Just Health
Why is health care such an intractable problem? First, define the problem: thanks to miraculous but expensive technology, people can live as long as they can afford to, with the result that the rich live long and the poor die young. That is patently unjust.
Let's give free catastrophic insurance to everyone. Catastrophic insurance pays for huge medical bills incured from an emergency or a debilitating, chronic disease. Anyone who is struck with a massive health disaster should get free coverage courtesy of Uncle Sam, which removes one of the worst injustices. The good thing is that very few people incur such costs, so the taxpayer burden will not be great.
Second, let's give free universal coverage to the poor. Fortunately, we already have a program of this ilk called Medicaid. Increase its scope and make it work better, and you enable the poorest to have good health care.
And that's it. What about the old? Means test them: If their rich, let them pay. If poor, they get Medicaid. Why make a distinction because of someone's age? Naturally, as you age you incur more costs, making the old more likely to slip into poverty because of health care costs. There is probably need of a sliding scale to widen the net of poverty-based government-provided health care as citizens age or incur more costs; we also make "catastrophic" a definition that changes by income level; but let the technocrats figure that out.
Universal coverage for all works poorly, as shown by most European countries with sclerotic health industries and economies starved for incentives. No government help for any is plainly unjust. A mix of solutions shouldn't be that hard to hammer out.
posted by Cicero at 12/02/2004
2 Comments:
Well, I feel like a mosquito at a nudist colony--where do I start? I guess I'll tackle this in chronological order.
First, it's a farce that universal catastrophic insurance would be a “small burden” on the taxpayer. I believe it was a fmr. Clinton administration official who scored the Kerry health "plan" (which was centered around a taxpayer-funded catastrophic benefit) and said that it would cost you and I $1 trillion over 10 years. But I guess it's just like many other things during the Clinton administration--it depends on how you define your terms such as "relatively small". Some of us would say that there are far more efficient ways to provide health benefits.
Also, while it is true that there are relatively few people each year whose care would trigger a catastrophic benefit, any health economist could tell you that it is precisely those people who account for the lion’s share of health care costs. Taking care of patients in an ICU following an organ transplant or caring for immunodeficient patients is phenomenally expensive and accounts for a vastly disproportionate amount of health care spending. The health economics saying goes that it’s the “small minority that costs the vast majority”. I'm not saying that it’s a bad thing to help those who are sickest--just that it would be foolish to think that it would be cheap.
Also, any health care plan centered around a federally-funded catastrophic insurance benefit is a massive taxpayer-funded Christmas gift to the insurance industry. If I were an insurance company I could think of no sweeter deal than to charge my policyholders for a health insurance benefit and then make the taxpayers bail me out when something like an organ transplant or open heart surgery was about to cut into my profits. That sure would keep my investors happy and my profit margins up.
Second, Medicaid. Medicaid is well-intentioned but performs poorly in most of the country. States in fiscal crisis have been slashing reimbursement to physicians so that it actually costs doctors money to take care of poor patients--a perverse incentive to turn the poor away and thus costing states less money. Another thing that states are doing is making the poor re-enroll in Medicaid every 6 months to a year. Why? To keep fewer and fewer of the poor enrolled in the program at any given time. There are so many problems with this absolutely vital program that I could mention, but I'll finish by saying that dollar for dollar research shows that giving people a choice of private insurance plans funded via refundable tax credits is a far cheaper and more efficient than Medicaid--and people like private insurance, states can’t screw with it, and doctors accept it. Medicaid is absolutely worthless when (as is true in many states) the only place that accepts it is the emergency room. It's a broken program that shouldn’t be expanded upon until it’s fixed.
The esteemed owner of this blog made me promise two years ago that I would never talk foreign policy and that in return he would never discuss matters of health policy. There were good reasons behind this arrangement, chief.
Great blog I hope we can work to build a better health care system as we are in a major crisis and health insurance is a major aspect to many.
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