The Candidates on Health Care

Let's hope these two pictures don't start fighting.

I've learned some interesting things from the health care plans of each candidate, Hillary's and Barack's. Also discussed by Paul Krugman of the NY Times here.

Here's my favorite. According to Hillary's fact sheet, the average yearly health insurance premium for a family in 2006 was $11,480. Eleven thousand dollars! That's more than it costs to mortgage a house (well, a small one at least). In effect, every family in the US owns a second home--their clinic.

Is there a big difference between the two plans? Well, both mention creating something similar to congress's plan, the FEHBP. Both want to increase coverage of kids especially. Neither is advocating a true single-payer system. Both want to 'increase competition' between health insurance providers, whatever that means. Both want to replace Medicare's ability to get discounts from drug companies based on size, removed during the Bush administration. Both stress preventative health regimens and incentives for 'quality'. Both discuss electronic medical records. Otherwise, they seem similar with the exception of some differences below. In general, Hillary's plan seems much more detailed, with more references and more numbers. They kind of fit the personalities of the candidates.

Hillary plans $3 billion a year for implementation of electronic medical records, Barack $10 billion. I suppose that doesn't matter since Hillary pegs savings from EMR implementation at $77 billion a year, once up and running.

Barack mentions a new 'National Health Insurance Exchange' that will increase competition, but I'm not sure how. Hillary doesn't really address competition between health insurance companies, but does talk about restoring discounts.

Hillary talks about 'sensible' malpractice reform, basically a system by which doctors are held to 'transparent' standards with regards to error rates. Barack doesn't really talk about malpractice reform. This is a big issue in some states where caps on damage awards have recently been rescinded. I'm not totally sure it's a good idea to measure MDs on quality while ignoring the price-cap issue and the sheer cost of malpractice insurance in many states.

Hillary talks about a national research initiative to find best practices. A new 'Institute'. That sounds nice, I suppose.

Krugman and others believe that Hillary's plan will lead to universal coverage, through mandates that require people to buy coverage. But neither plan says anything about what 'affordable' or 'reasonable cost' means. Barack's plan pledges universal coverage for children, but leaves out those who don't want to buy coverage. Doesn't that leave them back at the ER again? Aren't those the very catastrophic injuries that cost so much?

In reality, there's no great way to compare these because they're both simplified and hypothetical.

The bottom line, for me? If there were a single-payer system, there would only be one place to send a bill, one place to worry about funding, and one place that, if federal, would be required by law to disclose where all the money goes. Don't we want that? Don't we think that if we spend trillions on health care we'll be able to pay our doctors, create short wait times, and still do research?

I guess in the end I don't see the appeal of the system we have now such that we aren't talking about a single-payer system. Yes, Hillary's plan seems a bit tougher. But both are incremental change to a broken system. Good luck with that, says my cynical side. Is there a better way, asks my pragmatic side. Maybe not.

Single-Payer Healthcare

There's a great entry here on the Canadian health care system from the Health Beat Blog, which seems apropos given our current political chance to perhaps make some changes.

I'm no policy expert. But I do know my own finances. In our wonderful system that operates in a free market, this is what happened to me as a father of one to three children, depending on when it happened.

When I had employer-based insurance, as is typical, I had to pay a premium for my family of between $200 and $300 a month. I couldn't switch plans once I had chosen one even though I wanted to--so much for free choice of doctors. Once I became a student, I had to either sign up for student health--over $500 a month with lots of co-pays--or use COBRA, an obscure system whereby the newly unemployed person pays the 'full' cost of their insurance which in my case was $575 a month but at least I had the same doctor.

I was unemployed, paying $575 a month. Awesome. This is the system we currently have. Lost your job? Here's an extra $500 a month in expenses.

18 months later, we were eligible for Medicare. Cost: $0. Choice of doctors: well, pretty much any. In fact, my access to academic providers went up substantially, and I didn't need prior authorization. Wait times were similar. I got to keep the same pediatrician for my kids and choose pretty much anyone for my own primary.

Advantage, big bad government system. In both choice and cost.

But surely, doctors are paid better in the US? So you wouldn't want a government system? Well, I currently have $175,000 in loans from medical school. Partially because there were no social services whatsoever, so I had to borrow money to pay for health insurance. EVEN WHEN I'M WORKING the cost of health care per month will rise again to between $150 and $500 a month depending on where I work (let's say the American South is not 'service rich'). Do I want a good salary? Sure, but only because I have so many loans because I had to finance both my own education and pay exorbitant premiums for health care (under COBRA, above) while I was a student.

Is there any hope? There is one notable institution that supplies free health and dental care to all its employees. What? A medical institution that gives free health care to all its employees? They must be going bankrupt! No, actually. They thought about going to a plan before. Just playing for care without the administrative cost was...cheaper. Golly.

Pretty obvious to me. Government plan: free, better access. Employer plan: expensive, less choice. And that's even without any static for prior conditions and all that garbage, or mental health which is not always covered, and so on.

Oh, right, taxes. Well, let's see. Taxes might be higher with more services, it's true. From where I'm standing, however, government health care saved me on average $500 a month. That's $6,000 a year. Now, I'm no expert on taxes. But according to Wikipedia on taxation (granted they may have a bias) that's more than a person making $40,000 a year will pay for their TOTAL tax bill. So for me, going to a government plan actually more than paid for my taxes the years I was eligible. In other words--government health care helped my true out of pocket expenses go down, not up.

I don't know if this convinces you. It does me. Leave aside the small observation that all other developed nations have universal coverage, and that the nations with the largest tax burden and therefore, the largest support network also have the best social indices: that fabled land, Scandinavia.