With the whole country focused on the health care crisis and what to do about it, many who profit under the present system are trying to confuse the issues and delay progress in the hope that the movement will lose momentum.
In a recent comment to one of my posts, Sue made the following remarks, which she has since expanded upon at my request. They represent such a clear, rational summary of the main points we need to keep in mind, that I they are well worth repeating here:
Changes need to be made in the American health-care system. First, it is unconscionable in today's world that health care is dependent on employment. That made some sense in the era when people (meaning men) went to work for a company right out of school, spent their entire careers there, and retired a few years before their probable deaths from old age (at between 65 and 72). There was an unwritten contract that employees would be loyal and that employers would take care of their workers. This generally included health coverage for spouses and children. Now, of course, neither employers nor employees expect a lifelong employment relationship. In fact, many former employers now contract for temporary workers and workers may hold several jobs simultaneously. In this environment, employer paid or employer sponsored health coverage just doesn't make sense--much less work. And, for this reason, any health care coverage needs to be for everyone, not just for those who currently lack coverage. In other words, we need to disconnect the employment--health insurance connection.
Second, premiums range from outrageously expensive to totally unaffordable: both for individuals and for employers (especially the small businesses that make up the bulk of the employers in this country). The small company where I work is being hit with a 26% increase for the coming year, which is typical. Individuals and families will easily pay two or three times as much as individuals as they would as members of even a small group. And yet, if we were a larger company, our premiums would be lower and our coverage better.
Third, medical providers tend to be paid on a "per service" basis, which encourages them to order expensive tests and treatments and to see more patients than they can easily accommodate. Paying medical providers salaries rather than on a service basis could go a long way towards controlling costs.
Fourth, (and this goes right along with point three) we need a good peer review system to assure that the tests and treatments ordered are consistent. This doesn't mean that research facilities would be precluded from developing new approaches or pharmaceutical companies new medications, but it would assure some level of consistency.
Fifth, health care needs to be structured to emphasize preventative care. HMOs have received a bad reputation, due in part to the poor business practices of a few, but there are good ones. Kaiser Permanente and Group Health Northwest manage to take good care of their patients/clients while controlling costs and providing a high level of service. They could be excellent models for programs throughout the country. Also in this area, any program needs to include dental, vision, and prescription coverage to address all areas of preventative health care.
Finally, health care doesn't need to be a "single" provider to be reasonably cost effective. Choice is a good thing, but the choices should be realistic. We can't afford to have people running from doctor to doctor to find an agreeable diagnosis/treatment. Sure, this means a few people will be unhappy, but the vast majority will find their options more than adequate. Medicare and good HMOs are a good example of this: you can choose your doctor/facility within pretty broad parameters.
The Preamble to the Constitution includes as its raison d'etre "esablish[ing] justice" and "promot[ing] the general welfare"--two things that a reasonably thought-out health care plan would accomplish.
As to cost: if the money now being invested in employee health care by governments and corporations were pooled into a national program, I think we might find that we could cover all the people in the country for very little more than is now being spent on health care. Seems like we should give it a try.
While we may never agree on every point, this issue--unlike the economy--is one on which every one of us has some expertise. Almost all of us have fears, risks, and limitations associated our lack of adequate coverage or the costs of insurance. It doesn't take an economist to know that the public system, if it's not fixed, will soon be bankrupt. We really have no alternative but to get on with it.