healthcare rant
Jul. 30th, 2009 12:22 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
winterbadgerI read a post in a friend's journal about the "healthcare compromise" and, in agreeing with her, got so ranty that I thought I should probably post the result here instead of there.
The problem with there being a Democratic majority in name only is that it creates the need to achieve consensus among people with fundamentally different views, killing (IMO) any hope of effective reform through the death of a thousand amendments. The problem with attempts to get Republicans to buy into the idea of a government reform of healthcare is that they are not going to accept *anything* that really sets out to solve the problem in a way that involves the government. The GOP has become almost anarchist in its opposition to any form of government solution, so trying to get them to participate is IMO a lost cause and shifts solutions unnecessarily right of center.
And this effort so far seems to be only focused on getting people covered. Which is important, but the quality of coverage is as important as whether it's there or not. And the goal can't be *only* reducing the uninsured. It *has* to be about reducing cost as well, or the exercise is pointless and probably counterproductive. If we simply add more people to a system that is wasting huge amounts of money and delivering mediocre care, and then make government at all levels responsible for bearing the cost, we have a stake in the heart of federal spending and continued failure to deliver adequate care. Given which, I'm surprised more Republicans aren't pushing it along--it would certainly kill the idea of government involvement in healthcare.
I think a component of any program has to be banning any company from offering health insurance as a profit-making enterprise. Kaiser seems to do fine as a nominal nonprofit enterprise. Is the healthcare you get through it perfect? As a former participant, I would say "no, but it's a *lot* better than no health care, which is what many people get." As long as healthcare decisions are made by people who are trying to show profit to shareholders, bad health decisions are going to be made in favour of profits. In my ideal world, that's why insurance would be managed by a public corporation, like a utility, but I know that Americans are too wedded to the idea of private corporations doing everything.
Two of the biggest lies that need to be exploded in this debate (besides the whole argument about socialism/communism, which is so stupid it doesn't deserve to be addressed) are the contention that having a single-payer system prevents people from getting more expensive care if they want to pay for it and the implication that there isn't rationing of healthcare already.
One could perfectly easily set up a system where *everyone* gets a basic level of insurance for care, and then people with more money (often more money than sense) can add more care on top of that if they want. We have that already, effectively, in that people can pay out of pocket for procedures that aren't covered by their insurance. What we're missing now is the first part--affordable basic care for everyone.
And opponents of reform argue that single-payer would mean "rationing" healthcare, implying that it isn't rationed already. Which is preposterous. Of course it's rationed: it's rationed by your health plan when they set limits for what's reimbursable and what isn't, and by doctors when they hike the prices of all their procedures so they can break even after they give insurance companies discounts. It's rationed by the fact that wealthy people can afford to buy good insurance and to pay for procedures and drugs that aren't covered even by that insurance, when poorer people don't have either of those options.
Like everything else in the US, this system assumes that money is distributed fairly and evenly, that everyone who works hard can be as wealthy as they like, and that it's perfectly all right to expect that the essentials of life (food, housing, healthcare) be available to people based on how much money they earn, instead of making a commitment that some basic level of all of those goods be available to everyone, no matter whether they are poor or rich. It's one of the things I really don't like about my country.
The problem with there being a Democratic majority in name only is that it creates the need to achieve consensus among people with fundamentally different views, killing (IMO) any hope of effective reform through the death of a thousand amendments. The problem with attempts to get Republicans to buy into the idea of a government reform of healthcare is that they are not going to accept *anything* that really sets out to solve the problem in a way that involves the government. The GOP has become almost anarchist in its opposition to any form of government solution, so trying to get them to participate is IMO a lost cause and shifts solutions unnecessarily right of center.
And this effort so far seems to be only focused on getting people covered. Which is important, but the quality of coverage is as important as whether it's there or not. And the goal can't be *only* reducing the uninsured. It *has* to be about reducing cost as well, or the exercise is pointless and probably counterproductive. If we simply add more people to a system that is wasting huge amounts of money and delivering mediocre care, and then make government at all levels responsible for bearing the cost, we have a stake in the heart of federal spending and continued failure to deliver adequate care. Given which, I'm surprised more Republicans aren't pushing it along--it would certainly kill the idea of government involvement in healthcare.
I think a component of any program has to be banning any company from offering health insurance as a profit-making enterprise. Kaiser seems to do fine as a nominal nonprofit enterprise. Is the healthcare you get through it perfect? As a former participant, I would say "no, but it's a *lot* better than no health care, which is what many people get." As long as healthcare decisions are made by people who are trying to show profit to shareholders, bad health decisions are going to be made in favour of profits. In my ideal world, that's why insurance would be managed by a public corporation, like a utility, but I know that Americans are too wedded to the idea of private corporations doing everything.
Two of the biggest lies that need to be exploded in this debate (besides the whole argument about socialism/communism, which is so stupid it doesn't deserve to be addressed) are the contention that having a single-payer system prevents people from getting more expensive care if they want to pay for it and the implication that there isn't rationing of healthcare already.
One could perfectly easily set up a system where *everyone* gets a basic level of insurance for care, and then people with more money (often more money than sense) can add more care on top of that if they want. We have that already, effectively, in that people can pay out of pocket for procedures that aren't covered by their insurance. What we're missing now is the first part--affordable basic care for everyone.
And opponents of reform argue that single-payer would mean "rationing" healthcare, implying that it isn't rationed already. Which is preposterous. Of course it's rationed: it's rationed by your health plan when they set limits for what's reimbursable and what isn't, and by doctors when they hike the prices of all their procedures so they can break even after they give insurance companies discounts. It's rationed by the fact that wealthy people can afford to buy good insurance and to pay for procedures and drugs that aren't covered even by that insurance, when poorer people don't have either of those options.
Like everything else in the US, this system assumes that money is distributed fairly and evenly, that everyone who works hard can be as wealthy as they like, and that it's perfectly all right to expect that the essentials of life (food, housing, healthcare) be available to people based on how much money they earn, instead of making a commitment that some basic level of all of those goods be available to everyone, no matter whether they are poor or rich. It's one of the things I really don't like about my country.
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no subject
Date: 2009-07-30 06:23 pm (UTC)This whole healthcare MESS just makes me so mad I could scream. I can't stand hearing the latest about it anymore, because it's just so clearly going wrong. /sigh/
no subject
Date: 2009-07-30 06:33 pm (UTC)