Sunday, May 22, 2005

We will have national health insurance in america

Decoding Health Insurance - New York Times

A physician long opposed to both personal health insurance and national health insurance changes his mind thanks to the pending arrival of very inexpensive individual risk measures through genetic testing. He feels that so many people, rich and poor alike, will be unable to obtain health insurance that there will be no alternative to national risk pooling:
... As a doctor I have always been against health insurance except for catastrophic care and for the very poor. It has been my experience that the doctor-patient relationship is the most personal and rewarding for both the patient and the doctor when a clear, direct fiduciary relationship exists. In such a circumstance, both individuals value the encounter more, which invariably leads to more time, more attention to potentially important details, and a higher level of patient compliance and satisfaction - all of which invariably result in a better outcome.

But with the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) Although I never thought I'd advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I've changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual's confidential, genetic makeup.
On the one hand, it's hard at first to see why bad genes should be much different from all the other bad luck that denies health coverage to many people. The difference is that this 'bad luck' strikes Republicans as well as Democrats. So I agree, there will be some sort of obligatory risk pooling, and it may turn out to be hard to use any criteria but citizenship to define the covered pool.

BTW, I agree with him on the pernicious effects of health insurance on the doctor-patient relationship.

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