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Oct. 21, 2013
There is so much discussion about the pros and cons of the new health care law, and it seems to get us nowhere. I think we need to go deeper and see if we have a common ground to begin with.
The first question would be, “Do you believe that all people in our nation have a right to health care?” As it stands now, we do believe that, and hospital emergency rooms can not turn away people in distress. We do not abandon the sick and injured and let them die in the street. If you believe we should let them die, then this is the end of the conversation.
If you believe we should provide health care, then there are two questions. First, how do we deliver that care, and secondly, how do we pay for it? I will not go into the first, but it is not a given, and should be explored. So, how do we pay for all this care? The total cost of delivering the care can be spread over the ones who actually use it, or we can spread it over all those who use it and are potential users. (that would mean everyone). Either way, the costs have to be paid.
Currently, we have a mixed approach. Some costs are borne solely by the users, but most are borne by those collected in the potential use pool. This is called insurance. Insurance companies work the best when only healthy people sign up and never get sick.
That is what they strive for in our current system. As much as possible, deny insurance to those most likely to need it, and put those people into the “use of service” category. A side effect of this is it is the largest creator of personal bankruptcy in our nation. And a secondary effect is that it increases the overall cost basis for the care providers, since service was delivered and goes unpaid.
That cost has to go somewhere, so it always leads to higher rates for the insured from the insurers. All this and some other costs have skyrocketed our cost of delivery, and now we struggle for how to pay for it all. Again, if you believe that we do not let people die in the street, we have to pay the overall bill.
We can punish the sick and injured and elderly and disabled for being that way, and make them pay for use. But, as we have seen, they are bankrupted fairly quickly. How do we pay the overall bill?
And, of course, we need to find out why the bill is so high, but until we get that sorted out, who pays for what we are using now? Some sort of pooling of resources from all people seems the reasonable way to go, since eventually almost everyone will use it. Then the question is, what is the most effective and efficient way to do that? I think this is the question that the designers of the Affordable Care Act were trying to figure out. I don’t think their initial design is a good one, from the limited data I have. It seems too complex, too hard to understand, and adding far too much red tape. It would have been simpler to use the best system we now have.
That would be Medicare. Expand it to cover all people and eliminate the barrage of confusing systems now facing the health care providers. I know there are many who will scream “socialism,” but this is the best and most efficient system we currently have, and I have not seen any other options suggested. Unless you want to let people die in the street. How we pay for expanded Medicare, is a whole different question.
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