Tonight's debate will probably have some time devoted to health care. As it should. After Social Security, the health care system is the biggest problem we've got that government can do something about.
(The economy might be a bigger problem, but it seems to sail along just fine even with gross mismanagement like the corporate tax bill passed yesterday)
I am sympathetic to the notion of some form of universal health care, but also skeptical that that would fly politically. Moreover, it's not immediately clear whether the transition costs would be worth it from where we are now.
Kerry's plan is a good one, both politically and substantively. Politically it doesn't bet the farm on an all-around package that would be great in theory, but hard to get through Congress. Substantively, it puts the highest priority on solving the biggest problems that can be solved by the government. (and I know, I know, you never solve anything in health care systems, you just restart the clock on when you'll solve the next set of problems)
In the American health care system those problems are that we spend lots of money overall to give some people great health care, and some people far less than what they need. One of the reasons this happens is that insurance companies (money-making businesses) understandably don't want to be caught insuring people who get really sick and cost a lot to treat. This is what's known as "catastrophic" events. If a course of treatment goes over $30,000 that's catastrophic. For you, if you don't have insurance. For your insurer, if you do.
The problem is that it's hard to tell in advance who is going to have these catastrophic events. It's worth an insurance company's while to do something to avoid covering these people. This is why some people have problems getting insurance; because they fit the profile of people with a higher risk of catastrophic events.
The bottom line is that insuring catastrophic health care coverage is a miserable business; it's risky and low profit for the companies, and no fun for consumers trying to get good coverage.
Averaged out over 290 million people, however, catastrophic costs are relatively predictable year-to-year. This is why it makes sense to have the largest possible "pool" of people insured together -- the whole country. That is the best part of Kerry's health care plan.
Another good part is that Kerry proposes to cover all children. It's an absolute f***ing scandal that we let children's health care coverage be dependent on whether their parents are in work or not. And it's a scandal too that covering that gap in children's coverage varies so widely from state-to-state.
Some of those 45 million Americans without health insurance that you hear about are mature adults capable of taking risks themselves. I think they're pretty foolish, but hey, if you know when you're going to find out you have cancer, more power to you and your choices ...
Children have no such independent decision to make, and if equality of opportunity means anything, it means giving all children health care coverage until their late teens. It's worth noting that the catastrophic problem and the children's coverage problem are quite different aspects of the health insurance system.
The catastrophic coverage problem is all about the problems of insurance plans being too small relative to the riskiness of the population and the cost of the treatment. It is a problem mainly on the supply side of the insurance market -- companies aren't willing to offer something people want.
Children's health care is, by contrast, relatively predictable and the procedures are generally cheap. For health care providers it's a good steady source of income, and they'd be willing to supply it. The problem is with the way we arrange coverage, through employer-based insurance plans covering families.
We got to have this system through historical accident during the Second World War when the steel companies and steel unions negotiated a contract that included health coverage. Other industries followed; Congress added in tax deductions to make health care premiums a cheaper form of compensation than wage increases, and that's where we are now.
Even if you believe in a 'free market' form of health care provision and insurance coverage, there's no logical reason that it should be tied to current employment.
Good as Kerry's plans are, I don't think he'll be trying to reform that which is a pity. Presented the right way it's an idea that could have support from conservatives as well. The problem with any reform efforts in this direction is that a lot of wealthy people (including the current Senate majority leader) have a stake in the current arrangements.
Posted by robe0419 at October 13, 2004 3:12 PM