Wednesday, July 22, 2009

Missing the point

So the issue du jour is healthcare reform. I watched Obama's press conference, and although I am willing to see what happens, I think the administration, and many others, are missing the point of the whole problem with healthcare.

The problem with healthcare is not healthcare itself. It is with insurance. The problem is not that there are too many people who don't have insurance. The problem is with insurance companies being profit driven entities whose sole concern is the stockholder and nothing more. Take away insurance as an issue, and you will have a solution. What?

Okay, look at it like this. Consider your average doctor who works in his/her own small practice. What's the biggest complaint you'll hear of from those doctors? Malpractice insurance. With increasing costs being passed from the insurance companies (which aren't a true reflection of of what it really costs to pay for healthcare) to doctors, they pay higher costs each year and pass the cost on to the patients.

In addition to those costs, they also have to pay for: staff, supplies, equipment, and unless they are buying the building in which their practice is located, rent for the space. Oh, and if he/she employs a staff (I've never seen a doctor without a nurse, have you?), there's a good chance he/she is paying for them to have medical insurance as well. But the doctor is also paying for the leasing company to also have insurance, and he is also indirectly paying the makers of the medical supplies and equipment to have insurance as well. The result of this, as for everyone else, is increase of cost, with little to gain in the bottom line. The largest beneficiary of this structure is who? The insurance company, its executives, and of course, the stockholders.

On the one hand, one (such as my father) could argue that an insurance company is not a charity, but that they do help people. Right. If we dig back into history a few hundred years, we will see that insurance first began in the New World through the slave trade. Nervous slave traders were losing many of their "properties," and to insure that they did not lose any more money than what they pay through a premium, they took out insurance through most famously Llloyd's of London against their stock, in the event that any slaves were lost. Hardly a benevolent start, eh? It was rooted in an amoral practice and under the guise of helping those in need, has continued to prosper in the past 400 years.

So let's just say we take insurance away. The publicly traded insurance companies are forced into selling off their assets back to the government through a government buyout, which effectively eliminates insurance companies all together. The stockholders trade their stock for T-Bills, and you have one cost offsetting another (in theory, although I'm no expert on this, but it could work).

So in our minds, you ask, so who pays for healthcare? You do, but at a significantly lower price. After all, the most expensive and detrimental variable for this country has been all but destroyed.

So what then? Well, what if you could walk into a doctor and tell them of your symptoms, and they tell you that a strep test costs $10 (even then, it costs even less than that), and the visit to see the doctor or nurse practicioner costs $10. Would you pay $20? If you say no, then it also means that you wouldn't pay a $20 copay, which I'm betting you most gladly would. It's just a changing of the mindset. But this is literally how it is done in other countries.

I've heard the argument that the country is too big for there to be a national healthcare system. But, if applied at the office level, it doesn't matter how big the country is. In this case, the government doesn't have to run the system. If competition in the market is allowed to play out, doctors would be forced to keep their rates lower and government wouldn't have to intervene. They could, perhaps, still provide assistance in the same way that food stamps work for those whose incomes fall below a certain level, but by and large, they wouldn't have to regulate it or pay for the new system.

So as I sat and watched, I grew increasingly frustrated and began to think about this in a little more depth. Until the way we operate is fundamentally changed, removing profit from insurance, or eliminating health insurance companies completely, there will be no real fix, and our country will sink further and further down.

Get the point?

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