The White House has started several discussion groups on Linked In, one of which is What is in the Health Care Bill? Needless to say, the majority of people posting are in favor of the legislation and display limited tolerance for opposing views because they focus on the “goodies” contained in the legislation. I took some time to post a different perspective (what, you are surprised?).
Let us step back and think about this beyond the sole context of PPACA.
What is the real problem we are trying to address? It is health care costs, because the cost of health care is the main driver that creates the uninsured and causes various underwriting standards for insurance companies that everyone hates (the same underwriting that is applied to your auto insurance, your homeowners insurance and even your life insurance, not to mention Medicare where you pay a penalty for late enrollment as well). There are many drivers of cost that in turn is the driver of premiums (insurance companies as an industry operate on a 5% profit margin far lower than even your local regulated utility). Making health care affordable requires dealing with the underlying cost of health care and the reasons for it. PPACA does not do that, quite the opposite in fact. Subsidizing premiums for families earning up to $88,000 or giving tax credits to small employers is not making health care affordable, it is shifting costs and masking the real problem.
What is the real problem? In large part, it is the fact that we cannot accept the concept of insurance when it comes to health care; rather we are convinced that every service prescribed be covered and largely paid for by someone else. Why for example is health “INSURANCE” required to cover oral contraceptives, or the voluntary reversal of a vasectomy or a flu shot or even a routine physical? Does your auto insurance cover an oil change or your homeowners a new roof when you decide it is necessary? Would you pay those premiums if they did? These examples are not insurable risks nor are they catastrophic in nature cost wise.
And, yes it is exactly the same thing when you compare an oil change to a birth control prescription, they both cost about $30.00 or less, it’s money, your money (perhaps more accurately it is someone elses money).
Politicians have also touted the fact that “nobody should come between you and your doctor.” Well, to receive the optimum level of care that is exactly what IS necessary in many cases. Our system is disjointed and uncoordinated and you have no way of knowing if you are receiving the best or most appropriate care from your doctor who in reality is a small businessman. Did you ever hear of anyone who was going to a doctor who was not “the best?”
In 1961 when I started administering health benefit plans, there was no coverage for anything other than hospitalization and physician services in the hospital, plus a small fixed dollar amount for tests and x-rays. There was no coverage for office visits or other outpatient care or Rx. Back then, an office visit cost $5.00. In 1963, we started to “improve” the coverage and added a major medical plan with a $100 deductible and 20% coinsurance for outpatient services and Rx. We also abandoned fixed fee schedules for physician services and instead paid the “Reasonable and Customary” fee that increased each year as doctors raised their fees. Guess what? From that point forward, nobody cared what their health care cost and costs began their upward spiral that continues today.
Yes, there are other factors like new technology our general health status, etc. but the fundamental problem is that we have little personal responsibility for our health care expenses as we do with every other expense in life. We have convinced ourselves that somehow $100 spent on health care is different from $100 spent on taking the family out to dinner. PPACA makes this situation worse by mandating more and unlimited coverage, and by further subsidizing the premiums, many Americans pay. In addition, by demonizing insurers, politicians have redirected our attention away from the real issues to a convenient scapegoat. Keep in mind that about 70 million Americans are covered by employer self-insurance plans all of which are facing the same cost issues without the involvement of any insurance company.
Heath insurance premiums and the underwriting by insurers are not the problem, they are the symptom. PPACA may help this person or that group today, but it does nothing to address the real problems we face and exacerbates the problem in the years ahead while creating a new entitlement mentality that the next generation will be forced to deal with.
Like it or not, that is the way it is.
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