The Path to Universal Health Care
Then,
I chanced upon a 60 Minutes segment that looks at a state funded cancer clinic being
shutdown, owing to the recession.
It presents a grotesque set of choices that isn’t us. Can't be (see way
below).
The health of the nation is both a matter of national concern and a metaphor for the rigor and balance that we strive for in the wake of the collapse of our financial system.
The Birth of
Pro Bono
Our great
society has an implicit promise to maintain a reliable safety net system.
Exhibit A: providing universal access to health care services.
The paradox is how to do so while simultaneously embracing fiscal pragmatism and maintaining market orientation.
Pro
bono publico
(usually shortened to pro bono) is a phrase
derived from Latin
meaning "for the public good". The term is generally used to describe
professional work undertaken voluntarily and without payment as a public service.
Pro bono service, unlike traditional volunteerism, uses the specific skills of professionals to provide services to those who are unable to afford them. (FROM WIKIPEDIA)
What I am envisioning is a government-sponsored initiative to apply pro bono concepts to the health services constituency of: Doctors; Hospitals/Clinics; Insurance Providers; Pharma; and Consumers.
It is an out of
the box way to instill a sense of collective ownership among the key stakeholders in the
vetting, deployment and administration of a federally-backed health services safety net delivery system.
Who knows? If it works, maybe the same concepts could be applied to evolving our educational system.
When Safety Nets Fail
God forbid any of us should find ourselves in such a horrible place.
Sick. Desperate. And utterly kicked to the curb.
"I don't want to die. I shouldn't have to die. This is a county hospital. This is for people that, like me, many people have lost their insurance, have not any other resources. I mean I was a responsible person. I bought my house. I put money away. I raised my two children. And now I have nothing. You know my house isn’t worth anything. I have no money. And I said 'What do I do, but what do all these other people do after me?' 'And they said we don't know.'"
In ‘The Recession's Impact: Closing The Clinic,’ 60 Minutes correspondent Scott Pelley, looks at the gut-wrenching impact of the recession on a once-indelible safety net: state and county medical services.
Watch the segment above, in all of its ugliness, intellectually understanding the paradox for local and state governments wrestling with horrific budget shortfalls.
Our system is defined by an asymmetry between the “guaranteed coverage” model that drives employer-based health care plans, and “medical underwriting,” a malignancy that drives the private individual market.
The awful truth is this. Many a “poor folk” literally become poor by virtue of the great injustice of getting sick.
In what becomes the ultimate sick joke, sickness renders them unable to work, which, in turn, leads to them to lose their insurance.
Then, horrifically, they are uninsurable in the private individual market because, by definition, they have a “pre-existing condition,” which, of course, started the vicious cycle in the first place.
Getting Real: A Moral Imperative
Frank Rich, writing in The New York Times, shines a jarring light on the moral imperative of our times, saying, “This is what Obama is talking about when he insists on pushing for change simultaneously on so many fronts — green jobs, health care, education, new financial regulation, infrastructure spending and all the rest. As has been true since he promised “a new foundation for growth” at his inauguration, the most important question is not whether he will try to do too much at once but whether he will and can do enough.”
We the People. Repeat. We the People. Repeat…
The Grim Facts
on Health Care:
- 46 million
Americans are uninsured under our current health system;
- 700,000 Americans go bankrupt each year,
at least in part due to the cost of runaway medical bills; this fact has no
parallel in other developed countries;
- When you lose your job, you lose your
coverage. COBRA provides a time
limited safety net but fully 90% of the people that are offered it, don’t
purchase COBRA because it is expensive.
Plus, it is only available for ~18 months, meaning that the chronically
ill will be subjected to the private individual market. Medical underwriting (introduced earlier)
means that if you can’t secure an employer sponsored policy, you will once
again, be without coverage. Finally, if your company goes broke, and the
employee insurance program goes away as a result, COBRA is pretty much
instantly unavailable to all (former) employees.
How about that as a double-whammy for suddenly finding yourself out of
work in a bad economy?
- The average premium is 3X in states that
have guaranteed issue programs (i.e., can’t be denied coverage because sick or
have pre-existing ailments).
Surprising? Apparently, people wait until they absolutely need coverage,
resulting in under-distribution of costs across the larger network of citizens. The most logical counter to this is to
mandate that everyone buy into the system above a certain economic level and
provide near-free lunch to those that truly need it (i.e., below a certain economic level).
- One thing to think about in terms of the
aging baby boomers – a massive demographic – is that there are large numbers that
are moving into a heightened health services consumption/reliance stage, but who are
either too “rich” for Medicaid or too young for Medicare.
- Administrative costs in the U.S. make up 24 percent of health costs versus 12 percent in Canada. If we could squeeze that inefficiency to make it on par (with Canada), that alone would pay for universal health care.
UPDATE 1: Great article by Andy Kessler (one of my favorite writers) on why the medical establishment is unlikely to embrace electronic patient records with full vigor. EXCERPT: Rather, the health-care industry's reluctance to digitize its records is rooted in a desire to keep medicine's lucrative business model hidden. Dangling $19 billion in front of a $2.4 trillion industry is not nearly enough to get it to reveal the financial secrets that electronic health records are likely to uncover--and upon which its huge profits depend. In those medical records lie the ugly truth about the business of medicine: sickness is profitable. The greater the number of treatments, procedures, and hospital stays, the larger the profit. There is little incentive for doctors and hospitals to identify or reduce wasteful spending in medicine.
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