Monday, April 20, 2009

# Posted 6:27 PM by Ariel David Adesnik  

NAIVE QUESTIONS ABOUT HEALTHCARE REFORM: My knowledge of our healthcare system is basically limited to my own experience as a patient. The actual health care has been quite good. But my experience with health insurance has been pretty awful, mostly because I've spent time at three universities and two different jobs over the past several years.

Right now, I have insurance through COBRA, which means I still have insurance through my previous employer, but have to cover my employer's share of the cost. Basically, I'm now paying three times as much for the same insurance. With premiums as high as they are now, that really hurts.

Not surprisingly, I tend to believe that our healthcare system needs a major overhaul to make it more affordable. What kind of overhaul? I dunno. I know what I want -- portable and affordable insurance that covers the same high quality services I get now. I just have no idea how to get from here to there. As such, my ears perked up yesterday when Larry Summers, the economics point man at the White House, said this on Meet the Press:
By doing the right kind of cost-effectiveness, by making the right kinds of investments and protection, some experts that we--estimate that we could take as much as $700 billion a year out of our health care system. Now, we wouldn't have to do anything like that, we wouldn't have to do a third of that in order to pay for a very aggressive program of increased coverage.
That seems like a silver bullet. Is it really possible that we could save that much just by being more efficient without consuming less healthcare? I sure hope so. But if healthcare is a business, why haven't insurance firms noticed these mountains of inefficiency and improved their own profit margins by squeezing them out of the system?

But say for a minute that these inefficiencies really are there and ripe for elimination. Summers' estimate suggest that if we get rid of inefficiency, we could either finance a government-supported program to provide healthcare to the uninsured, or we could build a much leaner private insurance system that makes coverage affordable for the currently unininsured.

My sense is that the Obama administration is learning toward the former option, but we may not know the details for a while. Personally, I don't like the idea of the government taking charge of such a massive program if there is a way for the private sector to do it equally well. If inefficiency is killing the system now, I'm not inclined to believe that more government is the answer. But who is out there, leading the charge, explaining how to save the healthcare system in a way that encourages competition and entrepreneurship, rather than central direction?

I'm all ears

Cross-posted at Conventional Folly
(2) opinions -- Add your opinion

I thought the best proposal I heard was a simple one: let any company licensed by a state to sell insurance sell it anywhere in the United States. 1)that would kill the special deals that let bad firms thrive in smaller states, because they would have competition 2)it would make it worthwhile for consumer reports to cover the different plans available 3)any "race to the bottom" effect could be dealt with by requiring that plans release their policies to anyone upon request, thereby encouraging 2). Of course, that would entail trusting people: so it's fundamentally a Republican plan. I don't know how Democrats would deal with it (unless they deal with it like they dealt with housing, creating homeless people).
I'm in a similar boat. I don't see why it would be more expensive to cover everyone since, let's face it, we already have universal healthcare--anyone can walk into an emergency room and get needed care regardless of ability to pay--but tying insurance to our jobs creates a deep financial insecurity that we would be better off without.

But every time I try to think practically about how to get from here to there, my brain locks up. The system we have now is huge, complicated, and many people depend on it for their livelihoods. And that's without even getting to the question of what end result are we shooting for.
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