Your concerns all seem very reasonable. In particular, the distortion of the concept of "insurance". But, two things.
First, that distortion already took place. Providers and insurers have spent the last two decades colluding on pricing and process in ways that transformed Blue Cross from an insurer to a poorly-regulated utility.
Second, your concerns are orthogonal to the debate. We should train more doctors, and we should create more tiers of service (nurse practitioner clinics in particular). That has little to do with whether we should allow de facto monopolies to lock consumers out of the healthcare market.
The health care bill takes this to a whole new level, and then sets it in stone.
Insurance and health care delivery was already a mess in the U.S. But prior to this bill, we might have evolved or legislated some solution that was not a stupendous giveaway to Blue Cross and Aetna. Too late now. They will never give up the privileges they get today. They get to be toll collectors on our outrageously overpriced health care system forever.
Meanwhile, I read articles with people celebrating because they think this bill protects them from the health insurance industry. It's all just too depressing.
When I look at the well-intentioned reform ideas coming from the opposition, I see things like "deregulate and sell across state lines". These ideas don't weaken the grip of BCBS and Aetna; they encourage consolidation and push us further in the direction of the Citigroup-izing of health insurance.
What's on the table will, on paper at least, ensure that startup entrepreneurs like me can actually buy insurance on the private market. We didn't have that ability before, at all. That's a win, from what I can see. Would I prefer not to have BCBS and United be the vehicles for that win? Of course. But what does that have to do with anything?
What's on the table will, on paper at least, ensure that startup entrepreneurs like me can actually buy insurance on the private market. We didn't have that ability before, at all. That's a win, from what I can see.
I do not have employer provided insurance. I buy private insurance on the market today. It costs me about $6000 a year to insure my family of four. I expect the cost of insurance, post-reform, to converge on the national average, which is around $13000. That's a loss of $7000 a year for us. Maybe somewhat less because of subsidies (we won't get much there). Maybe more, if the cost of insurance rises post-reform as it did in Massachusetts under their similar reform.
It is not out of the question that we will actually give up health insurance altogether and pay the penalty instead. This would not be a win for us.
If you aren't able to get individual coverage for around $6000/year now (national average), and would like to, then this bill will indeed be a win for you. Of course, if you don't like the coverage you get at that price, pay it anyway or get fined.
This is getting too long, but does it seem thinkable to you that this reform might accelerate the increase in health care costs? I think it quite likely myself. If it does, too bad for everyone. We're locked in now.
(Note: we tried to obtain coverage ourselves, using the Internet and a telephone. When that failed, we worked with an insurance broker friend of the family. Neither worked.)
There was no dollar amount that would have bought us private insurance. We got around it first by getting Erin a job that offered group coverage, and then by setting up group health insurance at Matasano. I'm happy to say we now subsidize coverage for all our employees.
The numbers are a red herring. COBRA vs. private health insurance costs are not the issue that should be scaring entrepreneurs. The possibility of getting stranded with no possible coverage option is what should be scaring them.
Thousands of dollars a year in new expenses is not a red herring and is plenty scary. It's not what's important to you, but it is going to be important to a lot of other people.
People who have chosen catastrophic coverage, or who chose to go without health insurance to save money are going to get hit hard by this bill. My guess is a disproportionate number of self-employed people fall into this category.
People will go out of business because of this bill.
I don't care about the people who choose to go without health insurance to save money. I wind up paying for them when they get hit by a car, when their appendix bursts, when they have a freak aneuryism, or when they fall down their stairs.
The same arguments suggest that people who drive infrequently and carefully should be allowed to forgo car insurance. After all, you can always sue them when something goes wrong with their plan!
I don't care about the people who choose to go without health insurance to save money. I wind up paying for them when they get hit by a car, when their appendix bursts, when they have a freak aneuryism, or when they fall down their stairs.
People go without health insurance because it is incredibly expensive. For a lot of people it is a crappy deal, or just flat out unaffordable.
It is interesting how people who thought they couldn't afford health insurance used to be portrayed as victims. Now they're the bad guys, they broke the system for everyone else, and you don't need to care about them. What a difference two years makes.
If you can afford health insurance, and health insurance is available to you, and you decide not to buy it because you're 25 and you don't think you'll need it, you don't deserve my sympathy. If you can't afford health insurance, you deserve whatever we can do to make health insurance affordable to you. Please don't try to drag me into identity politics. This isn't a "rich vs. poor" issue.
