Wednesday, February 23, 2011

Health insurance - Americans are sheep

Health reform discussions are boring. I wish could resist health care reform posts. It's a compulsion, but at least I only do them every few months.

We've known for decades where will end up. We will guarantee every American good enough health care. Good enough care means 21st century American versions of "barefoot doctors" using relatively cheap technologies that have been fully depreciated. People with money will still buy more luxurious care; sometimes it will be genuinely better care.

Good enough care will use more physician assistants, not because they're wonderful people [2], but because they're paid like teachers instead of like radiologists [1]. It will outsource pathology and imaging to New Zealand and Israel. It will negotiate cut-throat prices with manufacturers of off-patent drugs, and it will fight patent law dodges. Good enough care will have simple contracts and pricing, reducing the overhead of care provision.

ObamaCare is a significant first step to good enough care [4], and, unlike ClintonCare, it leaves lots of room for the concierge-care end of the luxury health market.

Darn, this isn't quantum mechanics. It's not even relativity. It's arithmetic. So it's agonizing that we Americans are such sheep. We elected a House of loonies dedicated to preserving this status quo (emphases mine) ...

Money Won’t Buy You Health Insurance - Donna Dubinksy [3] -

... Unlike many others, my family can afford medical care, with or without insurance.

Instead, this is a story about how broken the market for health insurance is, even for those who are healthy and who are willing and able to pay for it.

Most employees assume that if they lose their job and the health coverage that comes along with it, they’ll be able to purchase insurance somewhere. The members of Congress who want to repeal the provision of last year’s health insurance law that makes it easier for individuals to buy coverage must assume that uninsured people do not want to buy it, or are just too cheap or too poor to do so.

The truth is that individual health insurance is not easy to get...

... An insurance broker helped me sort through the options. I settled on a high-deductible plan, and filled out the long application. I diligently listed the various minor complaints for which we had been seen over the years, knowing that these might turn up later and be a basis for revoking coverage if they were not disclosed.

Then the first letter arrived — denied. It never occurred to me that we would be denied! Yes, we had listed a bunch of minor ailments, but nothing serious. No cancer, no chronic diseases like asthma or diabetes, no hospital stays.

Why were we denied? What were these pre-existing conditions that put us into high-risk categories? For me, it was a corn on my toe for which my podiatrist had recommended an in-office procedure. My daughter was denied because she takes regular medication for a common teenage issue. My husband was denied because his ophthalmologist had identified a slow-growing cataract. Basically, if there is any possible procedure in your future, insurers will deny you.

... As I filled out more applications, I discovered a critical error in my strategy. The first question was “Have you ever been denied health insurance”? Now my answer was yes, giving the new companies reason to be wary of my application. I learned too late that the best tactic is to apply simultaneously to as many companies as possible, so that you don’t have to admit to a denial.

I completed four applications for each of the three of us, using reams of paper. ... I was accepted by exactly one insurance company. So was my daughter, although at a 50 percent premium over the standard charge for a girl her age. My husband was also accepted by one insurer but was denied by the company that approved me.

Our premiums, which were reasonable at first, have increased substantially over the last six years; the average annual increase has been 20 percent. I now am paying premiums that are more than double what they were initially. And because these are high-deductible policies, we still are paying most of the medical bills ourselves...

... If members of Congress feel so strongly about undoing this important legislation, perhaps we should stop providing them with health insurance. Let’s credit their pay for the amount that has been paid by the taxpayers, and let them try to buy health insurance in the individual market. My bet is that they all would be denied. Health insurance reform might suddenly not seem to them like such a bad idea.

Americans tolerate this. We have tolerated a broken system for a decade.

It's worse than mere tolerance though. Against enormous resistance, with zero help from the Opposition, the Obama administration manages to get some form of health insurance reform done. So what do Americans do? We elect bozos who can do nothing but strive to preserve the status quo that feeds them.

We are such sheep. We deserve the GOP.

[1] Many family physicians are closer to teachers than to radiologists than teachers, however. Also there should be a way for PAs to train up to a medical degree, but that's a different story.
[2] The ones I've personally known were pretty fine people. 
[3] This Donna Dubinsky. A legend in the Palm days.  She is wealthy and can self-insure if she prefers.
[4] It only lays the groundwork. Politics and economics will do the rest.


cathy said...

An insult to sheep. Sheep are smart enough to run from the wolves.

John Gordon jr said...

We have a crisis of animal metaphors for human failings.

Frogs will jump out of warming water, but humans will adjust until they boil. Sheep will run from predators, humans are easy to fool. Wolves are not vicious, etc.

We need a new set of metaphors, but it's hard to find any species as disappointing as us. I suggest we use mythical animals.

Dumb as a minotaur works for me.