Thursday, April 1, 2010

My Opinion about the Healthcare Bill as recently passed

What is my opinion about the Health Care Bill just passed by Congress?  I have been asked this often in recent days by friends who are outside the system looking in.  This is dangerous territory, and I risk stepping in quicksand (or at least a big pile of poop), but here I go:

The essence of the bill is a straightforward tradeoff:   The government gives the insurance companies 30 million new customers - via subsidies to help them buy their policies, and in return these companies can no longer deny coverage for preexisting conditions or set lifetime caps on payouts.  My problem is that I doubt we can afford this in conjunction with other government expenditures without endangering the U.S. currency.

Our current health care system is supposedly based on capitalism with it's inherent efficiencies and survival of the best product at the best price.  But, this is not capitalism or a free market because there is no competition and very limited options for competing on quality and efficiency/economy of care.

The recently passed bill simply pours massive amounts into paying the insurance companies more for the same old insurance, while doing nothing to change the fundamental way care is delivered and paid for . . . and it will therefore drain unbelievable amounts of dollars from the budget. This was not health care reform, it was just a decision to fund a transfer of billions and billions to the insurance companies using the same old system. I do applaud the decision to prevent these companies from refusing to insure individuals at risk and for extending benefits for psychiatric and chronic care, but make no mistake, this is coming out of the taxpayers pockets, and the insurance companies will rake a huge share off the top. Redistribution of wealth is accepted in this country (e.g. our progressive income tax), but the authority responsible for that redistribution is expected to do so efficiently, resulting in the most overall good and without regards to special interest (insurance corporations.)

Dr Welby MD disappeared a long time ago.  Individually most doctors are altruistic, but they live and work within the framework of either a group of practitioners or as an employee of a hospital or health care system.  Every hospital I know, profit or non profit, and every medical group in the country have management with a job description to maximize the bottom line, and the insurance companies are happy to help them increase the revenues from health care since they are a cost-plus manager of health care - e.g. if they set their profit/return at 5% of gross, then the higher the gross revenues, then the more the 5% is worth. The changes in insurability are not major issues for them; the recent 30%+ increases (my own group had a 31% increase) in premiums this year will more than make up expenses added by the health care bill.  Even so, I suspect individuals with insurability problems will still have to fight a paperwork maize and incur extra cost in order to get that coverage.

Yes, I believe everyone in this country deserves "medicare-like" health care (even though medicare is currently running in the red and changes will be enforced in the future by economic realities.) I really don't understand why people are opposed to giving the rest of our citizens what we have given our seniors. And . . . it is a disappointment that Congress did not do the most fiscally efficient thing by simply extending Medicare to those who cannot afford insurance, rather than enacting this massive transfer of wealth to an inefficent healthcare system, and giving the insurance companies a windfall along the way.  Some may not be aware that it was Richard Nixon who also felt it the responsibility of the federal government to assure citizens of reasonable health care and proposed in 1971 a public/private system for universal health care, paid by the government through negotiations with competing private entities such as Kaiser, Mayo, Group Health, Cleveland Clinic etc as well as traditional health insurance companies. (Congress however became more concerned with impeachment than assuring health care for its citizens.)

What we perhaps needed was a complete remake of health care in our country, hopefully using the best elements of places like France, Germany, etc in order to bring quality, affordable, health care to everyone in this country. I don't think this bill will do that, but then the devil is in the details, and we will have to see how the law, as written, is applied (similar to the IRS code/ interpretation of the generalities in the tax law) before we know exactly what we have here, so I reserve my final opinion for a few years.


My fundamental principle as a secular humanist is the "golden rule" in its various expressions, and I take as my obligation the need to make life better for others.  This health care bill is deeply, severely flawed, but it is a start.