Thoughts on Kingdom, Church, and Grace from an American living in Hong Kong

Sunday, August 23, 2009

On the Healthcare Debate Pt.1

My friend and reader of this blog Bob recently asked me to do a post on my take of the healthcare debate.!

First of all the Republicans are reaping what they sowed. The American people have consistently voiced healthcare reform as one of their top issues over the years and in two terms of a Republican led administration, it failed to even register on President Bush's radar. Now President Obama is the one in the driver's seat framing the debate and the Republicans once again look like the party of "no".

Second, the fact that our healthcare is tied to employment is one of the reasons we are in this mess. During World War 2 when wage freezes were implemented, companies needed to find non wage package inducements to lure top employee candidates. In the following decades the American healthcare system got hopelessly entangled with employment benefits. Is your employer responsible for your car or home insurance? People have been afraid to leave their job for no other reason than the status of their family's health insurance. Healthcare reform must include the delinking of healthcare from employment.

One of the reason's President Obama has lost some steam recently on healthcare is because he has been more focused on providing a government run single payer option rather than addressing the real problem of skyrocketing health costs.

In order to drive down costs, insurance has to go back to what insurance is supposed to be for; those unplanned catastrophic events in our lives. You get cancer or heart disease, health insurance comes to the rescue. You don't use insurance for a 5 minute check up at the doctor's office. You shouldn't have to produce an insurance card if you have the flu.

Take for example; auto insurance.

What is it for?

You get in a crash or your car is stolen, insurance kicks in and takes over. You don't produce an insurance card everytime you tank up for gas. Can you imagine what your auto insurance would cost if paperwork had to be submitted and administrated everytime you needed wiperblades or an oil change? This ridiculous use of insurance for mundane issues is what has driven up medical costs beyond all reason.

Personal story: A couple years ago I had to have a nuclear stress test. It was a 2 hour test using a pretty expensive piece of medical machine. Fortunately I DID have medical insurance because I saw the bill paid for by the insurance company and my little exam cost US$ 5000!! Now I'm not saying such a test should be cheap (maybe $500)... but $5000??

And that not the kicker. Just to show you how screwed up and out of control our system is, a week later I get the signed diagnosis from the doctor. It was a single line that basically said all was OK. Doctor's diagnosis cost? ...$200
You think if you pay $5000 for a test the diagnosis would be included...but not in the insane crazy world of the American healthcare system.

Well...lets make this a multi-parter. I have a lot more to say on this subject especially on the current debate in congress right now...but I actually have work that pays the bills stuff to do now!


Redlefty said...

Great start!

Jon L. said...

A couple points: Bush (and McCain) pushed for delinking insurance tax incentives from employment and they were maligned and vilified every time it was brought up. Bush did manage to change the Health Savings Accounts laws so that people with high deductible insurance can contribute to a tax-free account that functions like an IRA. I turned down employer insurance at the college where I teach this past year to stick with my portable HSA account.

I think the 3 main things that have to happen are:
1. Shift tax incentives to individual plans rather than employer or union-based plans. Emphasize high-deductible health savings plans.
2. Institute point-of-service pricing. When we had something done at a Singapore hospital about 10 years ago, the nurses entered everything into hand-held computers and when we were done, it was like checking out of a hotel. Itemized prices were all there with no surprises 2 months later.
3. Tort reform. It's going to happen anyway if we end up with universal care because the government doesn't like being sued.

Bob said...

Thanks Steve. Some really good points here.

I was going to say something about health savings account but John beat me to it. What HSAs promote is personal responsibility. Sadly, that's just not in vogue anymore.

I especially appreciate your thoughts about employer sponsored insurance. I never really knew how we got to the point where it was just expected and you helped me understand.

I think we have to have reform but I am extremely skeptical of the "public option." And I think it's interesting that Obama is getting much the same reaction that Clinton (Hillary's plan) got.