by Arlos » Fri Sep 25, 2009 5:18 pm
The simple facts are these:
Regardless of whether or not this reform is enacted, people are going to need medical care, whether they have insurance or not.
People who are sick enough are GOING to go to the emergency room, regardless of whether or not they have insurance.
Emergency rooms WILL have to treat people. There is no way, whatsoever, that turning away sick people to die or lie there bleeding, or suffer with a broken leg or arm just because they have no insurance or sufficient funds to pay for insurance or the current uninsured cost of care will ever happen, period.
Care given to the uninsured comes out of ALL of our pockets, whether in the form of higher insurance premiums or higher taxes (even if state/local taxes). These costs are higher than they could be. Medical costs are rising at many TIMES the rate of inflation.
Emergency room care is the most expensive kind of care. People without insurance often use that as their ONLY care, because they can't afford preventative medicine via doctor's visits, etc, so frequently something that could have been corrected for $500 now costs, say, $15000 instead. This is insanely inefficient.
A completely unregulated insurance market will never happen, because in order to maximize profits, no one but the richest people would ever be able to afford premiums that would be charged to anyone who is not in absolute perfect health, has any sort of pre-existing condition, etc. This would mean vastly MORE people would be uninsured and would be be treated at the highest possible cost to everyone. The only reason that people getting insurance through their employers get coverage NOW despite pre-existing conditions is because of government mandate.
The above are all facts. The question now is what we do about it, here in the real world.
The Obama plan allows for choice. Anyone who currently has insurance is completely free to keep their current plan if they like it. Period. Also, insurance companies will be required to take people regardless of pre-existing conditions. besides private insurance companies, there will also be a public plan, which is not-for-profit, that anyone and everyone may sign up for IF THEY WISH TO, instead of a private carrier. On the flip side of this increased availability, everyone will need to sign on to SOME plan, otherwise the savings we're trying to achieve won't happen. Subsidies will be available for the poor and those who can't afford the insurance. For people who claim a government-run alternative to private insurers will put them out of business, please explain why the Post Office hasn't put UPS and FedEx out of business, then.
The result is, those who wish to pay for it, can get higher quality plans than the public option. Those who don't wish to or can't will STILL be covered, or will have to pay towards some of the additional costs that will be incurred by them being NOT covered. On the plus side, though, since everyone is now covered, costs can come down dramatically, because you don't have everyone else paying the entirety of the cost for those 47 million uninsured. Also, with increased use of preventive care, etc, we can further achieve a dramatic lowering of costs, by fixing issues while they are still small and simple, and before they require actual hospital care.
Also necessary in all this is some kind of tort reform, to discourage frivolous lawsuits, which will cut the costs of malpractice insurance. The trick here is to still allow suits in the case of actual malfeasance, negligence, or incompetence, but to cut out as much as possible what currently goes on, with doctors ordering tests that are entirely unnecessary, but are only done as a CYA in case of suits, and also costs for defending against baseless suits, etc. There has been some discussion on this already, but this is one area I'd like to see more done with. I do not like the idea of simply making the loser of a lawsuit pay for the whole thing, as someone could have a legitimate complaint, but still lose the case, and a double-or-nothing kind of setup like this could stop people from suing over legitimate malpractice.
None of Flink's suggestions are remotely practical, because they don't address the biggest fundamental flaw in our current system: costs generated by the uninsured. Yes, in his version of an ideal universe, a hospital WOULD turn away a mother who brought her 2 year old with a broken leg into the emergency room if she was uninsured and couldn't cover the bill for the care out of pocket, so those costs wouldn't be generated. That, however, is not even remotely the way the REAL world works. Nor do his "plans" cover the issue of people with pre-existing conditions and needing health care.
So, if you don't like the Obama plan, what WOULD you do to reform health care, given that we live in the real world and not an ideal one, and you have the facts I mentioned to deal with?
-Arlos
