I recently undertook a search for an individual health care plan that would meet average family needs. I was looking with a skeptical eye towards the current private system, & a hopeful eye towards a future hybrid private-public system.
The current system is humorous in a grim sort of way.
106 plans studied create a strong conclusion: individual insurance only takes the sting out of near disasterous accidents. Forget your credit rating if you're bedridden. Current individual plans are more 'emergency payday loans' than insurance.
Not one of the 106 plans covered maternity benefits. I did find 2 'riders' that were a hoot. One of them required coverage to begin 90 days before conception, while the other was limited to a maximum benefit of $2000 - but required 10 months payment of $250. Yep, that means you'd pay $2500 to get a 'benefit' of $2000.
How dumb do the insurance companies think cynics and skeptics are? And how can private medical insurance have any role at all?
I've been a skeptic of 'Obamacare', but some recent news regarding establishment of public options under health insurance exchanges brings a little bit of light into the dark reaches of my heart.
Firstly, a note on public health care. Most people simply can't afford luxury Cadillacs - either in their driveway or at the clinic. Real health care reform requires reducing costs for the vast majority of the middle class and definitely the poor. Unfortunately, the current private insurance and provider system is focused on providing Cadillacs.
Progressive States has a nice list showing movement by states to actually push for public care. Yep, that means eliminating the profit factor from insurance, and grouping citizens for leveraging providers to drop their profit margins. Why beat around the bush? Making health care affordable means cutting costs or redistributing wealth via subsidies. Which is more viable and practical?
To summarize, California, Vermont and Rhode Island are considering total universal single payer systems, while Iowa and Missouri are respectively moving on expansion of public non-profit health systems for low-income and children under 19.
However, not everyone is poor or middle class - and even some of the middle class would devote more of their income to medical care than others. For these people, it's necessary to offer them an alternative. Let them buy Cadillacs on their own dime.
Personally, I'd rather eliminate private insurers from the vast majority of medicine, beat down Mercks profit margin, and steal from the rich to pay for alternative energy development.
It seems clear where health insurance needs to go - a hybrid public and private system. What's also becoming clear is how we need to get there:
- Introduce a national program that brings immediate benefits to a wide variety of citizens and dispel the bugaboo of 'socialist medicine'.
- Use progressive states as 'public plan labs' to shine the way towards a future hybrid system. This would involve a public system for the broad 90% of the populace, and a private health care system which caters to the 10% people who like teak paneled waiting rooms.
In that future hybrid system, I would propose one element revised from Finland's system:
Have the federal government finance medical education in return for a pledge of hours to the public health care system. In Finland, general practitioners are required to work for the public system 3 days per week at government rates. They are then allowed 2 days per week in private practice where they can charge whatever they want and practice where they want (think teak paneling).
What better way to get more General Practioners to address that current (and looming larger) shortfall?
A hybrid public-private system recognizes 2 factors:
- Some people want to spend more money on medical care than others and value amenities like flowers in vases. They might also be willing to pay substantially more to cover experimental medicine.
- People are motivated by dollars, and doctors need more compensation than living up to egalitarian principles. Financing medical education assures that the public system retains access to the best, while also allowing those persons to pursue private ventures.
But that's all rosy thinking of the future. Is the current version of health care reform practical?
My cynical and skeptical self would put it this way: Current health care reform is - at the least - far superior to the 106 health care plans that I studied.
When it comes to individuals and small group insurance, the current health care reform bill laid out by the Senate will replace expensive Yugos with entry-level Cadillacs. Now we just need some real economical choices.