Map of life expectancy at birth from Global Education Project.

Wednesday, May 18, 2005

More on the ownership society

Despite being the People's Republic, we have a Republican Governor, actually a Mormon from Utah. It's kind of weird, it has to do with the former Dictator of Massachusetts, Thomas "Louis XIV" Finneran, who as Speaker of the House made sure the Democratic candidates for Governor always lost so that he could preside unchallenged over his veto proof majority. Anyhow, King Thomas is gone and Mitt Romney will be soon.

Meanwhile, we're stuck with the slick clown. He's trying to fend off significant efforts at universal or at least expanded health care coverage in Massachusetts with a Bushian proposal. The way "Doctor" Bill Frist (a surgeon who moonlights as a neurological diagnostician via home video) and the rest of the compassionate conservatives want to expand coverage is by making it lousy, and therefore cheaper. By imposing very high deductibles and copayments, and not paying for many services, you can make health insurance "affordable" for more employers and individuals.

The only problem with that theory is that it's only affordable if you don't get sick. Actually this trend has already started without any public policy push. My own employer recently switched us to a plan that, among other curiosities, imposes a $50 co-pay for an ER visit, even if you really do have an emergency. If they admit you, it costs you $250. They also charge $150 for a needle biopsy and other outpatient "surgical" procedures. So, if I'm raising my kids on $30,000 a year, and I have chest pains, I have a decision to make: should I decide it's just indigestion, or should I have it checked out and blow off next week's groceries? Interesting choice. Remember, I do have insurance. Kind of.

Anyhow, Mitt's Policy Director, Tim Murphy, is worried that if hospitals don't aggressively collect those co-pays -- you know, put liens on people's cars and houses and whatever else it takes -- they'll put pressure on insurers to raise reimbursements to cover the bad debt, and on the state to add some subsidies. You can read the Boston Globule article here. The hospital execs don't like this because, well, they aren't actually SOBs, at least some of them. They don't want to squeeze low and moderate income people who just had the bad luck to get sick, or have a sick child, for money they can't afford to pay. It kind of goes against that self image of service to humanity.

Look, this isn't rocket science. Expanding the number of people who have insurance by making insurance inadequate may appear to create more equity but it does not. Wealthy people can afford the co-pays and deductibles, but lower income people cannot. Sickness and injuries are still misfortunes that are not distributed justly by an invisible hand. And if people are discouraged from seeking care that they may actually need, or if they can't make the co-pays on their prescriptions (mine just went up by $15 a month -- it's a lot more for some people), they are likely to end up costing more in the end. And we will have done exactly nothing to control the growth in health care spending or make medicine more rational and efficient. We'll still have multiple payers, high administrative and marketing costs, no consolidated buying power, and we'll actually be discouraging preventive medicine.

We need universal, comprehensive, single payer national health care. That's it. All this farting around has got to stop.

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