health care reform: an easy guide for the non-politicalSep 06 '09 (Updated Sep 10 '09) Write an essay on this topic.
Popular Products in Personal Care
The Bottom Line A brief Q+A summary of the Obama-led reform proposals, their likely costs, and the reasons U.S. health care is so darned expensive.
A Facebook comment section recently turned into me writing a handy guide to Obama's health care reform. I wrote it precisely for people who *don't* like to follow the news. If you follow the links at the beginning, those won't be painless, but the discussion itself should be simple. I've slightly edited my words, but only for clarity. -------- J: "Do you know of a link or site that actually lays out all the info, like info on the health care policies/procedures/planned program?" -------- Me: "That's tough, because we don't know what the final compromise bill (if any) will look like. The text of the House bill is at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf A fact-check, section by section, of a well-circulated e-mail attacking the bill is at http://www.huffingtonpost.com/linda-bergthold/and-so-it-begins----the-a_b_249354.html I'll try to give the shortest summary of the bill that I can in my next comment." Me: "1) Everyone who has a health care plan they like can keep it, as a sort of 'grandfather clause'. 2) No one else can buy those exact plans: the insurers will formulate new ones. 3) The new plans, unlike current ones, will not be allowed to reject anyone who can pay: no disqualifying people for pre-existing conditions. 4) Everyone will be required to have health insurance. People making less than 4 times the poverty income (so, $80,000 for a family of four) will receive subsidies. Nothing will ensure that the subsidies will help them buy *good* plans, but everyone will buy a plan. 5) The amount of money any family will ever have to pay for medical care will be sharply capped: no more going bankrupt from million-dollar hospital bills. Most of these clauses are likely to be in the final bill. Less likely is the 'public option', which would allow people to buy into federally-funded insurance (a la Medicare, Medicaid, or the federal employee benefits). It's probably worth clarifying that no version of the bill has government paying doctors' salaries or providing health care directly. The Veterans' Administration already does that for veterans, and by most accounts does it well, but there's simply no one pushing to extend VA care in general." ------- J: "Ok, playing devil's advocate: What is to prevent my employer from changing the great insurance coverage I now have to one that is more on par with the changes forthcoming? What is to prevent Dr/specialities to diminish when payments are lowered on hi-tech or specialy services. I have listened to numerous doc's voicing their concern about capping of payments for certain tests, procudures, etc -- What is going to happen to my choice for services that may not be covered under the new plan. Capping payments leads to services just not being offered any longer.... Read More Do we have to cover illegal aliens on this plan? You gave a basic breakdown of a 1000 page proposal. What are the specifics being put forward in terms of those that are currently insured, specialty services, choice of hi-tech or new developments, wait time, etc. May sound nice, but paying for it, possibly losing coverage that I now have, and loss of research and specialty services are a concern." ------- Me: "1) Nothing. But nothing prevents your employer changing or canceling your health care now: my wife's has gotten worse several times this decade. 2) Insurance companies already cap or ration payments, and dictate your choice of doctors, because that's how they make money. You'll be buying from the same insurance companies; the difference is that if today you got sick, and filed a claim, they would scramble for an excuse to disqualify you ("you had a pre-existing condition we didn't know about!"). That would become illegal. 3) No, illegal aliens won't be covered. 4) You may absolutely read the bill and the fact-checks, but the essence is, the same companies will offer the insurance. You would be *less* likely to lose coverage than you are now. It's not likely to be a very good bill, frankly -- not without a strong public option -- but it makes your coverage safer and should prevent a lot of personal bankruptcies, perhaps including yours or mine if we're unlucky. My Dad's widow [his second wife] could've used that, for sure." Me: "Oh, you mentioned 'paying for it'. Fair enough. The bill would likely cost the government $50-100 billion per year. This is a shame, since as Americans, we pay $7400 per person -- the combined money spent by business, individuals, and the government -- for health care. Switzerland, Norway, and Luxemborg are the only other nations to even spend over $4000 per person. No, we don't get better results: the U.N.'s World Health Organization rates our health care system the 37th best in the world, and the friends I've had who've lived both in the U.S. and in Europe (Sweden, Belgium, England) all strongly prefer the European systems, even the two who started out as Republicans. Now, an extra $50-100 billion per year is still no more expensive than, say, fighting a war in the Middle East. But it's serious money. In theory the bill could pay for itself, if the "public option" was given the power to negotiate for lower rates, just as Wal-Mart, being huge, can pressure suppliers to sell to them cheap. But Obama promised the insurance companies not to do that." ************************ A quick question you might ask: Why is the U.S.'s system so much more expensive than anywhere else's? This has been studied. You may also wonder, can Brian break out the numerical lists again, since those really rock? Yes I can. The major factors are: one) American doctors -- who are paid per test and per procedure, and who furthermore can lose of money, time, and reputation in our poorly-designed malpractice system if a citizen jury decides that an extra test might have helped -- order far more tests and procedures than doctors elsewhere in the world. This extra care would be nice if it led to better results, but again, it does not. Some of the best hospitals in America, e.g. the Mayo Clinic, are strict about cost-control and actually cost far less than a regular hospital. zwei) Because the U.S. is the only country where people rely on for-profit health insurance, around 15% of our health care dollars go to administration and marketing: it costs the insurance companies a lot of money to sign us up, then find excuses to decide we're not covered. The for-profit health insurance companies also take a significant share of our health dollars as profit, of course. By contrast, most European health care systems spend about 3% of their money on administration, and none on profit. trois) Since the U.S. is the only nation that allows pharmaceutical companies to market directly to the people, Americans are frequently sold new name-brand drugs that have shown no evidence of being more effective than older, generic drugs. Other countries require evidence that the pricier drug is useful. iv) The rate of poverty is higher in American than in any other advanced nation; the poor have more health problems. five golden rings) Preventive medicine isn't used as much here, because it's super-expensive for the un-insured or poorly insured, who are charged much higher rates out-of-pocket than insurance companies have to pay. This allows problems to get worse, and to cost more via the emergency room. 666) Yes, Americans are fatter than people in many advanced nations. It is a (small) factor, yes. But we're no fatter than the Brits, who spend $3000 total per person to our $7400 per person, have shorter waiting periods for most procedures, and get slightly better results. G) Also, almost half of all medical expenses are incurred in the last year of each person's life, which is a higher share than in other countries. Obama's plan would, unfortunately, help with just one of these, by encouraging preventive care. He *did* originally call for $2 billion a year on "comparative effectiveness research", which other well-off countries have: basically it meant "prove that your medicine or treatment does anything we can't do just as well cheaper". It didn't mean "no expensive treatment", it meant "no expensive treatment unless that's what it takes to get the job done". But the media presented it otherwise. The result is that Obama's health-care reform will *not* have comparative effectiveness research. So if that worried you, worry no more. Any questions?  |
| Read all comments (18)|Write your own comment |
- Top 1000
