Originally posted by festus
"The myth that the United States has the best health care system in the world has long been shattered. We don't have the best health care in the world -- we have the most overpriced health care system in the world.
snip
Here lies the crux of our collective dilemma - the cost of health care in the USA.
I'm old enough to remember the days when, as a wage earner, it was actually feasible to pay for my own health care. Even when something major was involved, the cost was such that it could be managed with installment payments.
The last 40 years, however, have seen the cost of medical care balloon to the extent that for most wage earners, any event which requires hospitalization costs so much that it exceeds the ability to pay, even with installment payments.
The result is that people without insurance who need more than routine care very often present to healthcare providers as effectively indigent. The cost of their procedures then becomes the burden of the healthcare provider (who must provide it but absorb the cost) or the state, which reimburses healthcare providers for some indigent parties.
Thus, the costs are borne by all of us, albeit indirectly. We pay for our care, part of which cost goes to cover our providers' losses on unreimbursed indigent care, and we pay more taxes to cover what the state pays for indigent care.
So, what is an equitable solution?
I know ROC, he's a decent enough individual at heart (even though he's also an a**hole, but I suppose I shouldn't cast stones
). I'm sure he would not suggest that indigent folks should simply be allowed to suffer and die uncared for. Remember that for this discussion, "indigent" includes a huge segment of those we refer to as "gainfully employed" people.
So, how do we arrive at an equitable solution?
Its obviously not possible to get the cost tiger back in the cage. There's no way that we can expect the medical profession as its structured now to reduce costs enough to bring them into realistic alignment with individual ability to pay.
The only way people will be able to pay for their own care is by participating in some sort of pooled risk arrangment. This could be insurance from for-profit insurance providers, pooled resource schemes ("self-insured" employment groups, for instance), or some socialized medical care system.
I think we all agree its best if possible to keep the government from expanding its mandate to include healthcare. And, only truly huge organizations have the ability to self-insure.
This leaves insurance. But, guess what? Because of the huge cost increases in recent decades, insurance companies have raised prices accordingly.
The only way insurance is feasibly affordable is through participation in a large group. Large groups are able to spread costs over a large enough pool that they are able to negotiate an average cost that's reasonable. Individuals, however, are quoted prices for healthcare insurance that are exorbitant, because they have no bargaining power. Trust me on this, its one of the reasons I chose to stop being self-employed about a decade ago - I simply could not afford to continue paying for insurance because the cost went through the roof over the prior decade, and I did not want to invest in increasing the size of my business to allow for group participation.
So, rather than going to socialized medicine, we (as a society) must consider requiring all employers to ensure that their employees have medical insurance.
There is good sense in this. Employers should not see this as an entitlement their employees expect over and above their wages. They should see it as a cost of doing business, that cost being a measurable portion of their employees' compensation. It simply requires a change in the way you think about labor costs ("OK, I need 25 people, who I will pay $x/hr + $x/week for insurance").
So long as we mandate this by law, we make the playing field for all employers level. They all have the same ability to seek participation in group plans at the best possible negotiated rates to keep their costs as low as possible. They all pass the cost along to consumers.
The benefit to us as a society is to reduce the amount of tax money that must go to indigent care. Since we agree that the government is most inefficient in managing costs, any reduction we make there is probably also a reduction of care that is being provided at exorbitant cost. The net cost to us as a society will be better if private concerns pay, rather than The Tax Teat.
Does this mean that if you want to be in business, your life becomes more complicated? Yes.
The only other alternative would be for the government to mandate that insurance providers must provide "group rates" to individual consumers. On the surface, I like that best - make everyone pay their own way individually. However, this seems to be a really slippery slope that might lead to us effectively having a socialized healthcare system, since it would increase the involvement of government in the regulation of the insurance industry.
I think we're all best off keeping it all in private hands as much as possible. Hence, think of mandatory employer-sponsored group plans as a normal cost of doing business, same as the minimum wage.
**** my hat, my fingers are tired now
