Yesterday I attended about an hour of a presentation at the Lafayette Public Library on potential changes to Colorado's state laws re: health care policy. Last year the state legislature created a blue ribbon panel on health care. They solicited conceptual proposals and filtered down to four for detailed analysis. The meeting yesterday gave an overview of this process and was meant to be a forum to solicit comments and concerns.
Senator Brandon Shaffer and a couple members of the 208 Commission, as the panel is also called, heard from a range of people. I was intrigued at the points that were raised, and felt sympathy for the folks who have messed up scenarios regarding their specialized needs and their struggles to get proper treatment. The saying "All that matters is your health.." kept popping into my mind.
The key issues I heard include:
- The distinction between access and coverage
- How coverage should be funded (by whom, really)
- Whether health care should be tied to employment (making employers the vehicle instead of the individual)
- The impact of illegal immigrants on the system
- Getting the profit motive out of health care
Having this philosophical argument is crucial. I'm turning over in my head the notion of health care as a "right". If I think of the right to free speech or similar concepts, these do not involve a financial impact. This is decision of governing that allows for certain behavior without some kind of suppression. If I think of the right to a speedy trial or other more mechanical rights, to me these seem to involve a policy decision that does involve costs we presume are part of our overall justice system, and as such the machinery we set up should cost the same, per person involved, once it it set up.
But health care as a right presumes that every last medical option and indeed even experimental options should be provided to every person whether they are ill from an accident, genetic bad luck or extremely poor personal lifestyle choices. This philosophical debate will have to address the notion that some illnesses are simply too far out on the limb for society as a whole to be responsible for treating. I don't know where that line is drawn, and what an awful place to be right outside it. But how else, truly, can it be as public policy? And why should anyone assume society will break the bank to take care of them? It's a great ideal, but can it really work that way on a grand scale - that everybody's health problems are treated to the maximum technology available? This elephant in the room is what Sen. Shaffer and his colleagues must tackle. A daunting task.
Yesterday I heard the notion of a two-tiered system, that would provide some kind of minimal blanket coverage for everyone, and then other procedures would be covered by some other kind of ability to pay. I think pragmatically speaking public policy has to lean that way. I can't see how every person's illness can be covered by everyone who isn't ill paying in. How is that sustainable? (These FAQ's address some of my questions.)
And a key side note - where does an emphasis on wellness come in? The legislature just changed the law in Colorado that allowed insurance companies to provide premium discounts to healthier (fewer claims) groups, as this was deemed discriminatory against the groups with ill people, who could be charged up to 10% more. If you can't charge the people who are actually sick more, and you can't give those people staying healthy a break, how can this work? The structural generosity of coverage for everyone has to be tempered with some kind of incentive and benefit if you stay healthy. Whether it's good luck, genetics or proactive behavior, if you're healthy, you're healthy. Such healthy people will get pretty bitter about paying for the unemployed overweight chain-smoker's third bypass operation.
I sincerely hope the legislature will answer the right/privilege question and draw up clear expectations (and limitations) for the coverage everyone deserves/will get in terms of society paying for it. Once we know the "what" we're paying for, then can we argue about how to pay for it.
4 comments:
Well, Dan, if you worked inside the medical profession, you would have a different view of this topic. And if you had stayed for the entire session, you would have seen the differenct between those with medical insurance, those who don't, and those who have been denied it.
The overall assumption is that medical coverage equals quality care. It doesn't. It may mean some care. But not to extent those with serious coverage problems would like.
Anyway, I remember a quip made a few months ago about does anyone want those that run the VA involved with policy making on this topic?
At the moment, hospitals are shutting down and doctors are closing their practices.
I missed the powerpoint but was there from 1:45 - 3:00; what did I miss? Those without insurance demanding coverage of any kind? I support the notion, of course we should have the safety net of basic health care. But seriously, if you are unemployed for whatever reason, or have a more rare illness, how does all your treatement get covered by those who can pay? The parameters of what can truly be funded must be discussed. And of course everyone has their own niche concern that deserves full funding/coverage/treatment.
I don't know how the legislature will be able to hash this out. I want to be part of a creative but practical discussion. The 208 Commissioners have a tough road ahead.
I was also intrigued by the gentleman's point about how massive pension and mutual fund dollars are in stocks of the for-profit health care companies - start to criminalize their profits and your own investments for retirement could be hit.
People can of course switch their investments, but I haven't met too many people who scrutinize where their 401ks and pensions invest as long as they're going up. I bet there are a lot of seniors griping about the money pharamceutical companies make while at the same time having good chunks of retiremnet investments in those companies. Whoops!
It is true that often the same people who throw spears at the health insurance companies also are owners in these public companies. If the stock price falls in those companies, the shareholders yell for the CEO of those companies to be fired. The oxymoron in all this.
"Coloradans" want better coverage yet assume someone else will pay for this, the state or the Federal government. Translate that into higher taxes and a bureaucratic mess.
Schaffer used the example that everyone should have access to an ambulance service. In Lafayette, taxpayers are subsidizing the service. Two years ago when Louisville cancelled Boulder County Paramedics, they got the County to raise ambulance service prices in the County to subsidize Louisville getting the service from Pridemark. I had to explain to the county commission in charge of this the ramifications of their decision. (Louisville is now cancelling Pridemark due to poor service.)
So in the end there is this inherent conflict of who pays for whom? Plus the waste in hospitals is unreal. I was privy to a study done by Centura, the biggest healthcare network in CO.) Everyone games the systems.
My point was that the folks who pleaded their case were not the smoking, obese, hard drinking looking for their third by-pass.
Also Medicare does not required preauthorization yet are so costly to treat that doctors are refusing more Medicare patients.
Once again as I challenged the Doc there and he avoided the issue. When you sit in the exam room and are seen by a medical staffer, that person is not a certified medical assistant or RN. No way would any Doc let them stick a needle in their arm. These "MAs" are ex-receptionists or billing clerks. Their on the job training is you.
If you buy private health insurance (either individually or thru your employer), you're more than likely paying more than your fair share for health care already.
In 2003, according to the NYTimes, 20% of the population accounted for 80% of healthcare expenses. Half the population had virtually no healthcare expenses, 1% of the population accounted for 22% of the cost.
So, let's get beyond the who pays for whom discussion. We've been doing that for years.
Part of our current cost is those who have no coverage at all, yet incur health costs that are then paid for by various government entities. We still pay for them via taxes. We pay for Medicare/Medicaid as well via taxes.
So, the costs of healthcare are being paid for by those of us who are working, and making reasonable wages.
We can talk about all kinds of changes to how the system is paid for, but - bottom line - middle to upper level incomes will continue to subsidize the system in some way, shape, or form, whether directly via premiums or indirectly via taxes.
Instead, the discussion should be directed at how we can get the costs under control. How would that be possible if we nationalize health care? Name a federal agency that has it's costs under control.
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