Healthcare reform -- is it new?

Healthcare reform seems like a good idea -- everyone should have access to healthcare, regardless of income level.

So, how is this different from what we already have?

Currently, if you are too impoverished to afford your own health insurance, you may be eligible for State insurance programs, namely Medicaid. If you are older or disabled, there is Medicare.

But, what about the working under-insured?

If you work for a living and pay your taxes, you may not have enough left over to pay for health insurance premiums. If healthcare reform (as it is currently envisioned) goes through, then you may still find it hard to afford. Your taxes may increase and you will still be paying a monthly premium.

Even if this saves you some money (this is not entirely clear), it may reduce your choice in coverage, medications etc. (also not entirely clear).


In America, we also believe that we have a right to a public education, but the school facilities, access to textbooks etc. may not be on par with those available at private schools. You are able to pay, however, to improve the quality of education (this is NOT at all to say that public education is in any way of inferior quality to private) -- with healthcare it isn't the same. It will be unacceptable to the general population for there to be a difference in clinical care between private and public hospitals. Medicare and Medicaid beneficiaries receive the highest caliber healthcare in the world. When you enter an American hospital, you can not be turned away for insurance reasons (this is something under-appreciated by non-Americans sometimes).

What makes discussions about healthcare so difficult are that it is not entirely akin to other industries. When you choose a new car to drive, you base your decision on many factors: price, appearance, speed, horsepower etc., but when someone chooses their health coverage and are faced with a 100% coinsurance vs. an 80-20 plan, they don't actually mean that if their life is dependant on it, they understand that they have to pay 20% or they won't survive. Obviously we all want to live (most of us anyway) and the person who chose the 80-20 plan over the 100% plan did so to save money on the monthly premiums. Unlike car insurance, where if you don't pay it, they may impound your car, no one is suggesting that we impound someone's life if you don't pay your health insurance premiums (this is one of the flaws with the idea of mandatory health insurance). So, choosing how much health insurance coverage you want, is akin to gambling with a communal pot of money -- the person who saves on the premiums and buys less health insurance, is still going to be covered (through our taxes) if their life depends on it The incentive to be responsible and buy adequate health insurance is that if you don't do so you will go into bankruptcy from your bills.

So with nationalized healthcare reform, the working under-insured will not have a choice of being under-insured (taking a gamble and saving their money for other things) and will be insured by a mixture of paying their taxes and paying their premiums. The poor, will continue to have access to care, but their formulary may be even further curtailed (to cut costs).


The question is, what is going to happen to the healthcare industry -- what happens to all the executives, administrators, clerks, janitorial staff etc. if the private healthcare insurance industry collapses under a nationalized healthcare system?

Are we going to bail it out?


--
Dr. Daniel Kantor, MD BSE
Medical Director
Neurologique