Discuss Reform: excluding Single-Payer and "socialized" alternatives.

Honnête et Sérieux · May 9, 2009

The first thing that is essential to this discussion is an accurate representation of the issue.

There are not 46 million (or whatever ballpark figure) Americans who are uninsured, or ineligible for insurance.

This number is pulled from Census data, but honestly culling the data in the Census Bureau (CB) shows us that almost 10 million of these "Americans" are actually not Americans. Of course this raises a second debate about our obligation to insure non-Americans, but I happen to believe that our responsibility lies in insuring our citizens.

Next, the authors of the CB data admit that "health insurance coverage is likely to be underreported" in the Current Population Survey from which the data is compiled. Of course, it's difficult to estimate how 'underreported' this might be, but it only means one thing; the number is falsely elevated.

Next, someone who CHOOSES to forego coverage for something like a job change is included in this 'uninsured' number. For example, I chose to take six weeks off between jobs so I could travel. I didn't have to, but I chose to, and I don't think for a second that someone else had the obligation to insure me. I also could've afforded to purchase my own insurance during that time, but I chose to just wait until I started working again.

The Congressional Budget Office, however, does attempt to estimate this based on the most recent data available, and they came up with a number between 21-31 million. Keep in mind, we've already narrowed down the number to a more honest 36 million, so now we are left with about 5-15 million left of uninsured Americans, or around 1.6-5% of our population...hardly enough to warrant an entire overhaul of our healthcare system...but I'm not done yet...and here's why.

In 2003, a BCBS study found these conclusions (pdf); around 14 million Americans are eligible for existing gov't programs, but simply never take the time to enroll. Now I suspect there is some overlap in these numbers which would make it dishonest to think that we only have 1 million uninsured Americans, but the point is this; if we aren't willing to present the data honestly and accurately, then we can hardly expect those who advocate reform based on inaccurate data to be the ones who will come up with a functional solution.

The reality is that given this information, some are advocating using a sledgehammer when a scalpel may be the best tool (to paraphrase Obama). We may not need such massive comprehensive reform, but rather some tweaking in some areas, major modification in others, and an about-face approach to others.

But since this only addressed the issue of an honest approach, I'll toss out at least this idea; tort reform.

Obviously the cost of healthcare is high, but we could substantially reduce cost if we executed aggressive tort reform. I recognized that malpractice awards are a small part of the overall healthcare expenditures, but this doesn't take in to account for the massive cost of defensive medicine. A Kessler/McClellan study estimates that defensive medicine costs between $1700-2000 per year for each American family. Of course this would force litigants like former presidential candidate John Edwards to find an honest way to make his millions before entering politics, but it would substantially reduce the cost of healthcare, which is claimed to be the priority of some socialized advocates.

And this link references a poll, but it also includes information from research.

So to summarize, the best solution might be actually understanding the system instead of misrepresenting it and using that as dishonest fodder to institute unnecessary reforms.

ambermichelle · May 9, 2009

Hi,

You spent a lot of effort on your reply and I like a lot of your points. It may be that we don't need a complete overhaul, but you admit there are a lot of people who are uninsured. 1% of hundreds of millions IS a lot of people.

I believe insurance companies should not be allowed to deny coverage to preexisting condition patients. Sure, the way it is right now, it might be called unfair to force them because it would cost too much. But private industry has never solved this problem or even tried to solve it. They are able to claim that it would hurt their bottom line and threaten their company, and somehow we all say Oh, that's OK then, nobody has to help these people. State programs solve it for a few people but there are underfunded and don't provide for everyone. That is one place legislation needs to get out the scalpel.

I also believe a person, even with a preexisting condition, should be able to optionally get guaranteed coverage without it being tied to their employer. What if they have no employer, or get laid off in a bad economy? COBRA is only for people who are laid off from large companies and only lasts for 18 months, not indefinitely. If this option has to come from the government, it should. My son is a college student whose career choices are quite limited because he will be unable to afford his medicine under many policies. If when he graduates he is unable to find a job, COBRA does not help him.

Just showing up at the local ER won't help him either because his meds must be given 3 times a week and cost $30,000 a month--and the county cannot afford this prophylaxis protocol that keeps him from becoming crippled, having spontaneous head bleeds, etc.

That's another thing--why does this stuff cost so much? Part of it undoubtedly comes from, as you pointed out, litigation since the industry is recovering from major lawsuits in the 80s, when they looked the other way while the treatments they had in the 80s infected most of the patients with HIV. But chemo drugs as well often cost many thousands per dose, with spotty coverage across even the "insured" population. So a person has the choice of financial ruin vs death, if they are even able to come up with the cash.

It might not be an overhaul that's needed, but we need to fill in the cracks in the system, especially for those who were simply unlucky enough to be born with an expensive condition, or to develop cancer or some other problem that can happen to ANY of us, or our loved ones. A compassionate nation MUST do that or it is not compassionate.

keithjones · May 12, 2009

the fundamental error in most of the argument on these subjects is this: healthcare is not a right. life, liberty, pursuit of happines... rights. forcing someone else to pay for your medical bills... not a right. taking care of those less fortunate is a humanitarian responsibility, not a right to be demanded. government provides infrastructure, rule of law, and security(military).