01-22-2008, 05:28 AM
In all the rancor over health insurance, private/public and so forth, what's often forgotten is that health insurance, like all insurance, is for the most part a pretty mechanical affair. There are several components and one tough part. Basically any insurance setup consists of accounts receivable (collect funds from participants, government), accounts payable (pay doctors, hospitals for care), actuarial (frequencies of illness, costs of care, rates of compensation), security (fraud by patient or physician, patient information protection), the participant pool and policy. One apparently invariable rule is that the larger the pool, the more widely costs are distributed and the costs per individual are reduced. The hard part is policy, how to deal with rare diseases, extremes of treatment, levels of payment and so forth. These are difficult decisions simply because all resources are finite.
The two basic problems with private health care insurance that I see are that the pool is fragemented with many little and big companies carving it up, thus ratcheting up risk and costs, and that the first responsibility of any corporation, insurance or otherwise, is return of value to shareholders. Thus, in the tough policy decisions, the first to be served is the corporation, not the patient. This was exemplified recently by the girl why died due to the refusal of an insurance company to cover a liver transplant. They used the "experimental treatment" rationale not to provide coverage. Obviously, given the history and progress of transplant medicine, this seems very dubious. Clearly they were saving money for the corporation and were seemingly less worried about the health of the patient.
Personally I see the only rational system of health care in the modern world is single payor with the govenment performing the mechanical duties (as Medicare does now). The pool is maximized to include all of us, thus spreading costs as widely as possible. The difficult task of creating policy should be absolutely public and transparent, with panels of professionals and input from both physicians and citizens establishing the parameters of treatment. The rules and procedures, and therefore costs and expenditures, should be then well known. There would obviously be consequences for everyone. Physicians would be more free to simply provide medical care but might not be looking at the big incomes they enjoy now. There would undoubtedly still be limitations on truly experimental or poorly established treatments. Rather than a profit center, hypochrondria would be actively discouraged.
If single payor were implemented my guess is that the cost of health care to individuals and families would actually decrease given the increase in the size of the pool and assuming objective technical and professional drivers for policy rather than the political and profit making drivers we have now.
The two basic problems with private health care insurance that I see are that the pool is fragemented with many little and big companies carving it up, thus ratcheting up risk and costs, and that the first responsibility of any corporation, insurance or otherwise, is return of value to shareholders. Thus, in the tough policy decisions, the first to be served is the corporation, not the patient. This was exemplified recently by the girl why died due to the refusal of an insurance company to cover a liver transplant. They used the "experimental treatment" rationale not to provide coverage. Obviously, given the history and progress of transplant medicine, this seems very dubious. Clearly they were saving money for the corporation and were seemingly less worried about the health of the patient.
Personally I see the only rational system of health care in the modern world is single payor with the govenment performing the mechanical duties (as Medicare does now). The pool is maximized to include all of us, thus spreading costs as widely as possible. The difficult task of creating policy should be absolutely public and transparent, with panels of professionals and input from both physicians and citizens establishing the parameters of treatment. The rules and procedures, and therefore costs and expenditures, should be then well known. There would obviously be consequences for everyone. Physicians would be more free to simply provide medical care but might not be looking at the big incomes they enjoy now. There would undoubtedly still be limitations on truly experimental or poorly established treatments. Rather than a profit center, hypochrondria would be actively discouraged.
If single payor were implemented my guess is that the cost of health care to individuals and families would actually decrease given the increase in the size of the pool and assuming objective technical and professional drivers for policy rather than the political and profit making drivers we have now.