Sunday, March 8, 2009

On The Stupidity of Employer Provided Healthcare

Time for a rant. Sorry.

I've been hearing and reading a lot of crap lately. All kinds of people are up in arms about the fact that Obama wants to do something about health care. There's all kinds of FUD being spread around as a result. I'm no health care expert and I would never claim to be one, but I do have an opinion or two, and a couple of facts to state:

1) I personally know too many people who don't have and cannot afford health insurance. I'm not talking about bums living under overpasses either, but good, hard working people - some with jobs, some who've lost jobs in the economic crash. And if a working software engineer is seeing these problems regularly, they're going to be a lot worse among people whose incomes are lower.

2) Getting health coverage through one's employer is stupid. Even in the best of cases it means that things can change in nasty ways during a job change, but much worse is possible. Lose your job, lose your insurance. Have a serious medical condition requiring ongoing treatment? Too bad. Got a family that depends on you? Too bad for them too. If it really was the case that everyone who lost his or her job deserved to lose it you might make an argument in favor of this turn of events, but I think you'd lose it when others - dependants of one sort or another - are considered.

3) A lot of vitriol is thrown around about the government being a lousy solution. How it is inefficient or corrupt. But no one ever stops and says "compared to what?" Recent events in the financial system - multiple ponzi schemes and billions of dollars lot - should be enough to make everyone take a step back and realize that there is no group of people that isn't subject to corruption and the effects of greed. Not one. The government is no worse than any business in this regard, and (in fact) it might be better, since much of our government is supposed to be open and accountable. The same cannot be said for the innards of most corporations.

Don't get me wrong. I'm not saying I have a solution for health care in mind. I don't even know to what extent the government should be involved. In truth, I haven't a clue what a real solution will look like, but I do know that anything that continues to tie health care to employment is a problem. I've also come to the conclusion that insurance as we currently do it is a bad idea. Insurance companies are supposed to spread risk around. Everyone pays a little in and the company pays out when people experience the insured risk. But if they limit themselves to only insuring those at little or no risk, they aren't performing the service for which they were created and have instead become money making machines. In the process those who cannot get coverage are hurt. I find that unconscionable.

It may be un-American, but I actually think we get something for our taxes. Things like roads, courts, national defense, police, fire & EMS services, environmental protection, and (when it works) regulation to keep the most greedy among us from taking advantage of everyone else. My list is a good deal too short, but you get the idea. My taxes get me something in return. The life I lead is better because I pay them.

Specifically on health care, I would love to see a day when someone who is sick or injured doesn't face death, bankruptcy, or poor quality treatment for lack of money. To be honest, I'm willing to see my own taxes go up to make that happen. I've seen enough people worry about whether or not to go to a doctor or hospital already in my short life. That is not a choice anyone should have to make for financial reasons. Ever.

To this day I think a society can best be judged by how it treats the least fortunate among its members. On that front the US stinks. It needs to be fixed.

5 comments:

  1. You didn't think I'd let this one pass, did you? :)

    IMO, a health care system that relies entirely on the government to manage it, is just a bad case of tyranny waiting to happen. It would take next to no time for the political party in power to use that system to forward their social agenda, whatever it is. Want access to affordable birth control that doesn't involve a whole bunch of 'abstinence'? Not when the Republicans are in power! Want to keep and bear arms in defense of yourself and your family? Hey, that makes you a danger to yourself (so claim the Dems) so lose the guns or lose your insurance, and all constitutional counter-arguments need not apply!

    The potential for abuses abound.

    I think what they should do is set up at least one health insurance company that must, by law, be non-profit. It should be the only health insurance offered to all Federal employees, including our elected officials. It should also be precluded from saying 'no' to anyone just because they're already sick when they come looking for insurance.

    Then add in some serious regulation on the rest of the health insurance industry. Make them pay up, and prevent them from dropping someone from their rolls once they've started to file claims for serious medical issues -- no matter what. DON'T LET THE INSURANCE CO. WEASEL OUT OF THE BET THEY MADE, NO MATTER WHAT THEIR EXCUSE.

    Between a strong dose of regulation and good old fashion market forces, most of the problems with insurance in this country can be fixed. To be sure, there's a few corner cases that would have to be addressed beyond that, but with a little creative thinking we could take care of them too.

