very expensive. It’s so expensive that you can’t even get a straight answer how expensive it is! What other product doesn’t let the consumer shop for price and also doesn’t guarantee results? Could you imagine buying a car and not being able to find out how much the car cost until you get a bill in the mail? And not getting a warranty or guarantee of performance on your car either?

  How much does it cost to spend a day at the hospital? The US average is $1910, but in Iowa the average is $1288. This New York Times blogger wrote about her $5,000+ emergency room bill when her son had a fall and needed 14 stiches. How can a visit to the emergency room cost more than twice as much as a night at the hospital? An emergency room is not allowed to turn anyone away, so they become the medical care provider of choice for those who can’t afford to pay, where a hospital doesn’t have to admit everyone and that cost is built in.

  Whether the health care system is run by the government or private entities or some mix of the two it won’t be sustainable unless costs can somehow be contained. The government seems to have done a decent enough job of controlling costs with the Medicare program. They pay so much for doctor visits and procedures and the doctors and hospitals seem to accept it and take Medicare patients, however grudgingly. Capitalists say that this causes non-government health care consumers to pay more as a de-facto subsidy to make up for the fixed-rate Medicare patients, but this already happens to people without insurance to account for the deals insurance companies currently make with health care providers. If I make an appointment to visit my doctor and don’t have insurance, it would cost me $95 dollars. Since I have insurance it costs me $20 for my co-payment but my doctor doesn’t get $75 from the insurance company; he gets around $50 as part of a prearranged deal.

  I like the new health care law but I don’t think it goes far enough. I would have liked to seen the Medicare program expanded to cover everyone and the health insurers could switch to the ‘supplemental coverage’ business that they currently pitch only to senior citizens to all Americans. I’m not too thrilled about the government providing health care insurance subsidies to those who can’t afford it because that encourages higher insurance premiums, but I end up paying for people who can’t afford health insurance in the form of higher insurance premiums anyway.

  The other component of rising health care costs that the new law doesn’t address is the terrible health habits of many Americans. Did you know that despite all the warning labels and advertising bans, there are 47 million cigarette smokers in America? (Here's proof!) Or that 1 in 12 people in the country have diabetes? Or that 1 in 9 aged 20 to 65 have diabetes? (Here's more proof!). I had no idea there were so many diabetics around, but I should have known based on the amount of commercials I see for painless ways to test blood sugar levels. Now that the government will be giving individuals health care subsidies based on income, can a subsidy formula based on income and health habits be far off? Can you imagine having to pay to subsidize the health insurance of the guy in line in front of you at the convenience store buying 2 packs of Marlboros, a 12 pack of Bud (not Bud Light), and a box of Little Debbie Honey Buns? Or that person atthe all you can eat buffet with a pyramid of food that would make a Pharaoh jealous(and a Diet Coke, naturally)? I doubt the government would ever have the will power to ban smoking and crack down on the incredible amount of sugar in foods, but at least now they would have a legal rationale if they chose to. Maybe at some point we will be required to eat certain foods in order to get our health care subsidy. The first President Bush made it clear that he wasn’t going to eat broccoli and the second President Bush also made his disdain for the vegetable known (Read all about it!), but the next President Bush may not have a choice.