Health insurance is not the same as health care

The President is warning that if we don't pass his health care plan this year, it will be a disaster for Americans. He acts like there won't be time to make any changes next year, and that we must rush a bill through - probably without having a chance to read it and study the impact on the economic environment and the repercussions for health care for Americans.

Why can't we take this slow and make sure we do it right? Why do we have to rush it through before the American people know what they are actually buying for the trillions of dollars that it will cost us?

Obamacare has some odd proponents - including the insurance industry, who are supporting the idea of universal health insurance, as long as there isn't a government insurance program that will use taxpayer subsidies to drive them out of business. They have no problem with taxpayer subsidies - as long as they are getting what they consider to be "their fair share".


My question is this: if we are attempting to fix the problems of our health care system, why pursue an insurance based health care policy?

One problem with insurance is that it ends as soon as you can't pay the premiums any more, or as soon as your employer stops paying the premiums.
This means that while you are healthy and working, you have coverage, but when you are unhealthy and not able to work, you are not able to pay premiums, so have no coverage. This is what makes it profitable for insurance companies - when you most need the service, you aren't eligible.

This is true of private insurance, employer provided insurance, and even government provided insurance - when there is no longer enough money coming in, the insurer will cut benefits.

Another problem is that if you are paying the insurance company, you are not paying for health care, but for a promise of health care.

It reminds me of the Seinfeld episode where Jerry tries to pick up a rental car and is told that, while the company has his reservation, they have no car for him. Just as Jerry argues "It doesn't matter if you can TAKE my reservation. What matters is that you can KEEP my reservation.", I say "It doesn't matter if you have health insurance. What matters is if you can get health care." - the insurance is a promise to provide care when it is needed, if the insurer finds it possible. Health care is exactly what it says it is.

A further problem with insurance is that it disconnects the health care provider and patient from the decision making process. Health care providers often feel pressured to plan treatment based on what insurance companies are willing to reimburse them for. Patients don't have as much of a reason to weigh the costs and benefits of various options against each other.
In many cases, there are various choices within the broad categories of surgery, medication, therapy, lifestyle adjustment, palliatives, and non-traditional treatments that are ignored because the health care provider can't be reimbursed by the insurance company for them, and the patient only asks about options that are covered by their insurance plan.
This disconnect creates a system where patients and health care providers are not discussing options, and not making their own decisions. Often, this leads to higher costs as we find that one size doesn't fit all.


If the government wants to involve itself in health care, and use taxpayer subsidies to provide a more "socially just" access to care, I see tax exempt health savings plans as a far better option, along with tax credits for health care expenses.

Health savings plans are a great idea, but one that many people might decide not to invest in, because we don't like to think about bad things happening to us. If there were a health savings plan set up similar to a 401k plan, where employers could match contributions as a benefit to attract employees, that would probably work better, but it still wouldn't convince everyone to save up for a possible health emergency. Effective health savings plans need to be tax exempt (with penalties for withdrawing them for non-health expenses), lifelong, and transferable to your heirs. I have seen health savings plans where the money just evaporates at the end of the year - they are fine for saving up for a planned procedure or regular medical cost, but not very useful in the long run.

The larger end of the equation would be medical expense tax credits. These would go a long way to ensuring that an accident or unexpected illness wouldn't wipe out a family's ability to survive. Of course such tax credits would have to be regulated, as we could easily see people getting more money in tax returns via these tax credits than they would pay in taxes, or even earn in a year of working. There would seem to be a need to restrict the number of years a person could claim medical tax credits in excess of their withheld taxes. Perhaps once every seven years, as we restrict bankruptcy?

Whatever is done, the first two steps are to:
1) cut any free or subsidized care for those who are in our country illegally
and
2) restrict the limit of care provided free to felons in prison to the lowest level of care available free to law-abiding citizens.