Tuesday, March 27, 2012

The Supreme Court takes up Health Care Reform

It is official today. We had all four seasons this month with the below freezing temps this morning.  Funny that it took until after spring officially began to get a winter morning.  The summer weather we had last week was quite interesting.  I drove to work in my shorts and bare feet, changed into work clothes, then changed back to shorts for the drive home.  Can't recall doing that in March.

If you haven't heard, the Supreme Court has begun debating the various challenges to the individual mandate section of the health care reform bill passed in Congress,  and signed by the president two years ago.   Interestingly, some other aspects of the reform package have already taken effect.  Young adults under the age of 26 can now be covered under their parents health insurance, pre-existing conditions can not be used to deny health care coverage to an applicant, certain preventive care procedures do not require a co-pay, and there are no longer lifetime monetary caps placed on health care benefits.  None of these have been challenged; in fact, I would think that the vast majority of people would agree that each is a good thing.  I guess the health care reform package was not completely unpopular or off base with the beliefs of most Americans.

The Supreme Court's ruling is expected in the summer.  If I were to predict the results, I expect a split decision, which would effectively reflect the views of Americans at large.  My gut feeling is that a number of rulings will be forthcoming, but the big decision on the mandate will be 5-4 upholding its constitutionality.  This, of course, will not be the last word.  Those in agreement with the decision will proclaim that the system has worked as designed by the founders with all three branches of government in agreement with the concept.  Those against the decision will decry the result as judicial activism and will vow to continue to fight the law and the ruling by bringing it back to the Congress and President, especially if the Senate or Presidency changes party in the fall.  Clearly, as is the case with the Roe vs. Wade abortion decision in the 1970's, this ruling will be challenged over and over again.

Curiously, many of those you see on TV everyday railing against the individual mandate have health care insurance. Certainly every Congressmen or Senator has not only one of the best health care packages but one that is priced to them under "market" value, if not altogether free. And anyone over 65 against the health care reforms is probably receiving their health care coverage via Medicare. Those people against government interference and participation in the health care industry who are receiving their coverage via a government agency may want to rethink their position. Or at least admit to themselves and us that they believe they have a right to health care provided via our tax dollars but that others do not.  Personally, I would like to see someone from either party propose a law eliminating the health care benefit for our elected officials, especially those in Washington. They generally have jobs outside their elected positions, let them get their insurance through their employers. Or on the open market where they will pay an individual premium based on their individual or family health history. Perhaps the conversation would be altered a bit.

The unfortunate thing is that this debate over health care, whether an individual mandate is constitutional or not, is not the debate we should be having.  We are an aging country.  How much are we aging?  My research indicates that the median age (the age where half the population is above and half below) has been increasing by 2 years every 10 years for the last 4 decades.  While this trend will not continue forever, it will continue until those born in the 50's and 60's, when the birth rate spiked producing the "baby boomer" generation, begin dying off.  In other words, we will continue to age, as a country for another 2 decades or so.  Additionally, we are living longer so while the percentage of the elderly in our nation will increase via the high birth rates of the 50's and 60's, these same people will live longer to boot. 

Whether we want to admit it or not, the longer we live, the higher chance of health issues, the higher cost of health care.  So, for those who think that the individual mandate will reduce the costs of health care, they are being naive.  As are those who think that a market solution will somehow lower costs.  Frankly, I don't believe there is any program that can be devised that will reduce the cost of health care.  The discussion should be focused on how we can best survive another 20 years of rising health care costs.  How much of our resources we are willing to allocate to the health of our aging citizens.  How we will change our priorities so we can provide the proper health care access and services to the generation born after World War II when America was full of promise and potential.

So, what are the real issues.

1.  Too many Americans without health insurance at all.

2.  Too many sick Americans who can't afford the insurance they need

3.  Too much money being spent on everything except actual health care.

Americans without health insurance cost America everyday.  Through emergency visits for health issues that could best be addressed by general practitioners, through missed sick days in the work force, through accumulating symptoms that end in debilitating disease that could have been treated earlier and cheaper.  Now, whether the cost of adding these people to the health care equation would be less or more than the savings resulting from reducing the extent of those occurrences is debatable.   What is not debatable is that the sickest Americans will certainly cost more to insure.  But the question shouldn't be, what plan is the least expensive, should it?  Certainly, that shouldn't be the issue if we are serious about our claim to be a Christian nation.   Health care access and services defy the ability for the "market" to provide a solution because those with the most need will invariably have the least amount of resources to satisfy that need.  The poor get sick.  Probably more sick because by being economically disadvantaged they miss out on the benefits of preventive health care. 

So, if we assume that health care costs will increase because more people will be insured, including those previously uninsured because they were sick, is there enough money being spent in the health care industry that is not directly being spent on acutal health care services.  Should some of the profit for health care insurers be sacrificed to help fill that gap?  Should certain medical professionals learn to live on a bit less income?  Should patients who are accidently injured or even killed (not through malpractice but because humans sometimes make mistakes) be limited to compensation that is fair without being destructive to the health care provider or facility?  Should a lawyers compensation be capped when a lawsuit is successful,  and conversely should a lawyer be responsible for the costs when a medical lawsuit is considered frivolous?   Should Americans who have decided to take any and all pills to correct any and all maladies then be allowed to seek huge damage claims when that particluar medication results in a side effect that was clearly indicated on the bottle?  Should the pharmaceutical industry cover its costs for research on Parkinson's, breast cancer, HIV, ect, by making up diseases and then producing a pill to cure it.  Shift work disorder?  Restless leg?

I would like to think that if we all did our part, the pharmaceutical industry, lawyers, health care providers, health care insurance companies, and patients, if we all decided that access to the best health care system in the world for everyone guarantees us all the best health care in the world, then we would have the money to insure all Americans, sick as well as healthy. 

Finally, if nothing else is done, how about we do these two things.

Insure the health of all Americans based on the biggest pool possible; all Americans.  All 30 year olds pay the same premium for the same coverage.  As do all 50 year olds, etc.  One big pool determined by actuarials who already know the incidents of illness, death, etc via their work for life insurance companies.

Mandate that all Americans carry catastrophic health insurance.  This premium will be collected via a payroll tax, or through an unemployment check, or social security check, or IRS refund if needed.  But it must be placed in a lockbox where it is not used for anything but costs associated with someone whose resources exceed their ability to pay.  (See major mistake made with the Social Security Trust fund, as reference for what not to do).

Like it or not, disease does not care about one's politics, race, economic status or occupation.  Yet we seem to be embroiled in the discussion about health care as if these traits mattered.  It is not only a shame, but it reflects poorly on our claim to be the greatest country in the world.

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