First off, though, oldstyleliberal applauds the Henry J. Kaiser Family Foundation for its online side-by-side analysis of the candidates' similarities and differences on health care proposals, accessible at this web page. oldstyleliberal also salutes the health care archive at Fact Checker, a compendium of the ways in which the candidates' statements about this and other issues are at variance with the facts. When a candidate fibs, Fact Checker hands out to him or her a dubious award it aptly calls the Pinocchio.
Before trying to sort out the tangled politics of health care today, oldstyleliberal would like to point out some of his biases and assumptions going into the process. First of all, he wonders why it is considered necessary for all Americans to have health insurance. Specifically, does a lack of insurance keep the uninsured 47 million from receiving the health services they need? And if they do get some or all of those services and don't have enough money to pay for them out of pocket, how do these services get paid for?
Based on something he read years and years ago in, he believes, Atlantic Monthly, oldstyleliberal is under the impression that those without insurance and without fat pocketbooks do in fact get at least some of the health services they require. When illness or emergency strikes, they go to free clinics or to hospital emergency rooms. If they are in a bad way, they can even be admitted to a hospital, where they can receive treatment or undergo surgery if need be. The cost of all that gets passed along to paying customers in the form of higher bills.
But that system of what amounts to informal "risk pooling" — without benefit of a formal insurance plan to manage and fairly distribute the pooled financial risk, that is — has many drawbacks, not the least of which is the failure of the uninsured to get the preventive care and chronic-disease treatment that would avert the emergency in the first place.
Insurance companies are in the business, first and foremost, of pooling risk. Health insurers receive premiums from those who are covered — along with, usually, contributions from their employers — and they pay out to health care providers some significant portion of the insureds' accrued charges for services rendered. The majority of the insured actually receive fewer dollars in benefits than they pay in premiums each year ... until they get sick, that is.
The minority of the participants in the insurance risk pool who in any given year actually get treated for major illnesses (or for normal but high-cost rites of passage such as pregnancies) are the ones whose benefits-to-premiums ratios are high. Averaged over the entire risk pool, though, the total payouts by the insurance company in any given year are enough less than the total of premiums-plus-employer-contributions to leave a tidy profit for the company.
Most of us who have health insurance coverage depend on employer contributions to defray part of its cost — or, if we're retired, on insurance contributions that are part of our retirement packages. If employer contributions vanished, we might then receive the erstwhile contributions in fatter paychecks instead, but if health insurance was not somehow made mandatory for all of us, many of us would — let's admit it — squander the extra income on necessities like food and luxuries like cell phones and trips to Las Vegas. (That's why many of the current proposals are for "mandatory" programs.)
So the current system works pretty well for all but the 47 million citizens who lack any health coverage whatever. As oldstyleliberal understands the situation, the truly poor and chronically jobless can fall back on Medicaid and, if they're seniors, Medicare (which also covers middle-class retirees). The group without any health coverage at all are, in many cases, those who far enough above the poverty line not to qualify for Medicaid, but they do not have jobs with employers that will pick up "their share" of the tab for health insurance coverage. These uninsured can't afford the steep premiums on their own, so they do without.
Another portion of uninsured Americans have been turned down for coverage because of high risk factors like pre-existing medical conditions. oldstyleliberal does not fully understand why insurers cannot accept those with dicey health conditions into the risk pool, and raise premiums for one and all so as to keep the high costs associated with the new, high-risk members from draining the pool. But that apparently does not make good business sense, presumably because if one company did it, all its low-risk customers would flock to other insurance companies whose premiums remained low.
Furthermore, some "economically uninsured" who lack jobs that provide health coverage are in fact the same people as in the high-risk, poor-health group whom insurers spurn, since the relatively poor tend to have more pre-existing conditions than the well-off among us, who have better access to preventive care.
Now for some of the solutions offered by the presidential candidates.
Democrat Dennis Kucinich proposes a system of the "single-payer" type which at one time oldstyleliberal was in favor of. A single-payer system would basically be like Medicare, but for all citizens, not just those over a certain age. (Medicare and Medicaid would be folded into it.) As oldstyleliberal understands it, the government would run the system, but health-care providers who are eligible for cost reimbursement would remain private. There would be no premiums or employer contributions. Instead, according to this rundown of the Kucinich proposal:
The plan would be financed through a federal payroll tax increase from 1.45 percent to 4.75 percent for both employee and employer; stock transfer tax of 0.25 percent on both buyer and seller; income tax surcharge of 5 percent on annual income between $184,000 and $279,999 and surcharge of 10 percent on annual income of $280,000 or more; and repeal of the 2001 and 2002 Bush tax cuts for the wealthy.
Such a system would ostensibly cover 100 percent of the population. By making the risk pool as large as possible, it would allow one and all to be insured without excessively nicking the healthy to pay for the sick. It would hold down overall health care costs by blocking unnecessary, or unnecessarily pricey, procedures. There would also be savings, supporters say, due to consolidating the numerous current insurance companies' high overheads into those of one, supposedly efficient single bureaucracy. (The current insurance companies could still offer supplemental coverage, however, to those willing to pay for it privately.)
Critics say such a publicly financed system would fail to live up to its promises to reduce costs, though, because government bureaucracies are inherently wasteful. They also say similar systems tried in countries like Canada do not have consistently good results in terms of improving the quality of health care. Opponents of single-payer systems claim further that eliminating market forces in the health-care industry would make things worse instead of better.
Some critics even say a single-payer system is tantamount to "socialized medicine" in which the government actually tells citizens what health-care providers they can use and what services they can have. oldstyleliberal thinks that charge is completely bogus. Patients would still be able to choose their doctors and hospitals and get the care they feel they need.
Perhaps the biggest liability of single-payer proposals is that they have only a small base of political support. They have been raised and rejected in the past without attracting major support in Congress or among politicians in general. Naturally, the health insurance companies hate the proposals, since they would lose the bulk of their business, so lobbying against such schemes is intense. If somehow Mr. Kucinich managed to become the Democratic nominee and win the general election — and it would take a miracle for that to happen — he would face insurmountable obstacles in getting his proposal enacted.
Meanwhile, not of the other Democratic and Republican candidates, to oldstyleliberal's knowledge, favor a single-payer system. More on their alternatives in the next post in this series.
No comments:
Post a Comment