Thursday, July 30, 2009

Explaining part of the health care reform issue

The lousy coverage of the health care reform debate has been bugging me, to the point that I don't know where to start criticizing. I finally decided I'd start small.

One of the reforms we need is to stop letting insurance companies find ways to drop people's coverage as soon as they get sick. If insurance companies are allowed to only provide health insurance for healthy people, then they're not really providing insurance at all.

On the other hand, if you force all insurance companies to accept any patient, you'll have people who will game the system... they'll skip buying health insurance as long as they can get their routine care cheaper than the cost of the premiums, and only buy insurance if they find themselves facing a long term illness. As little sympathy as I have for insurance companies, that's not fair for them. And further, it will mean that if the insurance companies are trying to keep premiums down, then everyone else will have to pay higher premiums to provide enough funding to cover those who buy insurance only when they need it.

Fortunately, the answer to both problems is relatively easy... universal coverage.

If everyone is covered, then no one is getting dumped for pre-existing conditions, or for forgetting to mention they had an ingrown toenail on their application form. And, if everyone is covered, no one is gaming the system by waiting to get coverage.

With universal coverage, there's plenty of money flowing into the system - someone is paying premiums (or their equivalent) for everyone, and the financial burden is spread out evenly. Sure, some people will complain that the healthy are subsidizing the health care costs of the sick, but that's kind of like saying that the long-living people are subsidizing the life insurance of folks who die young... that's the whole point of insurance! You pay to fund the unfortunate, hoping you won't be one of them.

Getting universal coverage isn't easy. Right now, it's looking like we're going to maintain private health insurance companies (hopefully, with an additional public insurance company run by the government). We'll need regulations to make sure that they cover everyone. But then we're going to have to fund coverage for everyone. That can either be through taxes - yeah, right, like that's going to happen! - or through a set of mandates.

It's not very pretty; no one likes to be told what to do. But if you don't want people gaming the system, you need to make sure they're paying into the fund (or that someone else is on their behalf), one way or another.

So it's looking like that's what we'll end up with... assuming we want effective health care reform.

If we'd rather remain the last industrialized nation that doesn't care about the health care of its citizenry, we could use the Republican plan, or just make some cosmetic tweaks.

Wait, I'm repeating myself, aren't I?

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