Thursday, 6 August 2009

Health Care: C'mon America, Grow a Heart

I was watching some smirking conservative rail about health care on YouTube, and as soon as I heard the phrase "government takeover of health care," I knew what was coming. Whenever you hear that phrase, sense has left the room and Polly the Right-Wing Parrot has taken up residence on the TV set.

I don't consider myself a Democrat or Republican any longer -- they both annoy me with all the partisan bickering and grandstanding -- but the right wing shows itself more often to be about as dumb as a sack of rocks. So let's look at health care, in people terms. And let's look at it in the context of the conservative solution. I've even picked out what looks like a white paper of sorts (okay, a bit of a stretch, but it seems to contain the major talking points) from the great mouthpiece of conservative philosophy, the Heritage Foundation. This piece reveals what the conservatives think is most important in designing a health care overhaul.

Let's also introduce two people and see what the conservative plan would do for them. First, Jim: he's a good guy, volunteers at his local church, even votes Republican, but just lost his job. He's 44. He goes out on the open market, finds a health insurance policy -- it's a bit steep, at $700 a month, but he swallows hard and pays up. Then Jim finds out he has lung cancer. He starts undergoing a lot of expensive treatment. His insurer identifies him as a money loser and tries to rescind his policy, going through it with a fine-tooth comb, then finally discovers something: Jim didn't reveal that he once saw a dermatologist for acne. Ah hah, they've got him! The company cancels Jim's policy and saves a few hundred thousand dollars that year. The CFO gets a big bonus. Jim dies in a hospice.

Now for Sally: she's a good person as well, a single Mom bringing up two lovely girls who is forced to take a job with an employer that, like many over the last nine years, has dropped its health insurance benefit. She had breast cancer five years ago and her right breast was removed. She appears to be cancer free now. She goes out and tries to find a policy, outside of work. And gets turned down. Again and again and again. She can't buy insurance anywhere at any price. Even if she could, the amount would be so ridiculously high that she couldn't afford it.

Now, can we all agree, right and left and in between: these people deserve to be covered by health insurance in the richest country in the history of this planet?

Okay then, let's look at the all-important guiding principles for the Heritage plan for health insurance, point by point, and see how they would help poor Jim and Sally:
1) Make consumers the key decision makers. In a consumer-centered health care system, indi­viduals make the crucial decisions [on] medical treatment and insurance. The government’s role should be limited to providing means-tested financial assistance and ensuring transparent pricing to increase consumer choice.

Okay, wave a magic wand. We've got transparent pricing and financial assistance. The problem is, Sally is uninsurable, or insurable only at astronomical rates -- no one wants to touch her. She's not a good bet at the private industry health care casino. A government tax credit of $1,000 a year, or even $5,000, isn't going to change that. And if she's eligible for "means-based assistance" of say $400 a month, based on her income, that won't help if her health history has priced her way out of the market. Also transparent pricing won't help Jim and Sally either. Take Jim. He's simply a drag on profits, and that's regardless of what kind of open pricing your health care system has. His lung cancer is an inconvenience to the bottom line. So they both lose.

2) Allow individuals to buy and own their coverage. When a parent purchases breakfast cereal for a child, the customer is the parent, not the child. Although it’s probably not a good idea for parents to allow younger children to choose a cereal, it’s clearly a good idea to allow consumer — not their employers or the government — to choose their own health insurance.
Let's see, this principle helps ensure that smart choices are made, as consumers will know best what kind of policy they need and what kind of deductible they can afford. They will spend their own money more wisely. Sounds great. How much does it help Jim and Sally though? Zilch. Nada. Keep on movin' ...

3) Empower consumers to choose the right plan for them. The most basic decision consumers must be allowed to make is which health insurance plan to buy. Even the most sophisticated consumer may not have all the relevant information, or sufficient time to gather and analyze it, when deciding among providers and treatments. A consumer-oriented system makes the facts and expertise available to assist consumers.

Let's imagine that consumers are kept fully informed. In fact, they are amazingly informed. They study health plans day and night, private industry helps them comprehend the minutiae of policies with toll-free hotlines, all of America's coffeehouses are full of people chattering about health care all the time ... and if Sally has breast cancer, she still can't afford a policy. And Jim still loses his coverage.

4) Remove barriers that prevent a range of choices. Market competition works when consumers are free to choose among many options and when suppliers are free to innovate in meeting consumer demands and preferences. A precondition to any well-functioning, consumer-centered market is the removal of regulations that unduly restrict either consumer options or supplier innovation.
Picture this: barriers are torn down at a blinding speed, insurers can compete cross-state with no restrictions. Innovation explodes, and is encouraged. Every major insurer finds a way to open an office in every corner of America, even remote counties in Wyoming and small villages in New Mexico. Consumers are free to choose from thousands of options. And Sally still can't find affordable insurance and Jim still can't get his insurance back.

5) Make prices transparent to consumers. Government can play a legitimate role in ensuring a market functions fairly and smoothly by establishing basic rules for clear and up-front prices so consumers may “comparison shop.” Government already requires grocers to include the unit price for products sold by weight or volume, for instance, and also requires lenders to disclose the effective annual percentage rate (APR) of a loan to pro­spective borrowers. For the health care system, lawmakers and stakeholders will need to agree on appropri­ate standards for calculating and communicating prices to consumers.

Thought exercise: health insurance becomes incredibly easy to comparison-shop. The transformation blows away even the most skeptical of skeptics. Policies become simple to compare side by side, thanks to metrics that the industry itself agrees upon. Consumers are able to save a nickel here, a dime there. Brilliant! And Sally and Jim? They're still left in the cold.

6) Consumers must have regular opportunities to choose. For a market to be truly consumer-centered, individuals must be able — at least periodically — to reconsider past purchasing decisions and make dif­ferent choices. A market that restricts consumer choice by unreasonably locking consumers into deci­sions has the effect of shifting the balance of power in the market back to suppliers.
Okay then, envision an insurance industry that undergoes huge changes, allowing consumers to opt in and out of insurance policies at will. You can cancel your policy 13 days into the month, get a prorated refund, then sign on with a new insurer for the remainder of the month, pay a prorated amount, and then change insurers again on the first of the following month! It's incredibly fluid, the free market without friction, no penalties for jumping back and forth. Consumers rule! And guess what? Jim and Sally are still screwed.

So what do the conservatives do about Jim and Sally, once you strip away all the fancy-sounding rhetoric and paens to the wonderful free-market mechanism?

They let them die. They let them die because they think that buying health care should be like buying widgets or bicycles or DVD players, never mind the fact that when your widget breaks you don't spend five days in your bedroom crying and thinking you'd give all the money in the world to have that widget back.

They let them die because they don't understand health care is different.

Now I ask you: Is this an America you want to live in? Or is this an America that needs to grow a heart?