Tuesday, March 27, 2012

Looking for the Right Health Care Reform

With the current Supreme Court hearings on the Affordable Care Act, I thought I'd repost one of my columns that was printed in the Edmond Sun on Dec. 29, 2009. Here's the link: http://www.edmondsun.com/opinion/x546158515/Looking-for-the-right-health-care-reform


EDMOND — After months of hearings and haggling, Congress is in the final stages of reforming our health care system. Lawmaking has been compared to making sausage — combining perfectly good steak with other less desirable ingredients, then trying to pressure it through the legislative machinery. It’s not pretty, and we get the good with the bad, but that’s the way the process works.

There’s no question we need health care reform. Americans pay more than twice as much for health care per person as in other industrialized countries, and that cost is growing three times as fast as wage increases. But what do we get for our money?

We’re 50th in the world in life expectancy, just ahead of Albania. Our infant mortality rate is higher than in other Western nations. Sixty-two percent of all bankruptcies filed in 2007 were linked to medical expenses, even though 80 percent of those who filed for bankruptcy had health insurance. We spend more than a thousand dollars per person per year on medical paperwork and overhead alone, more than three times as much as in Canada. And for all that, we leave 45 million people without any coverage at all.

How did we get in this mess? In 1900 there was no such thing as health insurance. Medical care was paid for through barter or out of your own pocket. In today’s dollars that averaged about a hundred bucks a year. Now we spend $3,000 a year on health care per person.

When hospitals faced empty beds and unpaid bills in the Depression, Baylor Hospital administrator Justin Kimball developed a plan under which teachers could prepay for hospitalization. Within a year, 75 percent of Dallas teachers had enrolled; soon, other employers began offering such benefits as a recruiting incentive. Private health insurance coverage grew from 9 percent in 1940 to 70 percent in the 1960s. An entire insurance industry has mushroomed around the idea.

But times have changed. Today the percentage of Americans with health insurance provided through their employers is 56 percent and falling. To mandate that burden on all employers with penalties, as current legislation proposes, will be difficult to sell.

Republicans, and now Sen. Joe Lieberman, balk at the idea of having a public option to private coverage. Medicare and Medicaid are both “public options” of sorts, and help moderate the cost of health care. But the insurance lobby has a lucrative product and they don’t want to lose it.

Howard Dean is right — the current proposal working its way through Congress will be a victory for the insurance industry, not everyday Americans.

Good health care shouldn’t depend on the wealth of the patient. The cost of heart surgery is the same for rich bodies and poor ones. Why should a wealthy person have access to it and a poor person should not?

People have no more right to medical care than they do, say, to highways. But the government builds highways and bridges for everyone to use because it benefits all of us. When we buy a car, our choices are governed by our wealth. You only buy a Lexus if you can afford it. But luxury cars and clunkers share the same highways, where equal access is guaranteed to all.

The same principle should apply to health care.

I once listened to a radio personality named Rush Limbaugh. Before his prescription drug abuse problems surfaced, he once said his health care solution was to simply pay cash for routine doctor visits. He said it really didn’t cost that much, and was easier than dealing with the insurance paperwork. He’d save his health insurance for catastrophic care.

I hope you’re sitting down. For once, I agree with Limbaugh.

Instead of expanding a system that doesn’t work, let’s wean ourselves from our addiction to health insurance. Let people pay for everyday medical expenses out of pocket. We should expand Medicare and Medicaid and SCHIP to cover all Americans, employed or not, for catastrophic illnesses that would cost more than, say, $10,000 a year. In turn, employers would pass along the premium savings to their employees. The healthier we lived, the less we’d need to visit the doctor, and the more of that we’d pocket or spend on other bills. The added income would generate higher payroll taxes to help cover the cost.

The issue of abortion coverage would disappear because first trimester abortions usually cost under $1,000. Almost all plastic surgery also would be excluded. If that’s what you want to spend your money on, go ahead — but don’t expect the rest of us to pay for your implants.

I’ll leave it to smarter people like my friend Mickey Hepner to figure out the details. But spreading the catastrophic care costs across all taxpayers would make the system more manageable. Risks would go down, and more people would bear the responsibility for healthier lifestyles. Health care providers would focus on providing better outcomes instead of simply running more tests for the sake of profiting from them.

We need health care reform. But we need the right type of health care reform. Simply saying no isn’t the answer. Simply saying yes to the health insurance industry isn’t either.

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