Framing the healthcare discussion
The latest issue of the New England Journal of Medicine had an interesting perspective piece on the state of US healthcare.
The Amazing Noncollapsing U.S. Health Care System — Is Reform Finally at Hand?
Amid the myriad social transformations, corporate reorganizations, and policy innovations that have shaken the U.S. health care system, one great, puzzling constant endures. For roughly 40 years, health care professionals, policymakers, politicians, and the public have concurred that the system is careening toward collapse because it is indefensible and unsustainable, a study in crisis and chaos. This forecast appeared soon after Medicare and Medicaid were enacted and has never retreated. Such disquieting continuity amid change raises an intriguing question: If the consensus is so incontestable, why has the system not already collapsed? Perhaps pondering this question can yield insights into the system as the 2008 elections approach.
It is worth a full read (link embedded in title). The article talks about the form of universal health care that we do have now - that is the uninsured underclass are still treated via clinics, hospitals, and charitable organizations. No one claims this is high quality or thorough care, just that a safety net of sorts does exist - it just isn't run by anyone. The author argues though that this invisible net adds more complications to the issue of health care reform.
I'll make comments, but first go read the linked article, it is a good read, as determined by the expectation that everyone should have some disagreement with parts of it.
To me, the question isn't so much whether everyone should be covered, but to what extent. The idea of 'spend all you can to keep everyone alive as long as possible' isn't really a practical solution, but is certainly what we all want for ourselves. So can a universal program really be put in place if it includes limited services - probably not. I recall that Oregon tried such a system in the late 80's but it didn't last, and was attacked by lawyers at all turns arguing that their clients ills should be covered as well. The other manner of limiting coverage is to cap the policy at a certain payout. Many private policies have such a cap, but many don't realize it. What about a low cap program, on top of which supplemental insurance can be added by those who can afford it. Again, the hooting and hollering would be huge (criticism is so much easier than proposing solutions).
What will likely happen in the next decade is a move away from employer sponsored plans to employer reimbursed plans. You will have to get healthcare on your own, and will have to pick among the best plans for you. Employers will reimburse to a degree, and the government may as well via tax policy. Everyone still won't be covered (those fully without means will likely still fall under the SSI programs), but coverage would be broader. Healthcare would also not be employer tied, so it can't be lost (unless it is not maintained).
HSA programs should expand and be more widely used (these are mostly good for healthy people), helping manage some of the cost. But the widespread use of HSAs, coupled with the continued spread of information and consumer eduction via the internet, should bring the consumer back into play in healthcare, which will also help drive / control prices. [Does anyone really care what procedure cost now. Just whether we are covered or not. But we still want to complain about those organizations that try to keep the prices down].
This book too should be read by those trying to grasp the concept of healthcare's problems and possible working solutions.