I am so sick of the health care debate, the right-wing scare tactics, the left-wing lack of balls to do the right thing. Just so I can write it down, this is what I want. I hope my right-wing nut case friends will chime in and explain to me what is so wrong with this simple approach.
What I Want
I want the NHS, which is a two-tiered system in which everyone is covered for everything, but people with more money or desire can buy supplemental insurance so that they can get a better experience than the universal one.
Oh no! Is that fair? Should rich people be able to get a better experience than poor? Duh! Of course they should! As well as more responsible people, people who prioritize things differently, people who just think their health care is worth spending money on. Being rich does come with its perks.
So what’s the difference for people with supplemental insurance? They don’t have to wait in the lines. Yes, there is rationing in a universal coverage system. There is rationing that is explained up front, that is decided on by a organization of professionals (NICE). The board of directors of that organization appears to be people with medical degrees much to my amazement. In America rationing is accomplished by several methods, including
- not bothering to cover you in the first place if you happen to have a pre-existing condition
- hiring people to figure out ways not to pay your benefit for you after you have received the treatment
- refusing the treatment up front
- just ignoring your bills and making you submit them over and over again
- being too expensive for you to have any coverage at all
Right-wing nut cases like to complain about unknown, anonymous bureaucrats making decisions about our health care, but don’t seem to mind at all that unkown, money-motivated people are currently playing a big role in our health care lives.
So in England, you wait in a queue for that non-life-threatening problem that requires an MRI, but you get chemotherapy right away if you have cancer. But you don’t wait for the MRI if you have supplemental insurance.
“Free” Health Care is Un-American
Best friend’s boyfriend, say what?
Actually, a universal health care system would really make life so much easier for so many people, including those very people who make America what it is: the entrepreneurs! Yes, right now if you want to start a new company or join one, you might just have to pass because you have a pre-existing condition. Some of the greatest companies in the history of the world have just not happened in America because, oops, one of the smart guys involved had a kid with a diabetes, or a spouse with cancer or a bad back, and they couldn’t give up their insurance at their current company.
(Fingers crossed that they never get fired from that company after they get sick.)
Then there’s all the millions of small business owners, you know, the Joe the Plumber types (except ones that know what tax brackets actually mean) that employ the vast majority of US workers (if I am to believe what I keep hearing every presidential election cycle). Imagine if they didn’t have the burden of paying the health benefits of their employees, ugh, such a small pool, high risk, bad bad.
But What About Those Damn Freeloaders!
My right-wing nut case friends just cannot get over the idea that one person might be subsidizing another person’s health care. I don’t get it. It’s insurance! You don’t know until you check out that last time whether you’re going to end up ahead or behind in the system. If you get cancer you will end up ahead, if you get a scratch on the knee, you end up behind. But at least you didn’t spend half your frakkin’ life worrying about it! Do they also worry about subsidizing the fire station? I don’t think so!
Ah, but with a federally funded program, people who pay more taxes will be paying more than those who earn less. This makes all the right-wing nut cases crazy. They assume that as soon as somebody sees a deal like that, they’ll all immediately quit working and making less money just so they can say to themselves, they’re getting more than they’re putting in. I for one don’t give a rats ass about that. The United States is full of hard working people. Not all of them are, there are the occasional welfare queens driving Cadillacs I suppose, there will probably be people who could be working but aren’t who get free health care, but really, is it necessary to agonize over it? Does it matter? Isn’t it the case that the country is full of hard working people who want to get ahead in their lives? The people that don’t want to work … well they won’t work … and they will go to the emergency rooms and get free health care anyway. Is it worth agonizing over? I don’t think so.
Costs
According to the World Health Organization, as of 2006 the United States spend twice as much (a little more than actually) on health care per capita than than in the UK. The UK spends half as much and everyone is covered! Yes, there are queues, there is rationing, but so there is in the United States. It’s just rationed differently. And in the UK you can get around the rationing by buying supplemental insurance. The costs of that insurance is low as far as I know, but even if it weren’t, a 50% difference leaves a lot of room to spend on supplemental insurance!
Most Americans are Happy with their Insurance
I’ve heard that. I am not sure I believe it. However, I wonder how many of them have pre-existing conditions? It’s only a matter of time. Everyone is going to get something, some time. I have been buying my own insurance, on and off, for years, and it’s not pretty.
For example, I have a condition called sleep apnea. Nobody will cover it. I must get a job at a regular company and then it will be covered (I think). (BTW - how strange is that, anyway?) But if I want to start a company, join a small company, work for myself, or just be a lazy bum, no insurance company will cover my pre-existing condition. Well, so wait, if it matters to me, I should save up my money so I can get that operation, or that sleep study, or that BI-PAP machine, or whatever it is I need. And I would be willing to pay out of pocket for that stuff assuming I can afford it. But, oops, what if something goes wrong while I am treating one of those pre-existing conditions? Say I have a simple operation and they, oops, paralyze me in some freak accident involving a drill? In that case, I am not covered. The subsequent treatments will not be covered. In other words, in order to PAY for my treatment out of my OWN money, I have to put my life’s savings, my kids’ college funds, my house, my family, everything I have accomplished at risk. In other words, I can’t really take that chance.
