There are two rather charged words that delineate this conundrum, "socialized" and "rationed." Many of my patients fear that if the government gets too involved in healthcare we will end up like Canada or England having a healthcare system where there may be long wait lists for not only elective surgeries but even just imaging tests. We want the best and we want it now. We don't want to see our care "rationed." The truth of the matter is that we already exist in a system that rations healthcare. Do I treat patients differently when I volunteer at an indigent spanish speaking clinic once a month? Sure I do. I see patients in my office without insurance from time to time. Do I treat them differently? Absolutely. We don't even consider sending one of them for joint replacements no matter how bad their arthritis may be. Sending one of them for a screening colonoscopy is out of the question. I recently saw a patient in my office who is becoming demented. As part of his evaluation I sent him for an MRI of the brain. This looks for evidence of stroke or other conditions that can be contributing to his memory loss. It is a recommended part of the evaluation but frankly has a very low chance of affecting how he is treated. I was able to see the patient and have the test done all in the same day. If he had no insurance, I likely wouldn't have even offered the test to the patient or the family. Taking care of diabetics who have no insurance is like playing darts in a dark room. They cannot afford the strips to check their blood sugar levels. If they are on insulin, I try and choose a dose that won't harm them, knowing that tight control is not going to be possible.
The American Health Care system is widely regarded as the best in the world. The health of our society, however, is not the best. Other countries do far better than we do in many areas. I firmly believe the reason is because we don't think of the dark side of our system, those without insurance who are on the outside looking in. We have two systems, a very good one and a lousy one. The flip side to freedom is equality. If we decide that equal access to basic health care is not important in our society, then so be it. We will continue to exist in this two headed monstrous state of medical feudalism. Are we that far away from "The Hunger Games"?
I feel that if we are going to provide basic services to all of our citizens, we must have an individual mandate. Guess what happens to the uninsured patients I described above who have a truly life threatening emergency? They get taken to an emergency and are taken care of. If they need heart surgery, they get it. If they are in a serious care accident, they get fixed up. The hospital rights off the charges but it doesn't end there. The hospital cannot afford to sustain such losses so those costs get consumed by the revenue that comes in from all the other patients who have insurance. The cost gets shifted to you and to me. This is one of the many reasons why our cost of healthcare is so high. I would much rather see us ask all citizens and non citizens to pay for insurance than to see my own costs go up and up and up. Thanks for reading my thoughts. I would love to hear yours and respond to them. Let me know what you think.
I don't like the mandate as drafted because it seeks to have the young and/or healthy pay a wildly disproportionate share of the costs relative to what they use. The CBO estimates that an average member of this group uses about $860 a year in healthcare. But the average cost of a single package in 2016 will be about $5,800 due to community rating, gender rating, and bloated minimum coverage requirements to "spread and equalize risk". Actuarial tables go out the window. It's like asking someone who drives a Ford Escort to pay premiums on a Ferrari. Why should I pay almost 7 times my risk rating to subsidize other populations and be a low cost cash cow for the insurance companies? I don't want to subsidize octomoms that pop out kids with no means of supporting them, illegals who wont be forced into the pool but who will continue to use the ER as a primary care facility, or the lazy / obese fast food crowd! We need incentives for responsible behavior and better health, not cost shifting within a broken system.
ReplyDeleteIf the mandate stands, it would make economic sense to pay the small fine, opt out, and buy insurance if needed. After all, pre-existing conditions will be covered and it would save thousands of dollars!! But this leads us into adverse selection territory and will cause everyone else's premiums to skyrocket.
If the mandate is upheld what's to prevent the fed gov from forcing us all to join private gyms. And on top of that, mandate that your minimum package must include at least 3 personal training sessions a month? I see no difference. I love going to the gym, but don't think the gov should mandate every citizen join with the goal of better health for all. The commerce clause was never intended to force people to engage in commerce with private entities...There has to be a better way.
Thank you for your thoughts. There are several items I had not considered. Let me respond to your points.
