Posted by
Gray Cat on Thursday, July 23, 2009 11:04:38 PM
Obama has been making a big deal lately about saying "if you like the health care coverage you have now, you can keep it". Sounds good, but the problem is with the plans going through congress right now, it isn't necessarily true. The current proposals set up an "exchange" of health insurance plans, but they actually prohibit you from participating in that exchange if your employer offers coverage. So if your employer offers lousy coverage, you have no choice - you have to take it anyway (remember, there's a mandate that all individuals have insurance, so you can't just pass on it). Now if you lose your job, voluntarily or otherwise, you lose that coverage but still have a mandate to buy insurance - meaning you have to go through the exchange. But wait - you're not going to be unemployed forever, and when you get your next job your new employer will most likely offer insurance again - which means you have to go with the new employer's plan, not the exchange. So that's three different insurance plans you'll be forced to go through, just for switching jobs once - and in two out of the three cases you had no say in which plan you got.
Admittedly, as bad as that is, it's only slightly worse than the current system. It's a long way from individuals being able to choose their own health plan and take it with them from job to job, which is how it should work. A lot of people on our side are concerned with a government sponsored option morphing into a single payer system, and rightly so, but the reality of the current system is that for most people it might as well be a single payer system. It's just that their employer, instead of the government, dictates to them what coverage they have. Why not put the individual in charge? What sense does it make for an HR department to choose which health insurance plan (and thereby which doctors and hospitals) hundreds or thousands of people who work at their company have access to? Health care should have nothing to do with your employer, any more than which brand of cereal you buy is your employer's business.
Employer-based health insurance is the biggest single mistake we ever made in our health care system. If health insurance was more like auto insurance, or life insurance, or virtually every other consumer product in existence, where individuals shopped around and purchased it for themselves based on their own price vs. quality preference, it's hard to believe we'd be in the situation we are today. You don't see the prices of food or clothing skyrocketing the way health care prices are, because if a company tried to raise prices like that some other company would undercut them and steal all of their business (econ 101 anybody?). Not so in health care, where deep-pocketed corporations engage in private negotiations with insurance companies for group coverage, and the individual has no say in the matter. Is it any wonder the prices of individual plans, for those whose employer doesn't offer insurance, are so outrageous? Those people are out there competing to negotiate rates with billion-dollar companies offering the insurance company thousands of customers in a single blow.
So what should we do? I actually think the health insurance exchange itself is a good idea, but it needs a few changes. First, make it available to everybody, regardless of whether your employer offers coverage. Also, skip the government sponsored plan - it's completely unreasonable to expect private companies to compete with a government that can simply sell insurance at a loss and fund it with tax dollars at will. Level the playing field between employer-based health insurance and insurance purchased individually - meaning, give individuals the same tax breaks employers get for purchasing health insurance. As for the mandate that everyone must have health insurance, I don't see a good way around it. If people don't have health insurance they go to the ER for treatment and the rest of us end up paying for it. Essentially they do have insurance, it's just paid for by everybody else, which isn't right. The other reason to keep the mandate is that having everybody in insurance is the only way to get rid of denials for pre-existing conditions (the whole reason for those denials is to prevent people from going without coverage until they get sick, and then signing up at the last minute, only to drop coverage again after being treated).
I hope we get something out of this that actually decreases cost and covers everybody, while at the same time maintaining quality and giving individuals the ability to choose their own plan and provider (what a concept). If Obama and the Dems end up accomplishing that, great. Unfortunately it looks like they're going in the opposite direction.