    There, now that I've ranted on your blog, I guess I don't have to rant on mine today. ;)

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  2. Ah, Steve, my paranoid friend. If only things were as simple as all that.

    Once again, I do not claim to know the answers, but here is a response of sorts.

    You worry about abuses on the part of the government. I worry about abuses on the part of people. Do you honestly think companies don't abuse people now?

    There are some wide-eyed innocents who think that companies will be better than governments at just about anything. That's bunk. Companies exist to make money, and that motivation can often lead to disgusting behavior. (See any recent newspaper or news website if you doubt me.) Governments, at least, don't exist to make money. Yes, they exist for other reasons, and yes they can abuse people. Our history is pretty mild in that regard, however, compared with, say, Nazi Germany. Bad things could - and sometimes do - happen here, and our government can be involved, but the same is true of companies. The only common thread is that each is composed of people, and that's where the problems start. From my perspective, removing the profit motive from health care - by taking it out of the private sector - at least has some appeal.

    (In truth nearly all of the financial rewards in our current health care system are screwed up. Why do doctors get paid more for invasive procedures than preventive ones, for example? Is it really rational that the same drugs sold in the US cost much, much more than they do in other countries? When manufactured and sold by the same company? Talk about a messed up system...)

    On your suggestion that we create at least one non-profit insurance company, I'm already reading complaints from existing insurance companies to the effect that they couldn't compete in such an environment. I don't know if that is true, but it is what their PR people are claiming, and I expect there will be some "interesting" TV commercials as a result.

    In truth, though, I'd think they would be happy about such a development. The for profit companies could just not cover anyone at risk - and simultaneously discontinue coverage on anyone getting sick - and rake in the money, while leaving the non-profit to take on everyone else. Gee, that seems like a fair way to distribute the burden of risk to me. (Er, sorry, left my sarcasm on there.)

    You surprise me a bit by wanting regulation. Regulation by whom? We already know that self regulation in any major industry doesn't work. (Read up on the current financial meltdown and derivatives if you disagree.) Would you trust the insurance industry to regulate itself? I sure wouldn't. But then who would regulate it?

    Let me guess. It would have to be a group of people who aren't part of the industry, but who would have the power to enact regulations. And that would make them part of - surprise, surprise - the government. And of course, since any regulatory agency itself could be subject to corruption, it would also need oversight, and so on. Sure sounds like a role for government to me, whether we want it to be or not.

    Finally, you admit your suggested solution might miss a few "corner cases". Let me mention the big one: everyone who can't afford insurance and their dependants. That's a lot of people, unfortunately. It's people who want to work and can't, and it's people who can't work at all for legitimate reasons. Talk to me about my own family's case sometime. (No, I will not discuss that on the web.)

    I'm afraid that adding more insurance companies to the mix - even the major, regulated, not-for-profit one you suggest - cannot solve the endemic problems in the existing system.

    As I say, I don't pretend to know what the solution is, but I can see some things it's not.

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  3. Am I paranoid? Well, perhaps I have reason to be. I guess I really should stop reading history.

    You'll notice that in my proposal I seek to find a solution that is a combination of private and public sector organizations. Why? Because I am wary of being backed into a corner.

    The long-dreamed-of universal health care system, run by your friendly neighborhood federal government, is a corner. It would leave the feds as the only insurer, which means that you have no choice but to go to them for your health care. This is a recipe for massive abuse.

    So what I suggest is a single not-for-profit health insurance company that's run by the government in the same way as the Post Office is run by the government. If some other entity wants to provide health insurance, they have to compete with the government one. I'm sure there will be people who will not want to be stuck with the fed's idea of what health care should look like, so there should always be a market place for private companies to compete in. Just like we have UPS and FedEx even though there's a Federal Post Office.

    Choice, Jeff. It's a good thing. It keeps people from getting backed into a corner.

    Of course, with or without a federal health insurance company, the private health insurance industry needs regulation. It is because our health insurance companies are not regulated enough that we find insurance companies currently just dumping people willy-nilly when those people discover that they're very sick and need really expensive health care. So regulate them so they can't do that. But don't regulate them so much that they can't survive.

