What should be done about health insurance? The Gilbert plan
Filed under: Insurance, Health
There was a moment in the last debate between John McCain and Barack Obama when the Republican candidate took Obama to task for his health care plan, calling it a "single payer system." "If you like that, you'll love Canada and England," McCain shot.
I would love Canada and England! I recently left my cushy job with benefits to hit the freelance lifestyle, with its attendant flexibility in spending waking hours with my three young children. I'm the primary breadwinner in my household, to boot, so I've been hemming and hawing over what I need in my budget. Cable's out, and I'm considering saying goodbye to the Blackberry (ohhh!). We don't drive, but I have a little in the budget for bike lights and the occasional replacement inner tube. I'll be honest: I wasn't thinking that much about health care costs. Maybe it was one of those fingers-in-the-ears moments, squeezing my eyes shut and saying "nahnahnahnahnah!" every time the topic came up.
I got my COBRA paperwork today, and just for health care, I'd be spending $1,036 a month; more than my mortgage payment (if you exclude taxes). I wrote about this on a local mamas' site, threatening to go without insurance and pay out of pocket for well baby visits and such, and was immediately begged (literally "please please PLEASE") to buy health insurance. I started griping about the costs and the cheated feeling I have: essentially I'm being asked to pay thousands each year to protect me from total bankruptcy, should there be a health crisis in my family. Tracy Coenen suggested I post here about what I'd like instead.
It turns out, neither Obama's nor McCain's plan would be ideal (though, for the record, McCain's would be completely unhelpful, especially for parents who work for small businesses). Instead, here is how I'd structure the health care system:
I would love Canada and England! I recently left my cushy job with benefits to hit the freelance lifestyle, with its attendant flexibility in spending waking hours with my three young children. I'm the primary breadwinner in my household, to boot, so I've been hemming and hawing over what I need in my budget. Cable's out, and I'm considering saying goodbye to the Blackberry (ohhh!). We don't drive, but I have a little in the budget for bike lights and the occasional replacement inner tube. I'll be honest: I wasn't thinking that much about health care costs. Maybe it was one of those fingers-in-the-ears moments, squeezing my eyes shut and saying "nahnahnahnahnah!" every time the topic came up.
I got my COBRA paperwork today, and just for health care, I'd be spending $1,036 a month; more than my mortgage payment (if you exclude taxes). I wrote about this on a local mamas' site, threatening to go without insurance and pay out of pocket for well baby visits and such, and was immediately begged (literally "please please PLEASE") to buy health insurance. I started griping about the costs and the cheated feeling I have: essentially I'm being asked to pay thousands each year to protect me from total bankruptcy, should there be a health crisis in my family. Tracy Coenen suggested I post here about what I'd like instead.
It turns out, neither Obama's nor McCain's plan would be ideal (though, for the record, McCain's would be completely unhelpful, especially for parents who work for small businesses). Instead, here is how I'd structure the health care system:
- Mandate one rate for everyone. It's mind-boggling that insurance companies pay far less than individuals for health services. It's nonsense: it doesn't cost less to provide care to a patient who has insurance, the only possible justification for this practice. It probably costs more for insured patients; hospitals have whole departments dedicated to billing insurance companies and knowing the ins and outs of Medicaid. Competing software systems navigate the mysteries of proper coding. If I'm going to the doctor, I should pay the same price as someone who has Blue Cross.
- All payment for care for catastrophic accidents, serious illnesses, births, vaccinations and preventative care / physical exams should be paid for by our income taxes. I shouldn't have to decide whether to get a mammogram or pay my power bill. I shouldn't have to worry about losing my house as I'm in the ambulance after an uninsured motorist hits me while crossing the street. If my husband gets cancer? I should only be crying about my husband's disease, not my impending homelessness.
- Insurance could pay for routine, elective and supplemental care. Want acupuncture? Couples counselling? Elective c-section? Extensive genetic testing for your baby? Occupational therapy? Infertility treatments? Visiting the doctor for routine flu? Insurance could pay for these costs. That way, the "haves" could still have more than the "nots." Individuals with insurance could see their physician for every ache and pain. Those who didn't have it, would have to pay out of pocket. (But if the aches and pains turned out to be cancer, it would be covered by taxes.)
- Farm subsidies and all support for unhealthy food should be erased. See Michael Pollan; no more wheat, corn or soy crop subsidization, period. No more transportation tax credit for food companies. This will save money to help pay for health care. Also, when America can't get cheap sugar, vegetable oil and processed flour, nor can they get cheap, tasteless, nutritionally-bereft produce from all over the planet, they'll start eating healthier and we'll save money on health care costs.
