Un-Liberaled Woman

Here’s the first “summary” (of possibly many) of my stance on healthcare/insurance and the prospect of nationalized healthcare (NHS). First, the current structure of medical insurance has great problems. There is no denying this when people are not getting care. But also the current structure is not a free-market and so shouldn’t be criticized as having free-market principles. In fact, the current medical insurance institution is heavily regulated through a pooling/employer-group based mandate. We have people not getting coverage, people making employment decisions based on insurance coverage and people not having the freedom of choice when it comes to their insurance provider and thus medical care options. On the flipside, NHS is no treat. While in some countries it may be great, in others the service is terrible.

For example, in another post it’s cited from a citizen in Canada how you have to wait in two hour lines for a blood test. Another friend while in a NHS country had a swollen foot from hiking and the diagnosis/treatment she got from the free hospital was that she needed to lose weight – keep in mind my friend is not overweight. Also, a current example of a NHS in the US can be seen in our military hospitals (Walter Reed hospital, anyone???), and many patients can end up with lower quality care as compared to private industry. Check out Trying To Grok on how she shares an ultrasound room at the military hospital. Then think about how many people who go to a private-industry hospital where they could have their own room. So the idea that quality would go up under a nationalized system in the US is false information. Or how about the issue of “free” healthcare with a NHS – Michael Moore does a great job of propagandizing when he leaves out the facts about socialized medicine – like, oh, that France’s “free” healthcare system is $2.7 billion in debt AND citizens pay out the wahzoo in taxes.

What I’m saying is for every example of a Diamond NHS system (if any) there are probably 2-3 Cubic Zirconium examples of a NHS. And before someone starts quoting the US’s healthcare rankings, keep in mind they are probably using a skewed system like the WHO.

“Those who cite the WHO rankings typically present them as an objective measure of the relative performance of the national health care systems,” states Whitman. “They are not. The WHO rankings depend crucially on a number of underlying assumptions — some of them logically incoherent, some characterized by substantial uncertainty, and some rooted in ideological beliefs and values that not everyone shares.”

Also people tend to leave out where the population is higher the NHS quality seems to correlate with lower rankings. For instance, the NHS might be great in a smaller area like Anytown, USA but may be a 9/11 disaster zone in downtown Chicago. But to be fair, people could also argue that about the current system.

On the side against the current medical insurance industry I find the following points:

• People are not getting proper coverage when they need it
• Medical costs are rising
• Insurance companies are dictating healthcare
• Employer-based coverage is resulting in healthier/younger employees carrying the burden for older/sicker employees
• People are making employment decisions based on insurance coverage
• People are not getting price benefits through lack of competition among insurance providers

Now here are a few the points against the argument for transitioning to a NHS in the US:

• Quality of healthcare will go down as compared to the private system
• Government run healthcare will be a monopoly and thus reduce the opportunity for innovative medical advances, competition and lowering prices of medical costs
• Government run healthcare will drive up taxes
• Current socialized programs like Medicare/Medicaid are already failing due to poor business/funding organization structures and will be bankrupt by 2020; Programs like S-CHIP are also poorly funded (mostly tobacco taxes) and more often result in not all lower-income children getting the proper coverage they need.
• Government run programs have a low success rate in terms of quality, funding and customer service – social security, police force, firefighter force, postal service, Amtrak, etc.
• Too many cases of government employees bringing down effectiveness of programs – now medical providers will not be held to same quality-standards as they are in the privatized system
• Many, many citizens in NHS countries already come to the U.S. for healthcare they cannot get under their own NHS – whether it is for quickness, quality, price or just plain availability.
• In other countries where there is a NHS, most of the citizens elect private health care coverage due to the poor quality of the NHS.
  Why make citizens pay twice for insurance coverage – one for PHC (with their own money) and one for NHS (through taxes)
• Citizens in NHS countries have to fight in court for the constitutional rights to even get standard procedures done for terminal illnesses, like removing malignant brain tumors that would otherwise save lives.
• People’s expectations of what they will be able to get for “free” under the NHS will be inaccurate in terms of what the funding would be able to provide.

Basically, what it all boils down to is that we want to make sure everyone has the freedom of opportunity in not only getting long-term, high-quality healthcare but that also they have the freedom of choice in dictating their own healthcare with their doctor/hospital/medical treatment of choice as well.

Under the current system this is not happening, but unfortunately under a NHS run by the government this won’t happen either. I mean people talk about insurance companies dictating healthcare but then justify a bureaucratic system will do better – I don’t think so. So what do we do?

Well, here are a few thoughts and I’ve based this on several studies on NHS systems in the EU, research papers from the Cato Institute, looking at other industries (auto insurance, plastic surgery, cell phone and design software), and just feedback from speaking with colleagues in NHS countries.

