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Winners and Loosers in a single payer national health care system
I have noted a number of letters to the editor lately that laud a single payer government run health care system. I have seen numbers associated with such an approach that defy credibility. I can not comprehend how we can include another 20-40% of the population and reduce the costs by 66% for any form of creditable system.
Certainly there is waste in the current system. But like earmarks waste is in the eye of the beholder. If you have diabetes you want coverage at standard prices while someone else might want that coverage to cost a lot more or be withdrawn since they perceive you are ill by your own actions. You can get to a 66% savings if all you provide is coverage for the healthy. If you have sick people in the mix I seriously question such savings. If you want to investigate real cost savings I suggest you look at the following for a comprehensive and thoughtful discussion of what we might do to improve health care and reduce costs. The offerings will not add up to 66%.
Since this is obvious to anyone with a brain I have been cogitating about who is writing those letters. At least one portion of the populace that might be guilty is the young just leaving home who are no longer covered by their parents insurance (if they ever were). We have a lot of those here in Lawrence. Anecdotally, I have noted for a many years that this cohort does not participate fully in health insurance programs offered by employers. Statistically they represent a significant portion of the uninsured of whom we are constantly reminded.
Since health insurance is currently handled as insurance everybody pays the same for the same coverage. The young rarely need the programs while the old consume the lion’s share of the available services. This means that the young subsidize the old. One can argue that you pay up front for the more costly care required when you are older. Many seniors have been paying into programs for a score of years or more. To the young the up front cost is significant.
However, since the coverage is not mandatory, many young entry level individuals forgo available coverage and bet on the come. Most get away with it. A few get caught and are billed for medical costs resulting from something totally unexpected. Since they generally can not pay, they declare bankruptcy and leave the residual unpaid bills to the rest of us. I wonder what percentage of the health care bankruptcies we are regularly reminded about result from this situation? To belong to an insurance program for the entry level cohort does require sacrifice (cheaper car, no cell phone, etc.) and many of this cohort do not think they should have to do that.
Hence a cry for a national health care system. They (probably correctly) perceive they will get basic coverage for a lot less than current commercial insurance will cost them. As long as they in general remain healthy the bill matches the service provided. Of course this approach fails to pay for the ill, disabled and elderly. The young presume that care for this latter grouping is either rationed, paid from the general tax pool or requires a greater individual cost.
From this perspective the real motive is greed. I want someone else to pay the costs of services I demand. Perhaps this is the way we should go. After all, this is the “wall street” approach. I got mine I could care about the rest of you! This notion can be very unsettling for those who are high cost under the current system. Will I suddenly and unexpectedly have to pay a lot more for my care (money I may not have) or will I not receive the care I paid for all these years? The inter-generational battle lines are drawn!
I would suggest a few general guidelines to consider if we want universal coverage:
o We not provide care to those who are not citizens. o We demand that everyone participate - and pay as if it were insurance. o We demand that responsible and cost effective changes be implemented to reduce costs. o We demand that health care not exceed a rational percentage of a family’s income o We demand the process not reduce the quality of care that about 50% already have. o We demand that everybody get the same coverage whatever it is (how about what the Congress now enjoys) o We demand that there be no rationing as there is in other national health care systems o We demand that the new system be prohibited from doing anything to favor/penalize groups or individuals. o We demand that the care provided be professional, timely and current and not treat the patient as a supplicant o We demand that service providers be paid responsibly for the sophisticated care they provide that has taken them long and costly years to acquire. o We demand that the program must always be fully funded so that accidental rationing does not happen as it has in present day government programs such as the VA, Medicare, Medicaid or TRICARE. o We demand there be no other alternative for the really rich to use to bypass what the rest of us get.
With what part of the above do you disagree? How would you do it? Will it really be cheaper? Who pays? Who wins? Who looses?