- Gardens and cooking programs in all schools as part of curriculum. Feed the kids food that was actually cooked (and grown where possible) onsite will greatly increase our nation's health. Take away the tests so the school systems can have money and time for the new food programs.
- Malpractice payouts should be severely limited everywhere. I think it's awful that some doctors make terrible mistakes. However, I shouldn't have to pay for them through sky-high medical costs. This system doesn't seem to be effectively reducing mistakes; it just makes people more miserable as they prolong their grief in a senseless search for monetary justice. Money won't bring your loved one (or missing limb) back. Somehow the rest of the world gets by without paying victims millions for other people's screwups. I'm sure we can manage.
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Reader Comments (Page 1 of 1)
10-28-2008 @ 8:48AM
Tracy Coenen said...
LOVES the single rate, elimination of farm subsidies, and limited malpractice payouts.
Wisconsin has lots and lots of bad policies, but one good thing is a malpractice fund with a limit to what patients can get. It's kept insurance premiums for medical malpractice low, and we get some great doctors here because of it.
Farm subsidies? Where do I start? One of many policies that must be eliminated. Heck, let's eliminate protectionism across the board.
And single rate? For sure. It's simply not fair that I get a lower rate for my services because I have insurance. And sometimes those discounts can be 50% of the original cost or more. This is terribly unfair to the uninsured. (Although if you are uninsured and you go to the business office and ask for the insurance rate, you'll often get it.)
Great post, Sarah!
Reply
10-28-2008 @ 10:05AM
Tom said...
One RATE! Sounds great and let's do it to the income tax too. Everyone will pay the same rate instead of those earning more paying a higher percentage of their income than those earning less. I like it. Good thinking.
Reply
10-28-2008 @ 4:18PM
tylerincmyk said...
I have always liked the idea of a flat tax. I'm not certain if the same could apply to health care. I certainly couldn't do the math, but I suspect that we'd be paying more. But more importantly, I wonder what would motivate investment in R&D if no-longer-competing health care entities could sit on their hand while someone else did the heavy lifting?
Tyler
Reply
10-28-2008 @ 9:48PM
The Fertility Acupuncturist said...
If acupuncture were covered by insurance, this would save tons of money. With an IVF cycle costing about $35,000 and acupuncture helping couples conceive after 3-6 months of treatment (cost=$6000 for a couple both getting weekly acupuncture and taking herbal medicine,) insurance companies could potentially save $100,000, hence reducing our premiums. Obviously, acupuncture could also be used for many other 'expensive' illnesses.
Reply
11-07-2008 @ 12:42PM
Stephen said...
What if we all forego health insurance? Hear me out! If we don't have insurance, maybe, just maybe, we will start taking care of ourselves rather than depending on the flawed state of medicine today. We should employ the philosophy, at least partially, of Hunter Campbell "Patch" Adams, M.D. and the Zanies. And most importantly, let's all accept one unimpeachable fact - we are all going to die. Quit pissing away our fortunes for another week surrounded by strangers, poking, prodding, and insisting we sign yet another release form.
If you insist upon risky, vain, or elective healthcare (see liposuction), then by all means purchase face lift and tummy tuck insurance and only patronize sufficiently gifted or insured doctors of cosmetology - apologies to hair dressers worldwide. This is not to mention the significant reduction of wambulance chasing lawyers. At the very least, might we choose from a menu of available coverages? Great-grandma doesn't need maternity insurance - unless she opts for invitro which might be narrowly defined as an elective procedure at age 93.
A hybrid model going forth has the potential to remove all the hidden excesses lavished on the current parasites of medicine - no more exorbitant and abhorrent insurance/banking executive compensation, and no need for malpractice insurance with a conscientious, properly trained, self policed medical force no longer afraid of the corrupt AMA or the at least mildly inept FDA. The profession of medicine can once again become noble, concerned with serving others, and not just a method for financing another glass building with the goal of filing the maximum number of claims in the minimum amount of time.
Sure there are holes in this - this is only 3 paragraphs. Feel free to fill in the holes! Let's get the conversation started.
Reply
11-07-2008 @ 12:53PM
sarah gilbert said...
Stephen, it's brilliant! I love the concept of foregoing health insurance. every time I bring it up I get a tongue-lashing (or, I suppose, keyboard-lashing) from loving mamas and papas who are sure I'm endangering my family by considering it. we need real reform, not tax credits, and the Patch Adams plan is a great place to start!
11-07-2008 @ 12:50PM
Stephen said...
P.S.
I love my chiropractor.
Reply
11-07-2008 @ 1:06PM
simon said...
great! why cant our geniuses have had this for us long ago - no, but congress has taken good care of itself all this time -pelosi,biden,macain and all the rest of them
Reply