Life is a Mystery

28 July 2009

The health freedom lie

This CNNMoney article has been making the email rounds and just hit my desk, passed along by my father-in-law who says “as in all things, be careful what you pray for”. It warns that we will lose five “freedoms” with health care reform. Oh yeah?

Who are you kidding?

1. Freedom to choose your own plan?

Who has that now? It is our employers who choose our plans. Hell, many of us with pre-existing conditions can’t choose _any_ plan. Tell me which plan will accept Alex when he is an adult. That’s right: only government-sponsored plans. This “freedom” is an illusion.

2. Freedom to be rewarded for healthy living, or pay your real costs?

This so-called “freedom” is the antithesis of “insurance.” Of course you don’t pay your real costs or get rewarded for healthy living. Insurance is a group of us (all US citizens, lets say) banding together to say we will help one another. Everyone deserves health care, that is the basic assumption at work. If we all pay into a pool, then we can cover the costs for reasonable health care for everyone. Notice that almost no one pays “real costs”. Some pay more than they “needed” to (they were healthy and presumably don’t wish otherwise), others paid less than their care required (they got sick, so they are not feeling very lucky about this). The whole point of insurance is that we all pay into a pool in a predictable way to help each other with unpredictable expenses. Unfortunately, our for-profit insurance companies have forgotten this.

3. Freedom to choose high-deductible coverage?

Well, we know who benefits from this “freedom”: the very wealthy. Who else would “choose” a high deductible plan? Health savings accounts are a sham, designed to remove the healthy from the insurance pool. The point is, do we care about the health of our fellow citizens and believe that a healthier society will benefit us all or do we believe that each of us is out for him or her self? We need to design a system _everyone_ can afford, not one just for the rich and healthy.

4. Freedom to keep your existing plan?

See #1. There is no such freedom now. Try changing employers and keeping your plan. Try staying at one employer for more than five years and keeping your plan. Our plans change every year and we have virtually no control over those changes. Doctors go in and out of “network”. Drug coverage changes. Deductibles rise. Copays rise. Where is the “freedom” here? Again, it is an illusion.

5. Freedom to choose your doctors?

See #1 and #4. Who are you kidding. You choose doctors that participate in your plan and the list of doctors participating in a particular plan shift from year to year. In fact, lately insurance companies and provider networks have taken to playing chicken, threatening to divorce and letting consumer outrage shake one side or the other down for a “lower cost”. This is nuts and it requires a huge expenditure of energy and resources to administer. Every once in a while (or if you are rich enough to pay “out of network” fees) you are lucky enough to get the doctor you really want, but for how long?

This article is a pile of steaming dung. It is the same dung-platter that insurance companies have been serving us for decades. Where is the real cost in our healthcare system? It is in the for-profit insurance industry that forces employers and providers alike to handle massive administrative complexity and renegotiate “choices” every single year. This is an industry that has forgotten that the reason we give them our money is so that they can spend it keeping our neighbors healthy, not so that they can take bigger and bigger profits off the top for “shareholders.”

A single-payer health care system would actually give you all five of these freedoms, freedoms you do not enjoy today. How?

#1: Single payer would give everyone a baseline of decent health care. It would leave for-profit insurers around to offer a variety of “cadillac” care for those who could afford it. Plenty of choice, just a baseline of decency to go with it.

#2: Your reward for healthy living would be your health. If you are motivated to be healthy (and most people really are), then you can build a relationship with whichever provider you wish.

#3: See #1, you can supplement your single-payer plan with whatever bells and whistles you like, as long as you can afford them. Not much different from today.

#4: Without a dependency on employers to select from a menu of complex plans, health care becomes simpler. You always keep your existing plan, it is _the_ plan. No choices each October. No worry if you have to change jobs or (worse yet) lose your job. You always keep your plan.

#5: You really can choose your doctor in a single-payer system. The are all “in network” and they all benefit from the streamlined administration that comes from dealing with only one major insurer. Yes, some insurance industry “gatekeepers” would be traded for government bureaucracy “gatekeepers”, but at least you have a chance, every now and then, of electing the government.

Unfortunately, I don’t think the current Obama plan will grant us these freedoms any more than the current system. It falls far short of streamlining the system in ways that would lower costs and make a doctor’s life easier. But just because it is not perfect does not mean that the current system is worth saving. The current US health care system is a sham of smoke and mirrors, made so complex that it tires out most anyone taking a good look at it. It is a system designed to profit a few and avoid paying for the care that many need. It deserves to be overhauled, and even the Obama plan will make it better if not ideal.

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Eric Celeste / Saint Paul, Minnesota / 651.323.2009 / efc@clst.org