Such visionaries as John McCain observe “I want to keep health-care costs down until I get sick, and then I don’t give a goddamn,”Â McCain’s views, of course, reflect the complicated schizophrenic relationship the American public has with it’s health care system.Â Stated another way, we are willing to payÂ for a used Chevy but want a Mercedes’ performance.
Despite such feckless sentiment there is growing momentum to do something about health care. Â Â Schwarzenegger’s plan is a variant of the solution being tried in Massachusetts.Â Another approachÂ provides universal coverage as a part of an expanded Medicare program. The PresidentÂ has recently suggested this very limited plan using tax incentives.Â It, of course, doesn’t address the issue of the working poor who have no discretionary income for health insurance or aggressive cost containment. There are other plans out there including one from the governor of Pennsylvania, and this from a coalition of private insurers.
There are many admirable aspects of the health plan proposed by the governor of California.Â Â It recognizes there is a problem, provides a scheme for providing health insurance to all,Â pays for it and puts the prestige of his office behind it.Â
LA Times:Â Among other provisions, the governor’s proposed health overhaul would:
â€¢Â Require every Californian to have health insurance.
â€¢Â Require employers with 10 or more workers to offer health benefits or pay 4% of the payroll to a coverage program.Â It also taxes hospitals at 4% of revenue and doctors at 2%.
â€¢Â Extends government insurance for poor children to more families.
â€¢Â Ban insurers from denying coverage because of medical conditions, occupation or age.
Health care solutions are stymied by unrealistic expectations (see McCain above), conflicts of interest at every level of the system, and the ethos of profit driven private enterprises.Â This last factor allows and even encourages insurers, providers, suppliers, and medical monopolists (the Medical Industrial Complex) to maximize profits at the expense of health care access and quality.Â Â Add to that the fact thatÂ sick patients are not rational consumers and are unable to shop for the “right” price we hear so much about in economic circles.Â Â
How else to explain the current costs of health care?Â Price increases in the health care sectorÂ exceed inflation on a consistent basis.Â Many new drugs cost more each year than new automobiles (including the above mentioned Mercedes) or for that matter, than the median and average salaries in the U.S.Â Over a lifetime there are single drugs that will cost the system more than the value of homes. Â Hospital costs are 5-6 times those of just 20 years ago.Â Total health costs are expected toÂ be 1.9 trillion dollars this year and 2.9 trillion by 2009–that’s real money by the way!
Any new health plan will have to tamp down expectations and expenditures with improved efficiency and resource utilization.Â The challenge is to do this withoutÂ decreasing quality, andÂ access while maintaining the support of the public.Â Whether our culture is up to this task is very questionable given our track record over the past 50 years.