Health Care Follies

Part of the President's State of the Union message in a week or so is going to be focused on health care. Since the early 1990's, when we were all told we had a crisis, politicians have been trying to find a way to make the system work, be cheaper, etc.

We all remember "Hillary-Care" circa 1993-1994, where the whole country was going to go onto a national program, and it bombed, never getting anywhere. It wasn't just "the right" who killed Hillary Care. Everyday folks from all walks decided they didn't want a guy or gal in DC deciding what was "an appropriate treatment regime", they thought their doctor was better suited to decide that.

Tennessee even tried a state run version of it, and they are scrapping it as it became not cheaper, but more expensive for everyone involved.

Robert J. Samuelson has a great Op-Ed piece in the Washington Post this morning on "The Fix It Myth" of health care (reprinted in Newsweek). He explains that, on a basic level we all want three things from the health care system:

(1) provide needed care to all people, regardless of
income;
(2) maintain our freedom to pick doctors and their freedom to
recommend the best care for us; and
(3) control costs.

Which is true, those are what most of us would like to see. He goes on to point out that we can have two of the three, but not all. Which is also very true, and no single item of the three is the culprit.

Canadians, who's system has come under fire from their own courts in recent years, get numbers 1 & 3, as do most Europeans. #2 doesn't work in their systems, because it means extra care being paid for. They only acheive number three by means most of us would find unacceptable, less new treatments available, fewer newer drugs available, no second opinions.

He makes another great point, and it goes kind of to the heart of the health care debate, and a few other one's we have in the country occaisionally:

We're living in a fantasy world. Given our inconsistent expectations, no health care system -- not one completely run by government or one following "market" principles -- can satisfy public opinion. Politicians and pundits can score cheap points by emphasizing one goal or another (insure the uninsured, cover drugs for Medicare recipients, expand "choice") without facing the harder job: finding a better balance among competing goals.

It's what we did with the medicare prescription coverage plan, COBRA laws, and pushes for portablility. They pander to a particular segment of folks who have issues with the current system. If you go back up to the list, each one of the things I just mentioned made goal number 3 unattainable.

His final paragraph is one I agree with, and know that there is no political will in DC, or anywhere to tackle.

Americans want more health care for less money, and when they don't get it, they indict drug companies, insurers, trial lawyers and bureaucrats. Although these familiar scapegoats may not be blameless, the real problem is us. We demand the impossible. The changes we truly need are political. We need to reconnect people with the public consequences of their private acts. We should curb the subsidization of private insurance. Medicare recipients, especially wealthier ones, should pay more of their bills. But these changes won't happen because people don't want to see the costs. We don't have the health care system we need, but we do have the one we deserve.

We, as a country, have gotten to a point on a lot of things where we want "a free ride", I don't care if it's cheap gas, cheap medical care, we want someone else to pay for it, but we'd like what we want, and nothing less. Everyone here in Virginia wants more roads, extra commuter rail service, and other mass transit improvements. We just don't want to have our taxes go up to pay for them.

There is only one place I know of that congress has been willing to make the recipients pay for more of their coverage, and it's not medicare, who's costs to the consumer have risen less over the last 15 years than private insurance.

It's military retirees and their families. When I joined in 1982, the idea of free health care for life was still there if you did a 20 year career. By the time I retired an HMO/PPO type system was in place, with an annual fee to use it. The fee isn't horrible by any means ($460/yr), but still there. Over the next 3 years my cost will go up 100% for premimums and between 100 and 300 percent for co-pays on drugs.

The reasoning behind this is to get guys like me with company plans to drop my government health insurance, and move into the company plan, shifting the cost from the government to my employer. The thing is that even at about $80 a month, my goverment plan is going to be about 20% cheaper than my (current) employers plan, and 150% less than my wife's plan. So we won't be switching.

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