Healthcare Redux

Healthcare is a topic I've written about before, but since it's hot again, I'll see if I can add a bit to my previous thoughts on the subject.

Our favorite fat communist filmmaker, Michael Moore, released a film called "Sicko". I don't need to see it to know it's full of stories about poor people who can't get treated for their maladies, corrupt politicians supporting evil and greedy drug and insurance companies.

He wouldn't even need to make stuff up like he did in Farenheit 911 to be able to convince anybody that the system is broken. I already concede that point - it is broken. But where he runs off the rails is by suggesting that the only solution is to have the government take over.

Let's start at the beginning.

Sometimes we wish for the good old days, where the country doctor with his little black bag made house calls. He treated broken bones and illnesses, administered medication, then was paid in whatever the patients had to offer. If not a few dollars, he might get a couple of chickens.

Today every malady requires a specialist. The General Practitioner is almost a thing of the past. All manner of high-tech devices have been invented that can pinpoint your problem without the need to cut. Thousands of pharmaceuticals have been invented to treat all manner of problems.

All that was made possible by health insurance. Back in the days of 80 percent marginal income tax rates, companies needed to get creative in giving compensation packages to their employees to keep their taxable incomes under that outrageous 80% threshold. So one of the things they came up with was health insurance.

I've been around long enough to have seen the evolution of healthcare firsthand. When I first entered the workforce, my employers provided only "Major Medical" insurance. That meant that if you had to go into the hospital for an expensive surgical procedure, the insurance would pay for it. Otherwise, you paid everything else out of your pocket.

Early in my career I was dirt poor. But I could afford to pay for both the doctor visit and the prescription when I got sick. If I needed a higher level of care and couldn't afford to pay on the spot, the doctor's office would simply set me up on a payment program. The bill would be paid within a few months without a major strain on my small budget.

Then one day my employer came through with this new thing called an HMO. We loved it, because it was almost free. Anything we needed, we could just go to the doctor's office and get it. Our share was $5. When our first child was born, I happily pulled a five-dollar bill out of my wallet to pay my share of the bill.

What happened? Well, when something is free (or almost free), people will use it a lot more. Kid got a sniffle? Take her to the doctor. Pull a muscle playing basketball? Go see the doctor. When it's practically free, why not?

Everybody came to rely on that health insurance, and now most consider it some sort of fundamental human right.

Today, the insurance companies have become the gatekeepers to the healthcare system. They created bureaucracies designed to look over the shoulder of your doctor and decide whether or not they will pay for his recommended treatments. They all have their own unique filing and reporting systems that must be used by the providers in order to get paid. And they are for-profit business entities.

Bigger corporations are "self-insured", which basically means they hire a company called a TPA (Third-Party Administrator) to manage their health plans. As the costs have risen higher and higher, companies are now seeking to cut their healthcare expenses. They cut their expenses by raising the amount they charge their employees for coverage, cutting out selected diseases or accidents they will cover, and by firing or avoiding hiring of anyone that might be a higher risk for health problems.

I'm not sure how smokers or overweight people can find a job these days, because they are openly discriminated against by companies everywhere because they just might end up costing the company one day if they get cancer or heart disease or diabetes or stroke.

So these days we are already solidly entrenched in a government-run insurance system. Most everyone over 65 is under Medicare, and now is also covered under a very poorly conceived prescription drug program run by the Feds. Considered honestly, the elderly need more healthcare than the rest of the population, so it could be fairly stated that the taxes of all working Americans go to pay medical expenses for our retirees.

The other socialized medicine in place is MedicAid, or variations on that program administered by every state. These programs use our tax money to pay for medical treatment for the poor and indigent.

For the rest of us, we can get great health coverage if we work for the right company that provides great health benefits for an affordable price. But if you're out of work, work for a small business that doesn't offer health benefits, or are a small business owner yourself, you are very likely to be uninsured.

Yes there are millions of uninsured Americans, either because they can't afford to buy their own insurance, can't buy insurance even if they can afford it, or simply decided to save the high premiums and take their chances.

Just about everyone will need some sort of surgery or other expensive medical treatments sometime during their lifetime. Some small business owners choose to forego the $1,000 monthly premium for health insurance, knowing that if they have an accident or illness while uninsured, they will be bankrupt. They figure that the odds are higher that their business will fail and they'll be bankrupt anyway, so they take their chances on being uninsured until the business begins to be successful.

Someone who quits their job or gets laid off must be offered COBRA coverage by their employer. Family coverage premiums under COBRA range between $800 and $1200 per month. The average person simply doesn't have that kind of money, especially one who was terminated and hasn't yet found a new job.

I despise the fact that I've been paying outrageous monthly premiums for health insurance that hasn't actually paid for anything yet. Between my high deductible and the restrictions in the plan, it will never pay any of my family's medical bills unless or until a serious injury or illness were to occur.

But I still don't want some government bureaucrat deciding for me what doctor I can see, what drugs I'm allowed, or when I can get a needed surgery. That's what happens when the government runs the system.

If affordable insurance for major medical was available for everyone, nobody would have to go bankrupt if they have an auto accident or get cancer.

Then, if routine medical care and prescription drugs were taken completely out of the insurance system, I think almost everyone would be able to afford their routine doctor visits and prescriptions. Physicians I think would welcome office vist fees of $30 or $40 if they never had to file an insurance claim and wait to get paid. Drug companies would be forced to bring down their prices as well in return for getting cash for every prescription filled. No more bureaucracies, no more restrictions on physician treatment decisions.

It won't happen. Neither will government-controlled socialized medicine. Because the industry likes the status quo and has the money to make sure congress likes it too.