Friday, September 12, 2008

Health Care -- Solutions?

In the previous post I tried to describe some of the issues around paying for health care.

So, what can we do about it?

Socialized Medicine
This is a non-starter in the US. Our public schools are socialized -- the people who work there are employees of the government and the people who use the services (the kids) don't have to pay to attend. Some other countries do this, but there is no way that that will happen here. No one is proposing it.

Single Payer
Something that has been floated, but also unlikely. In this scenario, the government becomes the insurance company, and the providers send them the bills. Presumably there would still be deductibles and co-pays. Before you get too worried about this, remember that a great number of us are already insured through the government. Add up the people who are government employees, on Medicaid or Medicare, or the VA and you got a good chunk of us. (I can't find the percentages right now, anyone know them?) Though there are certainly disadvantages to this route, it does have the potential advantage saving cost. Public institutions don't have to advertise, for one. The main disadvantage is that groups (employers) shopping for insurance plans is one of the places that competition enters the system and we could lose that. In any case though, it isn't happening here.

Pay or Play
This is part of a solution that informs Hillary Clinton's and Barack Obama's plans. Employers are encouraged to offer insurance, just as they do now, but if they are too small to get good rates, they have to participate in a program for small employers. Essentially all the little employers are bundled into one or several groups who then buy insurance for their employees based upon the risk pool created with them put together. If the program is run by the government, the amount that is charged to the employers and employees can be based upon various criteria. (We might want to give new businesses a very good deal, for instance, since they create a lot of jobs and have a high risk of failing.)

How much coercion?
Hillary Clinton's plan would have cost individual participants less than Barack Obama's because her plan required that every person participate. There would be many different ways you could get insurance. Most people would still be insured through their jobs, some because their employers were bundled in the pay or play model. People who were self-employed would have to buy insurance themselves. They could buy it from anyone they wanted, including a government-overseen program.

Barack Obama's plan requires that all children be insured, but does not require all adults to be. This means that some people, especially young and healthy adults, will opt out. That raises the cost for those who participate, but it is more politically palatable in the US.

What should a plan cover?
When we debated this way back when, there was a lot of discussion about "basic" health care. What was that? What was it that all insurance plans should have to cover. I love what both Clinton and Obama have put forth: the "basic" plan is whatever the legislators get for themselves. That is the level of coverage they have to make available to every citizen.

I'm going to take a break for a bit, but I am going to come back and tell you a little about McCain's plan and why I oppose it.

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