Wow - in the greatest country in the world, I cannot pay for my own treatment. If that is not broken I do not know what is.
The NHS Experience
I call the doctor and usually get an appointment within a few hours. I walk to the nearest NHS, sit down, rarely wait, don’t feel rushed, talk to a doctor about something bothering me, and off I go. I don’t stop to sign paperwork, copy an insurance card, I don’t have to make a co-pay, I don’t wonder whether the insurance company is going to deny me, and if they do, whether I just resubmit and they will pay that time, or whether I have to get on the phone, or what this payment code vs. that payment code means, blah blah blah blah blah. I go in, I get treated, I don’t feel like a cow being herded in and out as quickly as possible, the way it used to in the US before my doctor said “ENOUGH!” and got out, and started a concierge service where people pay her $400/month for the right to call her mobile phone number and get home visits. In other words, she got out so she could provide the kind of service she wanted to all along (the kind I get at the NHS) but couldn’t because she was being squeezed, and well, it’s a shame that only rich people can afford her as a doctor anymore.
That’s the kind of service I feel like we get here with the NHS. First time I went in there I just had to give them our name and address. I didn’t need to give them proof of citizenship. In fact, they didn’t care. If I live here I am covered. On the way out I was just lingering, trying to figure out if I could give somebody, anybody some money!
Health Insurance Madness
Think about the process in the United States. You want health insurance so you call up a company and you tell them about yourself. If you’re really sick the insurance company doesn’t want you as a customer and they will send you packing. What they really want is young healthy people who will pay the premiums and get sick hardly ever.
So when you apply you tell them all about yourself and they hire people to try to figure out if you are telling the truth. Later, after they have accepted you, you submit a claim and if it’s more than a certain amount or it’s just not run of the mill, they do some investigations to make sure you are actually eligible and that you didn’t lie on your application years ago.
If you’re a doctor and somebody comes in and submits insurance, they bill the insurance company for you sometimes, often even. They have no idea of the insurance company will pay, of course. After all you might not have satisfied your deductible yet. You probably don’t know, either. So the doctor submits the bill to insurance, the insurance sends a letter to you in the mail indicating yay or nay, send something back to the doctor, you call the insurance company and explain why they are wrong and should pay, they ignore you, the doctor sends you a bill because you haven’t paid yet, and around and around it goes. I had that go on for 12 months once. Who do you think made money in that scenario? Who do you think paid the costs of sending all those letters, all the time spent on the phone, the insurance people, the doctors administrators, all working on not paying a $100 bill.
People, all this nonsense costs money. There are reasons why we spend twice as much as the UK and this is one of them. Remove this inefficient nonsense from the equation. Have one big insurance pool, cut costs, remove middlemen, create a board of people to oversee what treatments are covered and when, explain it all and put it on the web, and let the voters decide if they want MORE health care or LESS health care, either by voting for increases in taxes or by buying their own insurance on top of the universal coverage.
Stop the madness! You can have your cake and eat it too. Universal coverage plus a secondary insurance market.
What Obama Wants is No Good
I’ve heard Obama wants to offer everyone an alternative insurance. At first that sounds great. I mean, I don’t want “free” health care, I am willing to pay out of my own pocket for it, I just want to make sure I can get coverage for a reasonable price (made possible by a large pool) without nasty pre-existing condition issues (like if I were working at a corporation).
But that won’t work because if you can get insurance whenever you want, then you just start paying when you get sick and stop paying when you are cured. The only way it works is if everybody pays into the system from the moment they are born or at least the moment they have an income. There can be no timing the insurance market. You’re in for life and not a moment shorter or a moment longer.
Obama needs not to be afraid of the notion of rationing. He needs to be upfront about it, he needs to point out in no uncertain terms how much rationing exists today and how its implemented. Some people will try to get him with the idea of death committees or the notion of putting a price on a person’s life, and when they do that you just have to tell them to shut up. Is there a limit to how much a person’s life is worth? Hell yes! Do those limits exist today in today’s US health care system? Hell yes! Do they exist in all walks of life in the US and in the world? Hell yes! We could spent $10k/car on air bags to save a few more lives each year and it wouldn’t be be hard to calculate how much that extra spending cost to safe those lives, and therefore how much those lives are worth in our eyes. So, yes, there are calculations to be made when deciding who should get a share of the publicly financed health insurance, there has to be, just make those calculations up front and put them on your website.
If you want to buy yourself some insurance against those calculations … BUY YOURSELF SOME INSURANCE! It’s not likely to cost you that much.