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It's fairly clear that we got into this mess, at least in part, through the reliance on employer-paid health care - that is, it appears that the abuses, indulgences, etc. by large insurance carriers (which help drive up prices) are met with very little outcry because, well, the employer only cares about getting it cheap, the employee has little or no choice in the matter (and never deals with the amount taken out, the negotiations over coverage, etc.), and it's profit symbiosis for the corporations.
I don't think the answer is to suddenly cut the cord and go individual - although the market could possibly sustain it (and, in fact, might improve efficiency drastically), people would shit their pants, and the sudden void created would be ripe for even worse abuse. Not to mention reliance on the f-ing government to suddenly run an efficient insurance program - really? That's going to happen?
We're really in a hard-core mess, which is why the GOP rumor- and fear-mongering is so angering - there's no doubt something has to give. Fox News had a "counterpoint" to Obama from the guy who runs Aetna - oh, no kidding? He's not in favor? They only made $1.34 billion last year, it's AMAZING he's in favor of the status quo.
The only short-term solution that makes any sense to me is an overhaul of the regulatory system - installing controls similar to those in place for investment products could expose some of these high-profit 'irregularities', find where the 'average' person is being screwed in the actuarial table, decrease over- or under-the-table deals with hospitals and doctors that enrich both at the cost of the consumer, etc.
The fact of the matter is that nationalized health care should be the perfect solution - after all, insurance is simply pooled risk, so the larger the pool the more accurate our risk determination should become - but we're so far off course now that I'm not sure there is any way to get there, and I'm not at all confident government overhead and inefficiency won't be worse than simple profit+overhead from existing carriers, even as inflated as those are currently.
Quick edit to clarify a point numerically:
There is no doubt that insurance carriers are actually in FAVOR of higher-cost health care as a product, at least to the point where it doesn't price out the majority of the population (and, like every market-based company, they're pretty cognizant of where this point is located, and know they're not yet close). The reason for this is simple:
Insurance companies are required to pay out approximately what they take in, within a certain fudge factor. However, they are expected to invest that income, and earn dollars (profit) based on those investments while they hand onto the money (plus, potentially, a certain off-the-top number for overhead).
If health care costs X, they get X*investment% + X/overhead% in earn. If health care costs 10X, they get 10 times that amount. The math, at least for the insurer, is that a bigger risk pool (requiring more premium) equals more profit. The more stuff costs, the better, to a point.
Last edited by KSig RC; 09-15-2009 at 03:01 PM.
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