Health Care

[marcmagus]

A commentator after the debate last night suggested that McCain's proposed solution to the health care problem would result in a complete dismantling of the American health care system as we know it. My immediate thought, "Is that a bad thing?"

Seriously. Our "health care" "system" is a complete abomination full of half-assed misunderstandings of what it wants to be and how to get there. It can't decide if it wants to be a mandatory tax-payer funded charity or a voluntary free-market insurance program. The result is that it's the worst of both worlds, full of the inflated prices, random inefficiencies, and increased taxes often associated with bureaucracies and the cold, heartless, bottom-line driven uncaring of corporate greed.

On top of all that, because someone "cleverly" figured out that there were a bunch of advantages to making health care a job-related "benefit" (there are: collective bargaining advantages and untaxed income at the least), we have a system which makes it extra-difficult for people who don't earn their income from a single full-time employer to get any kind of insurance/care plan, and it pretty much denies people the ability to shop around for the best plan for their needs (because the choice in many cases is to use the plan your employer provides or throw away that money and buy another plan on top of it).

Oh, that reminds me of the other idealogical schizophrenia in our current system: insurance vs. care. If it's insurance, then it's paying some amount of money now against the unlikely event of a medical issue you would otherwise be unable to afford to cover. It makes sense for insurance not to cover pre-existing conditions; you're insuring against the unexpected, not the already known, or it's not really insurance. It also makes sense for them not to cover routine care or unnecessary procedures; you should be budgeting for these as well. [And they should be affordable, either because cost is low enough or income is high enough, or there's a major problem there.] Care, on the other hand, is there to take advantage of collective bargaining (and possibly unequal ability-to-pay based payments into a common pool) to ensure everybody who's part of the system has access to some agreed-upon minimum level of care available to them. It's actually more suited to routine care and minor needs than to major issues, and may not be able to deal well with emergency or expensive exotic needs (which one should probably separately insure themselves against). The problem with our system as it exists is that, again, it's a half-assed conglomeration of these two concepts put together, rather than in a way where each fills in for the deficiencies of the other, in a way that each inherits some of the deficiencies of the other (such as the care aspect of a plan not covering pre-existing conditions).

My current stance is that both sides of the ideological argument are right. Picking either one and going with it would be a drastic improvement over the crap we're attempting to live with right now. Both have major failures inherent which are unavoidable. The debates typically consist of each side pointing out those failures of the other and pretending the failures in their own system don't exist. There seriously doesn't seem to be any perfect system to handle this stuff at this scale, but there are systems which are less full of failure than ours.

It's very hard to enact change in a large system, and I rather despair that there's any way to untangle this huge mess and turn it into something reasonable, even if we could sufficiently settle the ideological disagreements underlying it all. It might well be that the only way to get to any system that works is to, in the words of Neal Stephenson, "...just let the damn thing fall over and build a tower that doesn't suck." Although how to keep everybody alive and healthy while we're building the new one is a tough question; not that we're doing such a great job now, but I'd hate for it to get worse just so it can get better. But would it be better to keep seeking local maxima (so never really getting more than a little better) just to avoid the short-term worsening? I couldn't say.

Comments

[gaiaturtle.livejournal.com]

One of the reasons I am unwilling at this time to try to make a living doing freelance work is because I am terrified of being uninsured. Health care costs are ridiculous. I've had my share of minor health issues in the last year or two, which were treatable and manageable, but which would've cost me thousands of dollars to get treated had I not had health insurance. I had a roommate once whose uninsured friend had to have an emergency operation to remove her ovary due to a really bad cyst that she didn't know she had, and it cost her something like $20,000. She had to go back home and live with her parents and work for a long time to try and pay it off. That's INSANE. Our health care system is OUT OF CONTROL. And it terrifies me.

[directordale.livejournal.com]

It might not be bad to dismantle our health care system but it does not logically follow that McCain's solution would be better overall. Or that his solution is good at all.

[shield-toad111.livejournal.com]

If choosing between a plan for more routine health care and insurance, I'd choose insurance. If we got rid of most of the current health care system, the prices for routine care should sort themselves out to be something reasonable. Right now a lot of those costs are artificially high because of the nature of our current health care system. A quick search of vaccine prices shows that those can be pretty expensive, though ($20-$80/dose in the private sector for common ones)-- I have no idea how things would work out for babies. It's also possible that there would be some insurance plans with options to cover routine care for those that wanted it. (PetPlan insurance is planning to start offering coverage for routine care - they initially didn't have it because they thought there wouldn't be enough demand.)
Primarily what is more beneficial is having a system that covers major unexpected events. Because the costs of surgery are really just expensive. So have a bunch of private companies offer that insurance and maybe include a government program to cover vaccinations and other necessary checks for newborns that are necessary for herd health overall well-being of the population.

[oldsilenus.livejournal.com]

Wait... big corporations don't have problems stemming from bureaucracy?

Or, more to the point, I don't see how that is a problem that exists solely in the governmental sector; far from it.