The Amazing Maze of US Health Care

I am upset with President Obama’s handling of health care.

If I was responding to the recent Washington Post –ABC news poll I would respond “strongly disapprove” to the question:

Do you approve or disapprove of the way Obama is handling health care? Do you approve/disapprove strongly or somewhat?

But I am not sure the media analysis of the poll captures my sentiments.  To listen to them you might think Americans don’t want health care reform.  That’s not my view and that does not appear to be supported by the poll results.

The last president barely squeaked into office without a majority of the popular vote and the slimmest of margins in both the House and Senate.  And yet within two years he led the country into a war that almost no one wanted, and that has killed and maimed thousands of American service men and women.  That very same poll shows that 62% of Americans consider the war in Iraq not worth fighting. Read the rest of this entry »

The current debate is really about entitlements.

Which is the odd one?

Not whether but who.

The insurance companies argue that they are entitled to do business as they always have done.

Of course, they would be more than willing to accept money from the government to do more of what they have always done, as long as their profits are secured.

The insurance companies also argue that they perform an important service and that millions of jobs hang in the balance and we dare not disrupt this vital economic engine.  Somehow that argument did not seem to work for the auto industry or the steel industry.

Why?  Because in the current system, the insurance companies know that their customers, patients and subscribers, feel entitled to their health care benefits. Read the rest of this entry »

I have a hard time getting my arms around the public plan option debate.  As other have said far better than me, it is not central to health reform, although it clearly central in the debate around health care reform.  Instead it is a proxy for a lot of other issues.

UHCAN Rally June 25

Just about everyone in the health care debate/discussions has their lynch pin issue.  It’s what I call the “just fix this” syndrome. They range from, “If everyone would just exercise more,” to “if the government would just pay for everything.”  In between is a whole range of touchstone issues, including numerous proposals for delivery system reform, payment reform, tax reform, the list goes on. Read the rest of this entry »

Our plan just completed its annual open enrollment.  Members are permitted to change medical or dental plans; to add or remove dependents, and change life insurance options.

Open enrollments highlights certain flaws in our current system.

The logic of an open enrollment is compelling.  The object of any insurance is to spread the cost of any risk over time and over as many people as possible.  Open enrollment helps to spread the risk over time.

The risk of health care is different than other risks that we insure against.

We buy life insurance to insure against death; auto insurance to protect against an automobile accident; homeowners insurance to shield against damage to our home.

Those hazards (the technical term) generally occur without warning.  No one is likely to approach their insurance agent to buy auto insurance because they anticipate an auto accident in the near future.

Illness, on the other hand, can offer some warning.  Someone may experience symptoms and has not seen a doctor.  The doctor may have recommended expensive surgery.  Or maybe it’s just a young couple planning to start a family.

Open enrollment is the only opportunity that insurers have to spread risk over time.  By insisting that people enroll only during a specific time period, the insurer reduces the risk that someone is only enrolling because they know they have an approaching medical expense.

It may seem unfair to the person with an immediate and pressing need.  But to the others in the group who ultimately foot the bill, it makes perfect sense.  It is one reason why a mandate – an employer mandate or an individual mandate – makes sense.

Medicare has its open enrollment rules.  Their annual open enrollment for Medicare Part B is from January through March each year and is not effective until July 1 of that year. Read the rest of this entry »