Musings

Thoughts about healthcare

November 1: Welcome to the start of open enrollment, where your premiums and deductibles are going up.

I love learning about healthcare. It’s a huge, sticky, complicated problem. It makes a lot of people upset—including me sometimes. I’ve read a lot about it—articles, books, and even a long-ago college class about healthcare ethics. I’m not exactly qualified to write this, but I thought I would share some thoughts anyway.

There are problems with our healthcare system right now. And it affects 100% of the people in this country who are paying for those problems.

THE AFFORDABLE CARE ACT

Conservatives want to majorly reduce the government’s involvement in healthcare. But it’s not like the healthcare system was awesome before the ACA—you still had rising premiums, rising healthcare costs, and lots and lots of uninsured people. If we get rid of the healthcare exchange, 20 million people lose insurance. They could go buy it somewhere else, but insurance has never been that affordable (I remember looking at it around 2009 and we chose to be uninsured for about two years because it was too expensive). And without ACA regulations, you had things like lifetime limits and denial for preexisting conditions, which meant that some people simply couldn’t get a basic standard of care even if they wanted to.

The ACA basically put a question to the test: “Can free-market healthcare provide a minimum standard of care for everyone in the US?” That’s what all the regulations did: it forced everyone to get insurance and it forced the insurance policies to provide a minimum standard of care.

It didn’t work—prices went up and everyone is now upset and frustrated. Now we know that free-market healthcare cannot support an affordable minimum standard of care for everyone.

THE CHOICE

We’re left with a choice: return to free-market healthcare that does not provide care for everyone or increase government involvement and move to a government-based healthcare system.

Free-market healthcare has good aspects—you get a lot of advancement, research, cutting edge technology, that sort of thing. But only for those that can afford it.

A government system means that everyone can get care, even if it’s not the best care.

It’s a choice, and not necessary a choice between right and wrong. But I think there is one option that I like better than the other.

FREE-MARKET HEALTHCARE

Right now, healthcare costs are incredibly high. And I think they will remain high with free-market healthcare. Because free-market healthcare is motivated by profit. Doctors make a lot of money. Corporations, like prescription drug companies, make a lot of money. And as individuals, we have no bargaining power when it comes to healthcare, no good option of driving costs down. If you need your appendix out, you don’t find the cheapest option. You just get your appendix out. If you need medication, you pay for it. If you have any sort of illness, you get treatment and deal with the bill later. There is no real price on your health and your life. They can and do charge you a lot for it.

Administrative costs are also ridiculously high, maybe partly because of government regulation, but also due to our complicated insurance-based system. There are some other reasons healthcare costs are high, such as unnecessary testing, unwanted extension of life, or people suing doctors. It all factors in.

If the government gets out of healthcare, it remains expensive and many people won’t be able to afford it. Prices don’t magically go down because of no government regulation—they can go up instead.

The other choice is we provide everyone with healthcare with increased government involvement.

CARE FOR EVERYONE

If we believe that everyone deserves access to healthcare (and I know some people disagree with that), we need government involvement. Is it okay with you that people without enough money can’t get treatment because they can’t afford it? I don’t like that option. If you think you deserve healthcare, why not someone else? What makes you so much better—maybe that you have a job, you work hard? What about those literally unable to work? Or those who work as hard as they can but still don’t make much money? What about those with chronic conditions that they didn’t choose?

Don’t we want people to be healthy?

Government provides a public education system. Because educating people helps everyone. Without it, only the children of rich and educated people would have opportunities to be educated, and those without so much privilege wouldn’t have opportunities to improve their situation. The rich would get richer; the poor would get poorer. Our education system is very far from perfect, but it’s still needed.

Doesn’t healthcare fall under the same umbrella? Healthy people help out everyone else, right?

Don’t we have some sort of obligation as a developed country (so there is enough money floating around somewhere) to make sure that people who are sick can find treatment? That EVERYONE can have antibiotics or heart surgeries or chemotherapy or insulin or whatever else they might need to stay healthy? Or do we want to let the elderly, the children, the low-income, and now the middle-class to simply go without treatment?

A SINGLE-PAYER SYSTEM

Our healthcare system has problems, but I don’t think the solution is in the free market. The solution is in the government finding better answers than we have right now. That is what every other developed nation has done—their governments are more involved in healthcare so everyone can have access to it.

The people who have Medicare like Medicare. Medicare drives healthcare costs down: Medicare patients usually pay a lot less. Doctors and corporation may hate it because they get less money, but it benefits patients, those unable to negotiate for themselves.

What about Medicare for all, or at least the option of Medicare for anyone who wants it?

It would mean the government would set prices for people, instead of relying on prices set by doctors/corporations. It would also mean much lower administrative costs.

It also might mean that maybe we would have longer wait times or not so much cutting-edge technology. But everyone would have care, even if it wasn’t the absolute best care.

PROBLEMS AND SOME POSSIBLE SOLUTIONS

Medicare is not without its problems. Fraud, for example. And we need to figure out how to reduce unnecessary testing and unneeded medications. People take advantage of the system if they don’t pay for it—but you can still pay premiums and deductibles with Medicare, and that should continue, maybe even with higher rates. You don’t get free healthcare—you just get affordable healthcare, something we are extremely lacking right now (e.g. I just paid over $900 after insurance for a single doctor visit and lab work).

How do we pay for that? Well, a single-payer system would reduce healthcare costs overall, which is helpful. And I think if we took a lot of that money individuals and employers are paying into their current insurance premiums and healthcare costs, we could make it work. People wouldn’t have to pay more; instead, they might end up paying a whole lot less.

We’d have to give money to the government, and I know some people hate the government. I know the government isn’t perfect and they do bad things. But the government also does good: they help with the things like roads, infrastructure, utilities, parks, green space, schools, military—many things that you and your family enjoy right now without thinking about (disclaimer: my husband is a government employee).

It’s not perfect: it may result in a lot of job losses, lost profits, lower incomes, that sort of thing—it would negatively affect the people enjoying the benefits of very high healthcare costs. A transition would be tricky and hard to navigate to avoid chaos and disaster.

But we already sort of have a little chaos and disaster. Something needs to be done because what we have now just doesn’t work for anyone.

CONCLUSION

This is a super complicated issue and I’m not even scratching the surface of it. I may have posted incorrect or inaccurate data. But thanks for listening.

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