Delete1) Cost of the Mandate: All insurance is based on paying wildly disproportionate costs. I don't come close to using the amount of money that I pay for my health insurance. To be honest, I do not know if the proported costs are in line with what is common with health insurance today. I know that I pay a lot more than $5,800 for my health insurance.
2) Feeding the insurance company cash cow: I totally agree. I think this is a major problem with our current system. I hear very little from Washington about reining in the insurance companies. The CEO's of these companies are making more than $20 million a year. Unfortunately, the alternative is to have one insurer, the government. I don't feel comfortable with that at all.
3) Subsidizing high risk individuals. We are paying for them now through the indirect costs. Making them pay for their insurance will bring that down. Studies have shown that those with access to health insurance are far more likely to use a primary care provider and avoid the emergency room. I would like to see the insurance companies offer discounts to those with healthy habits. This is already being done to some degree.
4) The penalty. I totally agree that the penalty is too small. For those who refuse to pay and then show up with a big medical problem, the penalty should be substantial as this will break the system for sure.
5) Mandating behavior. I don't see how a health insurance mandate will dictate whether I exercise or not. There may be benefits as stated in #3 above. This would be similar to a good grade discount for car insurance or having to pay more if I decide to drive a red Ferrari.
Thanks for sharing!
My biggest concern is the slippery slope a precedent such as this would put our country on. This type of mandate gives the Federal Government way too much power to control the lives of its citizens. The car insurance example is completely different because when you don't have car insurance it hurts the person whose car you totaled. However, if you don't have health insurance you are only hurting yourself. Obviously, we all agree having health insurance is a very good idea. However, I don't feel like the federal government should be able to force us to make these choices. Sounds a little too close to Satan's plan to me.
ReplyDeleteThanks for sharing your thoughts. I actually agree with most of them. I think the car insurance analogy is pretty good. And to the most recent reply, I would say that a driver without car insurance hurts more than the person whose car was totaled. As an example, when my parents moved from Indiana to Kentucky, their car insurance rates nearly doubled (for the same coverage on the same vehicles). The reason? Kentucky has a very high rate of uninsured drivers, so those with insurance have to make up for those who don't. And those of us with health insurance are absorbing the cost of the not-so-good care for the uninsured.
ReplyDeleteAnd to the person who doesn't want to pay for the "octomoms" - well, you probably already are. Most people can't afford to have that many children, and if they do, are likely on Medicaid - taxpayer funded.
One thing we have to consider is that with the passing of ObamaCare, insurance companies will have to accept people with preexisting conditions. This will definitely increase health insurance costs for everyone. Along with increases of health care costs, I feel that individuals in our country are losing a sense of responsibility of managing their health. In other words, I feel that I should be held responsible for my decisions to smoke, drink, etc. In which I choose not to do these things to prevent health ailments both mentally and physically. The idea of passing the individual mandate seems to almost become an enabler for bad health choices.
DeleteThere seems to be several variables that need to be considered here. Costs will increase for everyone when insurance companies are required to accept preexisting conditions. Yet there is this other aspect of rates going up anyway for the insured in low non-insured areas.
For me, I would rather have the freedom to choose. And if my car insurance rate went up, I probably would find a competitor that offers a better rate and go with them.
It is my opinion that the car insurance comparison is a very good one abd i am shocked that some how others could not see that these are very similar expectations from society. i work as an FNP in a walk in clinic. most of our patients have medicade and come out for very trivial issues. because they pay nothing! they have money for cigs and tatoo's but not able to even pay their 5-10 dollar copay. i think we need to provide health care for all with restrictions on what is paid for and what is not. many of the issues that i see could be taken care of on the phone. education and gatekeepers are needed. 50% of those that i see want a work release, pain meds, or an antibiotic that they dont need. basically we need to stop abuse and yes all shoudl pay for health care. it should not be totally free for anyone. the idea that others pay a for coverage that they may not use is not a new idea. this has been around for along time. why do i pay so much in taxes? part of it goes for medicade, food stamps, and some i hope to take care of the really needy and not the abusers
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