1. Introduce a mandated health-status insurance and medical insurance structure. Health-status insurance will enable people to cover the increased costs during times where they need more medical attention. What is health-status insurance? Learn more about it here.
2. Pass laws that require all people to get medical & health-status insurance and that insurance companies are not allowed to deny coverage. Make these laws similar to the auto insurance coverage. Give people the choice to have health-status insurance with one company and medical insurance with another. And allow companies to provide incentives for people to carry multiple insurance with one provider – like how you get incentive breaks by carrying home & auto on one provider, etc.
3. Eliminate regulation for employer/group-based (aka pooling) insurance. This way tax breaks can go directly to the taxpayer. People then won’t stick with crappy jobs because of the need with insurance. People won’t lose insurance when they leave a job or become unemployed.
4. Allow for incentive-based, guaranteed-renewable insurance – think of how the cell phone industry has exploded with competition leading to higher-quality and lower-priced contracted calling plans, phones and accessories AND only within the last decade! Giving people the freedom to jump around with choice in medical cost coverage AND health-status coverage. Also front-loading premiums for the first year or two on health-status coverage will encourage healthier people to not just leave on the whim every year and will help cover for the insurance co. those rising medical costs on the sick. It’s not going to be incredible pricing overnight or even within the first year – but look to five, ten years down the line where people will be paying comparative lower and lower premiums for better and better coverage.
5. Allow medical insurers to compete to charge more for people with long-term expensive conditions and then less for healthy people. Similar in the auto industry, the more accidents/tickets a driver gets plays into risk/pricing. Age also plays into a risk. But the multitude of low-risk insured help cover the costs for the lower amount of high-risk insured. Medical insurance under the health-status/medical insurance idea is that only medical costs are paid through medical insurance, so with insurers knowing that there are health-status insurers out there, they will be more inclined to take on the sicker folks because they will look at it from a revenue opportunity as opposed to a cost-containment issue.
6. Possibly eliminate laws that mandate ER’s providing coverage for anyone that walks through the door. This is a huge part in driving up the costs of medical care. ER care is the most expensive and when the uninsured use it as a primary physician’s office and leaving unpaid bills for the hospital to pick up – that is a problem. But if the above suggestions are put into effect this shouldn’t be an issue and will protect hospitals from covering unplanned, burdensome costs.
7. Give tax credits to those who are below the poverty line/low-income elderly where they will not have to pay for insurance. Make this at the state-level and make it an incentive-based program similar to the old welfare reform. The more people the state is able to move off of govt.-funded care and paying for their own insurance, then the more money they have per person to fund healthcare insurance for.
8. Setup a government program that citizens can apply to for very, very extreme circumstances where the health-status insurance costs cannot cover the increased, unplanned medical costs. This way if people were every put in a position where they had to pay like $500k for a multitude of operations, they could apply and get some govt. assistance if their health-status insurance was not able to cover all of the costs for some reason. The percentage of these types of cases would be very low, probably less than 1% of all medical operations. But the application/review process should be heavily regulated and involve information/consent from the patient, doctor, medical and health-status insurance provider. Not just oh come fill out this form and we’ll put you in the system to receive a check with millions of other people. Think of it as an additional safety net to the health-status for extreme circumstances.
9. Give tax incentives to insurance companies that provide improved health-driven lifestyle programs. For instance smoking-cessation programs, better nutrition/cholesterol programs, etc. Make it easier for companies to work with citizens on improving their health and give them an incentive (tax break) to encourage them to do so. It’s a win-win for the company’s premium pricing and a for the person’s overall health.
10. Make physical education mandatory in all public education K-12. And make states regulate this. Illinois has mandatory PE. Let’s get kids on the right track. I personally think it should be 5 days a week, with the option to have up to 2 of those days be classroom style period on an aspect of physical health (ex. – nutrition). A ½ hour one day a week called recess is not teaching our kids about physical health.

If these types of steps are enacted and the medical/health insurance industry becomes deregulated/more privatized then insurance will truly have “portability and choice.” People “will be able to move from job to job without changing or jeopardizing their healthcare coverage.” Insurance companies will be able to provide “stable premiums that will not depend on how healthy you are.” And “no American will be turned away from any insurance plan because of illness or pre-existing conditions.”  And guess who said this but is straying away from these exact policies that could make these objectives happen WITHOUT increasing taxes on individual citizens.  Quick hint – he’s below enjoying what I’m sure is only a candy cigarette.

There are more choices out there to dramatically improve the current health insurance system. It is disappointing that we are not looking to the business models set by other industries for innovative ideas. Just turning to government is not always the answer and doing so without EVEN considering private, competitive-driving alternatives is doing a disservice to the customer – i.e., the healthcare of American citizens.

Also, one more side note to consider when pondering NHS and the costs involved:

Right now the current administration is leaning toward enacting foundation steps in the direction of a NHS. A typical down payment is usually around 10% – 40%. So let’s take that recent $600 billion proposed – you can then estimate the current projected tally for a partial NHS payment will be an initial cost of $6 trillion. That doesn’t include the yearly operational costs, doesn’t factor in planning for transitioning over the entire system and certain doesn’t factor in the R&D costs to help improve the system. So the figure is most likely to be much more than that. If this happens are we going to move back prior to the Kennedy era where people are at a 90% income tax rate? Are we going to get 100% income tax rate executive orders like we got in 1942? Or, the most likely scenario, are we going to see dramatic rises in consumer prices due to gas taxes, pollution/energy taxes, and capital gains tax – so that the class warfare psychology on the failed income tax can continue. At some point the bill is coming due and I don’t want to see our economy become that of say for example Argentina which fell due to similar socialized policies enforced by Peron.

Those are just some of my thoughts. And if you can imagine this is really just the tip of the iceberg on what I can say about this topic.