Thursday, April 06, 2017

The Problem with Health Insurance

Health insurance is complicated... who knew?

In the bass guitar world technology has been pushing the limits with lighter weight, smaller cabinets, massive power, and more low end extension.  My 6 pound head can run rings around the 65 pound heads of my youth and my 34 pound cab puts out more low end than the refrigerator sized (and weight) cabs of that same time period.  Still, common wisdom is that you cannot have cheap, light, loud, and low all in one package.  The laws of physics still apply along with basic economics.

In order to fix our medical care system, we must first acknowledge that the rules of math apply.  It is not possible to have everyone covered with good comprehensive coverage at lower prices that are affordable to everyone without government funding and government interference.  Lower priced plans with reduced coverage are only helpful until they are not.  Cutting payment to physicians or other providers can only go so far before the math no longer works.  A for profit entity has a bottom line commitment to the bottom line... and something eventually has to give in order for the company to make its profits.  All that adds up to one inescapable conclusion.: before the ACA, the system was broken.  Too many people were not insured.  Too many people went bankrupt because of medical bills.  Too many died because of lack of care.  Treatment plans were often chosen by bean counters rather than because of efficacy.  The training of physicians is expensive and favors some specialties over others regardless of actual social needs.  The nature of healthcare makes it impossible for it to respond to market pressures in the same way that other industries do.

The ACA attempted to fix some of the presenting problems without addressing underlying issues.  It succeeded in that small way and would have been more successful had the Republican Party not worked so hard to obstruct it.  (We hear how the CBO's numbers were so off... but that ignores the fact that their numbers were based on the plan actually being adopted while 29 states refused the Medicare expansion part of the program).  Because the ACA sought to work within the then, current system of for profit private insurance companies, etc., it could never deliver the product it promised of affordable, comprehensive coverage for all.

To get the product that a civilized country deserves requires a complete overhaul from top to bottom including training of physicians, funding of medical research, decisions regarding what care is provided (and not provided), how funding is allocated and what fee structures look like.  It will take years to accomplish... possibly decades... but if we do not begin the process, we will see our broken system continue to deteriorate and all but the very rich will suffer.