Health Care: What's the Current State?

A couple weeks ago I posted my thoughts on a discussion of the minimum goals for universal health care from a progressive perspective. I'm hoping to maintain this discussion over the next few months, as various proposals are suggested (and tried, in Massachusetts and California) for solving this problem at the state and federal level.

To understand what needs to be fixed about healthcare, though, we need to understand why the current system is broken. There are some obvious things.

* Some people are uninsured. This has negative implications for them, of course, but it also has negative implications for the rest of us, because emergency rooms are the only part of the health care system that we require to provide care no questions asked... so the uninsured among us end up frequenting the most expensive care facility option. It seems that it would be clearly good all around for everyone to be insured... but, of course, that not-insignificant money would have to come from somewhere.

As an interesting side-note, the state of Oregon is currently considering a significant tax hike on cigarettes, to provide health coverage for all uninsured children in Oregon (or, more specifically, all children of families under a certain income level). Vice taxes are always an interesting approach, though not particularly sustainable (part of the motive of the tax is to move toward eliminating smoking, thereby eliminating the tax revenues!), and certainly not scalable to be an effective overall solution.

* Many people that are insured struggle to pay for their insurance, and for the part of their care that they are responsible for beyond their insurance coverage.

This is the larger problem in our system, I think, and one that is little talked about. My health insurance has a lifetime maximum coverage amount of one million dollars. That seems like a lot... but with health costs as they are, any major ongoing hospital care could reach one million dollars in relatively short order. Because of the employer-based system, I have no option to compare plans or select a different company... I either have the plan my company provides, or I pay for an individual plan out of my pocket at exorbitant rates. What happens if my daughter, who has special health needs, develops serious complications and hits her coverage maximum? I have to change jobs to get a different insurance plan? Move to a different state?

My plan also has a $1000 per person deductible per year. That means that (excepting office visits) the first $1000 of health expenses each year for each member of my family has to come out of pocket. Again, I have no option to let that plan compete on the market and see if something better is available... I have to take it or leave it. I can afford it, and am grateful for the safety net my coverage provides... but there are many people for whom the out-of-pocket amounts they have to pay are a very real burden.

* Others? What would you add to this list? What other problems do you think exist in our current health care system?

Of course, we should also look at what is particularly good about our health care system. I think there are some important things here to keep in mind, things that we definitely would not want to lose in our reforms.

* Options, Competition, and Freedom. In general, Americans have a great deal of choice in what health care they receive and how they receive it. My current insurance plan allows me to visit specialists directly without a referral, for example. A previous HMO plan I was on required a visit (or call) to my primary care provider before being allowed to see the specialist, but the doctor was willing to give me a referral to just about any specialist I felt a need to see. For each of our babies, we were able to choose from a variety of prenatal care providers, and even hospitals. We chose options out of the mainstream, but our insurance covered those nonstandard options without blinking an eye.

Even where insurance doesn't cover a service, it is still available. My daughter has allergy issues that require nearly all her medications to be compounded (given in raw form, without the inactive ingredients, colorings and flavorings and the like, that she is allergic to). Insurance, for some reason, doesn't cover compounded medicines. It doesn't matter that she requires them for medical reasons; because the state laws and regulations allow them to exclude coverage of those prescriptions, and because so few people need that particular benefit, they (and probably all other insurance providers in this state) exclude it to save on whatever costs they can. Yet, we can still get her prescriptions compounded, and even have a selection of pharmacies in the area that will do it for us, and compete for price. We have to pay out of pocket, but the prices are quite reasonable because of the competition.

There are endless examples of situations where we exercise our freedom to find medical care options that are unique to our needs and desires. There are also numerous ways that competition within the health care field improves our care and lowers our costs. Any plan that severely limits to does away with those features, I think would be unacceptable.

What else would you list as particularly good aspects of our current health care system that you would not want to see lost in a comprehensive reform?

Mark