Strong opinions, weakly held

The health care primary

Timothy Noah is kicking of a new series for Slate on what Presidential candidates are promising in terms of health care reform with a look at Barack Obama’s health care plan. Here’s what he says about the state of health care in America:

Health care has lately ranked second, third, or fourth in polls asking what the federal government’s greatest priority should be, and I predict it will soon settle in for a long run as No. 2. (For the foreseeable future, the Iraq war will remain No. 1.) As I’ve noted before, the American health-care system is in an advanced state of collapse owing to the failure of an 80-year experiment in market economics. Politically, the problem has grown more urgent because rising health-care premiums and diminishing coverage are starting to cause serious problems for the middle class. Health insurance costs more and more and covers less and less. Per capita health-care costs are about twice what they were when Hillary Clinton tried unsuccessfully to reform the system in 1994, and the ranks of the uninsured have increased by 13 percent. Universal health insurance, which has eluded the political system at least as far back as 1912, when former president Teddy Roosevelt endorsed it in his failed Bull Moose bid, is starting to look inevitable. Even insurance companies think so, according to a May 30 article by Jackie Calmes in the Wall Street Journal. According to the Journal, the insurers have given up blocking universal health care, “Harry and Louise”-style, and are now redirecting their energies toward co-opting it.

I am inclined to agree that health care is the most important domestic issue that the next President can actually do something about, so I’m very curious about what the various candidates propose to do about it.

I think the media is behind the curve on this issue as well. Yes, we have a crisis in terms of the number of uninsured people in this country, but we have a second crisis for people who do have insurance. For the past few years I’ve had “good” health insurance, and my premiums have been absurdly expensive, working with the insurance company has been difficult, and I still have to pay out of pocket for many things. Prescription drug insurance is a joke. (The new tactic for health insurance plans is to lower the number of pills they’ll cover over 30 days so that your copay covers almost the entire cost of the medicine.) When you got to a pharmacy and your doctor’s prescription requests more pills than the insurance company wants to pay for, the pharmacist generally treats you like you and your doctor are accomplices in trying to perpetrate some kind of fraud.

I have been wondering lately whether it would be a better deal to forego regular health insurance and get a high deductible plan and a health savings account. It’s time for a change, and I’m eager to vote for someone who can bring about that change.


  1. I would say the biggest problem with the current health care system is that the patient is largely insulated from both their lifestyle choices and from the cost of the services they receive. I don’t see how this will change with universal health care?

    Whatever did we do back in the ’50s and ’60s before the government gave us HMO’s?

    The way I see it, the government already controls a VERY VERY large slice of the health care pie between medicare, medicaid, veteran health care, military health care, government employee health care (at all levels: city, county, state, fed) and I don’t see that they’ve managed to do any better than private insurance. Until I see the government get the plans they run right, I’m not giving them the reigns to control the entire health insurance pie. You really don’t want to be around my father-in-law when he gets on the VA for the crappy care he receives vs what he was promised when he enlisted 40 years ago.

  2. I actually think that you have the problems with health care exactly backward. The problem with health care isn’t moral hazard, at least for patients.

  3. The way I see it, the government already controls a VERY VERY large slice of the health care pie ~ and I don’t see that they’ve managed to do any better than private insurance.

    Don’t confuse the issue with misunderstanding. The goal is to have the government subsidize the cost of basic healthcare, wellness, and stuff that you normally go see your GP for today. Instead of my insurance spending $150, with me forking out a $30 copay (+ $640/month), let the government subsidize the cost of a GP visit so I still pay my $30 copay, but no $640/month (actual cost to the government would then be $120).

    I’m still going to carry insurance, but it will be for the important stuff like catastrophic medical emergencies that would easily run tens of thousands of dollars. My premium should be much less, because I’ll rarely use it. The insurance company will make a profit because they’ll rarely pay out.

    Don’t think it will work? Think our current system is best? That would come as a suprise to anyone who has spent time in Canada, Switzerland and/or Cuba.

    I wonder how you’d feel about living in a true “free market” Libertarian utopia, wherein all government services are privatized and pay-as-you-go: streets and freeways, fire protection/response, flood control, police services, border patrol, libraries, schools, etc. One would have to provide a credit card number and wait for the credit check when calling 911, but hey, at least taxes would be low.

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