    As for health insurance companies not being able to survive in an environment where there are non-profits around, please. The only thing that won't survive in that environment is excessive executive pay, and endless numbers of drones whose only purpose in life is to shuffle paper from Slot A to Slot B so that payment is delayed as long as possible.

    Finally, about people who can't afford insurance. I firmly believe in taxpayer-funded insurance for at-risk people (children, the elderly and the disabled) who can't get insurance on their own for whatever reason. I'll even agree that I should pay for the insurance of people who have a little bad luck, find themselves unemployed, and need a little safety net to get them on their feet again.

    But I do NOT agree with the idea that I should have to pay for the insurance of abled-bodied adults on an on-going, continuing basis. I don't live in a socialist country, nor do I want to live in one. People should work for what they have in life. If they want health insurance, then they should work to get it. It's just that simple.

    But MAKING me pay to insure a capable person just because they've chosen a path in life that results in a lack of insurance? Dude, that's just slavery. And I would object to it. Strenuously.

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  4. Well, Steve, on some things we're closer together than others. No surprise. And not that big a deal overall.

    Your agreement that there has to be some way to handle the people who cannot afford insurance helps a lot. Does it extend to people who are working but whose employer doesn't provide coverage? What about people working at the poverty level and still cannot afford it? What about a family in the same condition?

    And I agree that choice is a good thing. As I said, it's the insurance companies - not me - that are currently claiming they can't compete with the feds. As a rule I appreciate choice, but if the PR flacks the insurance company has running around lately are telling the truth, then the only "choice" is to keep the government out of health care. I don't know the truth there. I'm just passing on what they're saying.

    My big problem - not with you, but in general - is that too many people think these issues are black & white. As if there was a simple solution for anything this complicated. That's where things fall apart.

    If we aren't willing to appreciate the complexity of these things, and to understand that rational people can differ about all kinds of issues, then we wind up in partisan, name calling battles and nothing ever improves. We have to be willing to listen to each other, think deeply about these issues from all angles, and try to understand other points of view. If you'll recall, I said right at the beginning that I don't know the answer on health care. I still don't. I have some opinions about aspects of what we do now and some thoughts about ways we might change things, but I'm no expert.

    Health care if frigging complicated. There are no easy answers, and any changes will, of necessity, be a middle ground of some sort, involving compromise by everyone involved. Too many people in this nation think the word "compromise" is a bad thing, a character flaw.

    In truth, if there was an easy fix for any of the problems we face, we'd have found it years and years ago. We wouldn't even be discussing the issue now as a result. One of the things that caused me to write my initial post was the fact that so many people are staking out claims to "the truth" and "the answer". That approach will kill us. Possibly literally.

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  5. One of the "features" of my approach is that competition should force the cost of insurance down, if the free market is allowed to do its thing. So I expect that more people who cannot currently afford insurance, would be able to afford insurance.

    I have no solid answer for people in marginal jobs who simply will never make enough to afford health insurance. If we just give them insurance, then that increases everyone else's tax burden, which feels an awful lot like a kind of slavery to me considering that I think we're all already paying too many taxes. On the other hand, if we don't take care of them, that there's real public health issues in play, not to mention class-based resentment.

    This is where the rubber truly hits the road.

    Some people say the way to fix this problem is to eliminate all health insurance entirely. That way, the middle man gets cut out completely and the cost of medical care would settle to something affordable by the vast majority of the people. I can't say I agree with this strategy, but I do give it points for creativity.

    My person favorite idea is to end the war on drugs, and use tax monies gleaned from the sales of pot, cocaine, meth and the rest of it to pay for health insurance for the marginally employed. But I suppose that's just me rebelling against my Catholic upbringing. ;)

    As for insurance companies who cannot compete with the feds, I flat-out do not believe it. If companies couldn't compete with the feds, we wouldn't have UPS and FedEx. The federal government does almost nothing well (they bomb cities into rubble really well, but that's about it), so it ought to be possible for any private sector company to compete with the feds on health insurance. Problem is, in order to do it, those private companies have to their bottom line eroded and possibly some executive bonuses reduced or even eliminated. So of course they're against it.

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