Thursday, November 12, 2009

2 Issues Regarding Health Care: a query and its clarification

The health care reform package that passed the House of Representatives seems to satisfy the minimum requirements of morality. At least, it explicitly excludes the use of taxpayer dollars to pay for abortions.

It is at this point, that our critical engagement with the legislation must begin.

As citizens, we owe each other our best efforts at intelligent, informed, and charitable discussion of the legislation, the general situation of the country, the specific needs of regions, states and individuals - of what seems to have worked best, and where, and why - of what has failed, and why - of what seems destined to fail, and why.

What we need to exercise now is, in a word, prudence.

At the weekend, I will have some thoughts on what prudence is.

For now, let me ask a question about the cost of the package, one that a reader, Kevin from Texas, has helped me formulate:

Why 1.2 trillion dollars? As I understand the statistics, there are between 20 and 40 million Americans without health insurance at any given time.

This is between 7% and 12% of the population.

This means that somewhere between 93% and 88% of the population have some sort of health coverage at any given time.

The President of the United States told folks the package that passed the House would cover 96% of the population.

This, however, is only somewhere betwee 3% and 8% better than we are doing at present.

So, what I'd like to ask is: can we justify spending that kind of money for such marginal improvement?

As far as I understand matters, the folks who are at any given moment without health coverage are either, or some combination of, the following: just-graduated young people in search of employment; other people between jobs; people who, for whatever reason, are having a hard time finding a company that will sell them insurance.

Reforming the law to extend coverage past termination and to make policy portability possible would go a long way toward reducing the number of people in the second category.

Reforming the law to allow for the ready introduction of reasonable rules governing what is and is not a pre-existing condition, as well as what sorts of exclusions insurance providers can put on coverage, based on those conditions, would go a long way toward reducing the number of people in the 3rd category.

Very little, besides the recklessness of youth is keeping people in the first category from having coverage in the first place.


How much would legislative reform of the type I have articulated above really cost?

Indeed, both kinds of reform already enjoy broad bi-partisan support.

So, why not draft them, pass them, sign them, declare victory and go home?


There is another kind of reform that would drastically reduce the cost of actually providing health care (I mean running a doctor's office, a clinic, a hospital, etc.), which would presumably bring the price down, which would presumably reduce the cost of insurance coverage: malpractice tort reform.

Put a legislative cap on the size of malpractice awards, and doctors/medical institutions will not have to buy gargantuan malpractice insurance policies.

Granted: this last would mostly be an issue for state legislatures - but the Federal government could carrot-and-stick the states into action.



Kevin in Texas said...

Good questions and some potential improvements among your suggestions, LD.

One objection I've heard raised against at least the current House bill(on Catholic radio, actually) but never satisfactorily answered is formulated via the following chain of illogic:

1) Private insurance companies will no longer be allowed to deny coverage to anyone based on any pre-existing conditions (hypothetically good, if unworkable);
2) Everyone will be obliged under penalty of taxation and possibly jail to purchase health insurance, ostensibly to raise enough capital to allow private firms to cover all of those pre-existing condition claims mentioned in #1 above;
3) Those who choose NOT to purchase insurance will have their income docked a certain percentage as a penalty for non-compliance (notably, the penalty is predicted to be less expensive than buying insurance under the recent bill)
4) Insurance companies won't be able to enforce waiting periods for new policyholders before they are allowed to file claims; all of this leads logically to----
5) Since it's cheaper for people to pay the wage penalty than to buy insurance, and since private insurers will no longer be able to turn down applicants for pre-existing conditions nor enforce waiting periods before new people can file claims-----many people (most?) will wait until they become very sick with perhaps chronic illness to purchase insurance, sending premiums skyrocketing through the stratosphere for ALL policyholders; this will lead logically to----
6) private employers dropping health insurance coverage as a benefit because it's too expensive; this will lead to----
7) most people eventually jumping ship over to the public option offered by the government, which COULD lead to------
8) private health insurers going out of business completely, leaving only the government-funded and directed public option as the only health care option for Americans

I can't imagine a rejoinder to any of these objections that would still leave the public option as a viable part of government-mandated health care reform. Then again, I'm no economist, but the above series of events seems quite logical to this lay person.

So could the answer be found more easily in the Church's long-standing principle of subsidiarity, i.e., leaving most of these details to more local- or state-level entities to address?

My layman's guess is a resounding "YES", and if the alternative were to come to pass, I could easily imagine massive government involvement in health care rationing (a rose by any other name...) and perhaps eventually something akin to the fabled "death panels" --another "rose" term that bears careful consideration in light of the history of socialized medicine in many countries.

Kevin in Texas said...

I neglected to point out in the first comment that the chain of illogic is what is inherent in the bill as it stands and how it essentially creates the first four of my points, leading very logically to the latter, completely predictable issues. In fairness, I haven't delved into the bill, nor do I have any desire or time to do so, so I am only passing on information from relatively reliable news sources whom I suspect are more familiar with much of the contents of the current House bill.