Saturday, July 25, 2009

Common Sense and Perceived Loss of Health Care Freedoms

I think the plan is being slowed and may well be stopped not by ideology, or even by philosophy in a strict sense, but by simple American common sense. I suspect voters, the past few weeks, have been giving themselves an internal Q-and-A that goes something like this:

Will whatever health care bill is produced by Congress increase the deficit? “Of course.” Will it mean tax increases? “Of course.” Will it mean new fees or fines? “Probably.” Can I afford it right now? “No, I’m already getting clobbered.” Will it make the marketplace freer and better? “Probably not.” Is our health care system in crisis? “Yeah, it has been for years.” Is it the most pressing crisis right now? “No, the economy is.” Will a health-care bill improve the economy? “I doubt it.”

Peggy Noonan, “Common Sense May Sink Obamacare,” Wall Street Journal, July 24, 2009

Is American common sense sinking Obamacare? Maybe. My own sense is that health care has taken a back seat to the deficit, the economy, unemployment, and the sense that the stimulus has fallen flat. But , as details of Obamacare surface, and as people dive into the weeds of the proposals, people are getting the sense that Democratic proposals threaten health care freedoms.

According to Shawn Tully, editor at large for Fortune, who has read the 2000pages tortured legalese of HR3200 and the Senate proposal of Senator Kennedy’s Health Committee, these freedoms include,

1. Freedom to choose what’s in your plan.

The reason? The federal government will impose a minimum list of benefits that private plans will have to offer through “qualified plans” offered by health care “exchanges,” or some public option.

2. Freedom to be rewarded for healthy living, or to pay for your real costs.

Reasons? One, The proposals force all patients to pay the same rates, the so-called Community Rating, regardless of age or clinical condition,thereby gouging the young and healthy and making them pay the same as the old and sick. Two, the proposals force insurers to pay the same rates for all customers, regardless of risks and medical costs, thereby threatening their very existence as viable businesses.

3. Freedom to choose high deductible coverage.

This is a biggie. The bill would eliminate HSAs and high deductible plans, now owned by over 10 million Americans, and the fastest growing part of the private insurance market. This would deprive holders of these accounts and the freedom to spend their money, choose their own doctors, and set aside tax-free money.

4. Freedom to keep your existing plan.

Another biggie. Existing plans cover 253 million Americans, and more than 80% say they are pleased with their plans. To be sure, the proposals give ERISA employers that are self-funded, which include America’s large corporations, a five year grace period, after which employers would be compelled to offer “federally qualified" plans; ditto, for small businesses, which would be forced to offer “qualified plans,” Should existing plans change anything that might help them stay in business, small businesses would have to drop their existing plans and shop through the federal exchanges.

5. Freedom to choose your doctor.

Huge for those Americans who think they have enough good sense to pick their own docors. The Senate plan will require Americans to buy through exchanges and to get their care through “medical homes,” where you’re assigned a primary car ephysicians who will control your access to specialists and who will decide what services, liked MRIs or medical services, are most cost effective.


The Fortune editor concludes, “The best solution is to move towards a let-freedom ring regimen of high deductibles, no community rating, no standard benefits, and cross-country shopping.” This may not make sense to command and control central planners, but it seems to make common sense to most Americans who enjoy their current freedoms.


John said...

One thing is certain. Without legislative action, the sixth of the population without insurance are certain to keep their status. Perhaps when that number grows to a quarter or more of the population others will notice.

Canadian health care spends about ten percent of GDP for everyone and we spend over sixteen percent but leave out a sixth of the population. But of course Canadians wait longer for granny to get a new knee.

You know, if they sprang for eleven percent of GDP they could cut out all that waiting and still be five percent ahead of the US which leaves millions out of the system altogether except for ER visits.

ER once meant "emergency room" but a growing number of people go there for primary care, the most expensive primary care in the world. I guess they call it the best health care in the world because it costs so much.

Richard L. Reece, MD said...

I would respectively point out that 37% of people signing up for health savings accounts in high deductible plans were previously innsured. I would also note at least half of the uinsured choose not to be or are eligible and don't sign up.

John said...

Okay. I'll give you that.

So everyone making poor choices resulting in no access to care until facing an emergency deserves whatever happens?

At what age should people make rational choices? Late teens? Thirties? After breaking free of substance abuse? Or other self-destructive habits? You probably don't know anyone in such a group, but I do. And I doubt that ours is the only family in the country with adults like that.

This is not an individual problem This is a social problem. It's like the difference between social security and individual security. (I know there are those who would gladly snatch away Social Security as well, but I'm also not part of that group.) Health insurance should supplement basic health care, not own it.