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10:42 pm: Health care

For the record, here’s what I think we should do to improve health care in the US:

Public Clinics: I have no interest in providing or mandating insurance to the whole country. Insured or uninsured really makes no difference to me. What I care about is that nobody goes without basic health care just because they lack money. When I say “basic health care,” I’m talking about the same stuff that we provide to third world countries. It’s in the same stack as “food,” “clothing,” “shelter,” “clean water,” and so on. How do you provide this? Public clinics. Plain and simple. I’m told that many cities already have a decent model for this. San Francisco among them. I think there ought to be some nonzero cost as a gating factor – and that cost ought to scale with whatever you reported on last year’s income tax form.

I think that greatly simplifies the rest of the question. Once we take care of the people who *need* a socialist solution, we can let capitalism do its thing. However, in order for the market to function effectively, the consumer needs to be making decisions based on price and value. Instead, we have this crazy cabal of insurance companies, employers, and medical providers driving costs through the roof. Simply having a “public option” (clinics, not insurance) will do a little bit to control prices. However, that’s like saying that a public defender’s office serves to control prices on lawyers. Of course it doesn’t.

Regulate the most egregious sins of the medical Insurance Industry. These people are fucking us. The manner of the fuckery is well documented. Dropping policy holders when they are diagnosed with a serious illness, refusing to even offer a policy of *any* sort to those with “pre-existing conditions,” and so on. I say, if you want to provide health insurance, you need to:

* Never say “no,” to anyone. There has to be a baseline risk pool that everyone can get into. Sure, it’s gonna be pricy and restrictive. However, that pool must exist.
* Give me the option of paying for my own care rather than passing it through and affecting my premium.
* Offer policies directly to consumers rather than to businesses.

And here’s one for the providers: I need to see the price *before* the procedure gets done … and the price needs to be the same whether I pay or they do.

Okay, now the market can do its magic.

Among the small business owners I talk to, an individual medical insurance plan costs about $700/month. A family plan costs around $1200/month. That’s between $8400 and $14,400 per year. In a good year, that’s a lot of money for a checkup and a couple rounds of penicillin. In a bad year, it’s chump change. I suspect that if we stopped trying to cover both our social medicine and our insurance on the same sort of policy, we would see changes.

Ideally, I would like a policy with an annual deductible of about $5,000, that cost me about $4,000. Most years, I would make money, spending the $8,000 I’m saving on insurance. Other years would suck because I suffered major injury … but I would have that catastrophe covered.

Originally published at chris.dwan.org. You can comment here or there.



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