Don’t Forget Benefits When Looking at Costs
Debates on health reform can get ideological and philosophical quickly.
But the current crisis with the state budget brings the issue home, as the governor is now proposing to possibly cut coverage for nearly two million low-income children, parents, seniors and people with disabilities. These Californians can’t afford health coverage otherwise and, as a result, will live sicker, die younger and be one emergency away from financial ruin – just like the currently uninsured. Private coverage isn’t faring any better – estimates are that more than half of one million Californians have already lost coverage in the last 18 months of the recession.
When health reformers say the status quo is not an option, it’s not a slogan. The status quo is quickly deteriorating and the cost of doing nothing impacts real people.
We all have preferred solutions to the health crisis, and so while I would agree with Claudia Chaufan for single-payer as my preference, I disagree that anything else is not worthy of consideration. After all, there literally are as many types of universal health coverage plans as there are countries in Europe.
And even passage of a single-payer system would not end the ongoing public debate about the appropriate level and structure of taxes versus the level and type of services they would pay for. But it’s a good debate to have.
Single-payer would seek to replace what we currently pay in premiums and cost-sharing with a progressive tax system. Other reforms would seek, through cost-savings or subsidies, to make health coverage cost no more than a percentage of a person’s income.
That’s an important principle – to move to a health system where we pay based on what we can afford, rather than the current system where we largely pay based on how sick we are. Individual insurance costs more if you are older and sicker, and cost-sharing in any plan (through deductibles and co-pays) is by definition more expensive the more you need and use it.
We do have some safety net programs, but because they are limited, they have limited support and perhaps don’t get the financial support they need, especially in bad financial times like these, as the current budget crisis shows. Medicare gets broader support because it is universal for those over 65. John R. Graham has the nerve to call the generational compact of Medicare a “bailout.” I’m not “bailing out” my parents and grandparents by helping finance their health care; it’s in my interest for them to have health coverage in their retirement years, and I hope and believe my child will think the same when I am retired.
Finally, John R. Graham wonders why, in the Massachusetts plan, it is a good trade-off to spend $820 million to get savings of $250 million. The answer is the 400,000 people who have public health insurance coverage that didn’t have it and couldn’t afford it before. Whatever you think about the plan, it lowered the state’s uninsured rate from 10% to nearly 2%. I have my own critiques of the Massachusetts plan, but it seems disingenuous to talk about cost without mentioning the benefit to hundreds of thousands of folks, especially when talking about “cost and benefit” in the very same sentence. And it seems that those in Massachusetts are paying for the security – let’s call it insurance – that if they fall upon hard times, find themselves between jobs, etc., they will have access to affordable care, as well.
It’s a neat trick for John R. Graham to argue against taxes and then point to shortfalls in Medicare and Medicaid. If you underfund a health plan, it will be underfunded. That doesn’t change the fact that Medicare and Medicaid provide care to poorer, older and sicker populations by definition, and do so at a cheaper price than the private insurance companies.
No health coverage is going to be free. But the question is how can we provide health coverage more efficiently, effectively and affordable for all. And I would rather have the debate – deciding what we are willing to pay for the health care we need – in public in the context of a democracy, than have those decisions about premiums and costs solely made in private in the corporate boardrooms of insurers.
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Having lived in Europe (three countries) I am less than thrilled with the health plans. Yes, most of them work if you are healthy or have a minor problem but God forbids if you need real care.
Also, I object to having any “generational compacts”. I’d rather pay for my own care and leave my children to take care of theirs.
Strangely, nobody mentions vast money spent on illegals.
… and most Europeans who can afford have an additional PRIVATE health insurance so they can choose a doctor, get best care or they don’t need to wait in line in the clinic.