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Tuesday, July 28, 2009


Steve Cole comments:

Health care reform (a.k.a., the president's plan, Pelosicare, Obamacare, socialized medicine) is dead for this session, but the liberals are never going to stop trying to pass it. The American people have (poll after recent poll) said they don't support the plan (but do support some other kind of reform), and people have realized that the plan(s) being floated are (a) too expensive and (b) a power grab masquerading as health care reform.

There are issues that need to be addressed, such as health care insurance being too expensive, and I hope we can find a way to address them.

The "crisis" is overstated. There are (numbers vary, 45-50 million) Americans who do not have health insurance. But of these, 10 million are illegal aliens, 10 million qualify for Medicaid but just haven't gotten sick, and 10 million can afford health insurance but decided not to buy it. That leaves 20 million "gray area" people who are above the poverty line but below the "easily could afford it" line. A plan giving these people some kind of semi-subsidized (sliding scale) option to pay premiums to Medicaid would be swell, and could be easily implemented. Another option (which costs a pittance) is to use tax money to pay for private "catastrophic" policies for these "gray area" people and move on. Everyone else could be required to pay for at least catastrophic insurance, which is incredibly cheap.

Conservatives are being naughty about this. They say on one hand that "If you add another 47 million patients the system will collapse because there are not enough doctors" but on the other hand they insist that "those 47 million people are already getting care, often free, at emergency rooms and clinics". The second one is true so the first one cannot be.

The power grab was ridiculous. Telling doctors if they could or could not move into a given speciality. Telling a company it had to pay for insurance for employees. Telling a company that it can never change to any new plan EXCEPT the public option. Telling an insurance company that it must cover this list of things (instead of letting customers decide that the coverage is lousy and they want another insurance company.) None of this nonsense was needed to improve health care and all of it was a clear socialist big-government power grab and we all know it.

We do need to put health care insurance on an even playing field. If the unions won't allow the government to tax employer-provided health care as a taxable compensation benefit, then they should allow everyone else to deduct the cost of health insurance premiums on form 1040A.

The fundamental flaw of the proposed plans was that the premiums were subsidized by taxpayers, meaning this would be cheaper insurance and lots of people (and employers) would "switch" to the cheaper government option. Once people start doing that, private insurance companies would start go out of business for a shortage of customers, driving more and more people into the government plan (especially since if a company quit issuing policies, an employer would have no legal option except the government plan). The CBO said we couldn't afford to insure those "gray area" people, so how were we going to provide several times as many people with subsidized coverage?

And we all knew that the government plan WAS inevitably going to mean "rationed care" like in Canada and the US, where a few people die because a lot of people did not get brain scans, and you have to wait (in pain) six months for a gall bladder operation.

Why are health care costs rising? A combination of three factors: (1) patients who do not pay their bills, (2) doctors order more tests to defend against malpractice, (3) doctors out to make more money by cashing in on whatever the insurance company will pay.

(1) is a good reason to get some kind of coverage for everybody, but I think any subsidy should be "sliding scale" with people having to pay much of the cost, and anyone over the "struggling line" (above the "gray zone") paying the full fare.

(2) tort reform is needed, but is nowhere in the bills because the trial lawyers pay tons of money to one political party to make sure tort reform never happens.

(3) I don't want to badmouth doctors, but I have read doctor trade journals with articles about how to "milk" the insurance for every dollar of profit they can make and trick the relatives of patients into accidentally making themselves legally liable for the bill. I have seen groups of doctors buying their own MRI machines so they can order an MRI for everybody they can qualify under insurance just to make a profit. I'd propose that doctors not be allowed to own such expensive machines or get any profit from them.

We need to reform health care, but we do not need to use it an excuse to wreck a system that works just to push a political agenda.