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People choosing to buy or not buy insurance has gotten reframed, and I find it interesting to see how effectively the switch took place.
In 2008, your hypothetical 25 year old would have been portrayed as a victim, if anything. Screwed over by the greedy health insurance companies who make it impossible to get decent coverage at a reasonable price.
In 2010, he's the bad guy. It's his fault the system is broken. He is morally obligated to buy that health insurance now, and if he argues that he's getting a crappy deal for what he is paying, it's him who is being selfish and greedy.
There are certainly identity politics tangled up in health care reform, but I was talking about the reframing of an issue and fickle public opinion.
I sit on the side of the line that favors less and smaller federal government. One of the beautiful results of the power we give to States to govern is that as a country we end up with 50 solutions. Our diverse populous can then choose which one fits best with their ideals and personal circumstances--and we get this while still maintaining ourselves as a cohesive country.
Unfortunately, this time the government has chosen to white wall a solution across all citizens rather than to let the fundamental action of our country (States rights) do the work which would have resulted in a better solution, IMO.
In the other set of circumstances, the family can't obtain coverage. Something bad happens. Now, instead of having insurance cover it, they go bankrupt. We are all still paying the bills. The only difference that I can see is that in this set of circumstances, the family (a) didn't pay insurance premiums, and (b) was driven into bankruptcy.
What's the win you see in the second scenario?
With that being said, it seems to me that it's not increasing demand, but helping meet unmet demand. I'm a really high risk for skin cancer. If getting insured incentivizes me to get more regualar checks at a dermatologist, that's likely to save the system money over the long run. This isn't me falling to moral hazard.
The moral hazard in the system is for doctors and hospitals. My dad is a doctor (opposed to the bill, btw) but his main complaint is always about other doctors coding things like nasal congestion up to an unscrupulous level to pad their take from insurance companies. And don't get him started on hospitals.
Maybe that's something opponents of the bill are aware of and opposing. Maybe the bill does nothing to fix that. But don't blame patients for making rational choices regarding healthcare based on whatever system they find themselves in. Anyway, there's my uninformed opinion without much of a point :-P
Insurance companies, when not treated as healthcare sugardaddies, do not like paying for high healthcare as they want to make more money. They may give you discounts for going to more check up more, to reduce demand for their service later. If you can detect cancer earlier, than you may able to avoid higher cost cancer treatment later as well continue to be a source of revenues to the insurance company. Insurance companies don't make money off dead people, I think.
The insurers colluded with the providers to set artificial, market-oblivious standard prices for procedures on a region by region, hospital by hospital basis. From what I understand, prices were often set by allocation schemes negotiated between the payers and the providers, with no apparent regard to the actual cost, supply, or demand for the procedures. At the same time, even as they managed to drastically distort the pricing of health care, insurers apparently negotiated special payment processes directly with providers, thus creating not one but two artificial tiers of pricing.
It's meaningful to talk of "sugar daddies" and "insurance" only when there's a real market for health insurance. But no such market exists. For mainstream medical procedures, for the standard of care that Americans expect (a visit to a doctor, completion of the lab work the doctor requests, some form of radiology, and then a procedure or perscription to resolve whatever comes out of that diagnostic work), unless you are either willing to play chicken with the providers and say "no" when they try to collect debts, or willing to pay incredibly, drastically inflated prices for basic procedures, there is no way to get care without involving your insurer.
Doctors takes years to train, drug trial are still expensive, amongst other thing.
All what we're doing is adding million of individuals into the healthcare system without balancing the supply side equation.
It would also seem to treat health care insurance as a sugar daddy of healthcare, instead of being treated as a mechanism that reduce risks through incentive and such. This make insurance companies big juicy targets for healthcare providers. If people were to spend their money on the daily cost of healthcare, they would be more conscious of the cost, thus use it only as neccesary. Insurances would only be used in high cost emergency measures such as cancer and other diseases, which are preventable and can be reduced by individuals.
This reduce the demand for healthcare and give people incentives to lower their cost their healthcare cost through insurance's discounts, thus less strain on the supply of healthcare.
The taxation scheme also rob people incentive of saving for emergency measures, an alternative or complement to insurance spending, which may have the side effect of impacting long run productive growth or simply maintenance of current productive capacity(Capitals need to be maintained or replaced), as saving are in effect fund the production of capitals, which eventually lead to consumer goods and services.