Sunday, January 31, 2010

Healthcare Reform

First off, anything that's been in the works since 1912 (1) isn't being "rushed through, or jammed down the publics throat in the dead of night". The Senate votes that have taken place at odd times, 2AM, 4AM, etc have taken place because of archaic Senate rules that require 30 hour breaks between some votes (2). It isn't some nefarious plot to take votes without everyone knowing about it. (IMO)

Secondly, the government currently spends about half the total amount of money that's spent on healthcare in the US (3), so the idea that if the government gets involved in healthcare it will be ruined doesn't hold water.
Many solutions that have been offered by the Republicans simply won't work or won't work well enough. Tort reform is getting it's own post, but another example is selling insurance across state lines. As with anything else lowering quality means cheaper products and greater availability. Where the balance should be is a legitimate question, but the proposal does absolutely nothing to rein in long term healthcare spending. At best it will provide lowest possible quality insurance with a price that's rapidly growing (4).

Healthcare was 5.2 % of GDP in 1960, since then it's risen nearly every year, and now is at 16.2% of GDP. (4). In 1960 we spent 28 billion dollars on healthcare, by 2008 we are spending 2.33 trillion dollars every year. (4). We are paying more per capita for healthcare than any other advanced nation (5) (6). Yet, a simple Google search for healthcare rankings show that in every ranking done (there are many, because it's difficult to define what is "good" healthcare) the US performs dismally. I should however, insert a caveat here: for millionaires it is in fact the best healthcare system in the world (7).

Our healthcare system right now is geared towards denying care whenever possible while collecting as much money as possible. Insurance companies are no different from any other business: their goal is profit. I should clarify: the board of Wal-Mart cares nothing about their customers, their sole concern is profits. Small business owners as a rule have more concerns than solely profits. The owner of the small business down the street typically does care about their customers, they opened a business in order to fill a need or provide a service, and they should be well compensated for the value they provide to the economy. In other words, it's extremely rare for someone start a small business with the sole intent of making as much money as possible while providing as little value as possible. Being a small business owner obviously doesn't automatically qualify one as a saint, but in my experience they are overwhelmingly decent hardworking people that care about their community and provide an added value to the nation, and deserve their compensation.

But while some businesses operate with the ethos of adding value while being compensated, others (specifically giant corporations) operate under the philosophy that profit is their only goal. Corporations aren't evil, they're simply operating with the goal of maximizing profit. That isn't "evil" or "good", it just is. And it's beneficial in many ways, without huge corporations we wouldn't have all the advances we have now, the standard of living would be much lower than it is now.

The problem arises when a company makes its profit from denying access to healthcare. Then it becomes a moral issue, one of right and wrong. That's why access to healthcare is unique and profit seeking insurance companies are inherently a poor solution to the problem.

Our healthcare system is broken, and we need both short term and long term fixes. In the short term, perhaps selling insurance across state lines is beneficial. But the only way to curb long term costs is to switch from a paradigm of rewarding businesses for denying care. There are good things in the proposals, like not letting insurance companies deny benefits based on pre-existing conditions. But, the current proposals seek basically more regulations on the profit-driven insurance industry. Depending on the specific regulations, that's a beneficial thing. But the most effective way to increase access to healthcare while bringing down the cost both long term and short term, is to change the paradigm from rewarding those who deny care. Until we change that, more regulation will help but won't solve the problem.

(3) pg 45