November 20, 2008
How to Fix Detroit -- Single payer
A lot of people want to punish the "Big Three" for trying to keep their promises to their workers. After all, the Air Traffic Controllers, the Airlines, and hosts of other industries have all stiffed their employees, and look how much more efficient and profitable they are! [That was Sarcasm]. Aside from down-sizing senior management, the best thing that GM, Chrysler and Ford could do right now would be to get on board for universal single payer health care. Combine Medicare, Medicaid, and the disparate state plans into one unified system and pay for it with payroll taxes. Do that and one of the big costs of the current system would vanish from the Big Boys shoulders.
Instead of punishing and blaming labor for the stupidities of management, we need to finally do what most western nations did a long time ago; socialize those things that are (or should be) outside the money-measured system.
Defining human rights like a "right to medical care" as rights is difficult. Of course it is "right" that all humans should have access to health care. But it is a "positive right" and that makes its enforcement different from negative rights like liberty.
Positive rights like health care are requirements, not negative rights that can be enforced with fines and punishments for their violation. For a positive right to be real it must be privileged, it must be funded, and someone must positively make the goal of universal health care a reality before calling it a "right" has any meaning. There has to be a business model, a system that has "health care" as its mission, and people and rules that can enforce and provide for that right. Positive rights don't just happen without funding and effort.
That is why we've failed so far. People identified health care as a national goal, but they've been confused about what the market is, how to deliver health care, and who should own that market. As a result we've had a muddying of the requirements for a functional system. As a result of this we have a dysfunctional system.
Posted by cholte at November 20, 2008 05:22 PM
Hi Chris,
Long time. I don't know if a Single Payer system will fix Detroit, but it is telling that HMO's in general seem to be in favor of a Single Payer system, and Insurance Companies are not.
Just another case of "Out with the old boss...." ?
You could be right. But, reforming health care will be "fraught with peril" because of the misapplication of the principle of privatization that is so common today. Probably the HMO community wants in on Single Payer and knows it can get contracts, and involvement if it helps design it.
The Insurance companies would be reduced to providing "supplemental" policies under single payer. But they are likely to follow the "medicare" model and simply seek to privatize the execution of the program so they can load extra costs on the system and milk it for profits. They are doing this currently with medicare.
I don't really feel the need to demonize them, nor to cut anyone out of a final solutions. I used Kaiser for a while and I thought it had a decent plan at the time. But at the same time I've seen how rationing, and actuarial gaming, already skews health care. In poor countries the rich have good teeth, everyone else gets jokes about missing teeth. In middle class countries everyone can afford decent teeth, even Austin Powers. In our country we pay a lot of money to get poor quality dental care thanks to games played between providers and middlemen.
The issue is not whether companies act as agents of the governance of health care, but who ultimately governs or owns the system; all stakeholders or just a few. It's obvious that insurance providers and individual employers (or Unions) can no longer sanely manage even their own part of the national health care system we have -- so we have to go there. It's equally obvious that it wouldn't be fair to cut out private enterprise from the system.
Chris
The Company that I work for used to a have pretty good health insurance--which I imagine it still does for the owners.
The problem was, they could only afford to cover the employees--but not the employees dependents.
I was covered for a number of years, by my employer, but when it came to my wife and three children, our policy was to pay cash and hope no one became seriously ill or injured. Essentially, my family was uninsured.
I think mine was a common story. I could pay the insurance premiums and lose my house because I wouldn't be able to keep up with the mortgage as a result, or I could roll the dice.
Rolling the dice meant that if someone got seriously ill or injured we would lose our home, but paying for insurance meant that we would lose our home for sure.
For this reason, my employer has switched policies. Now, both employee and dependents are covered, but to afford this, the coverage is reduced to bordering on being catastrophic insurance.
The co-pay and co-insurance payments are high, the dental coverage is a joke, and the vision---well, it is cheaper to just see the optometrist at Costco, and by the glasses (for cash) there as well. (Note: our optometrist at Costco is first class.)
The good news is, if someone gets sick--as long as it is not me--we won't lose our home.
The sad part is, I am better off than the majority of Americans.
"It's equally obvious that it wouldn't be fair to cut out private enterprise from the system."
I couldn't disagree more. Single payor with the government as the payor and universal coverage for everyone is the only sensible plan. Anything else is barbaric. It's about time the United States joined the civilized world. What's the alternative to argue that their must be profit in healthcare? Utter non-sense!
I think a distinction needs to be made between the system itself and the players within the system. A Free market is a place where people can buy and sell freely. The distinction that makes the difference between a genuine free market and other kinds of markets is not whether the market itself is owned, but whether those in the market can participate freely. To have a free market in health care all we'd need would be public squares where anyone can rent a space for 10$ a month and do anything they want in the rental space. Of course that is not what medicine is about.
Doctors, Medical providers, and patients are the core markets of the health system. The Health System is a "mission centered" system their mission isn't to make lots of money -- it's to provide health care. Making it a free market is a perversion and a travesty. Doctors are happiest, not when they are paid millions of dollars (though some are), but when they are paid well to do what they love to do -- which is to treat and cure illnesses.
Currently we have "for profit" administrators charging both taxpayers and customers for every lollypop and bandage and rationing care based on income and what they can get away with. Cutting all these bastards out of the loop wouldn't hurt them (they are good at finding other places to bite and suck blood from) but it would go a long way to restoring this travesty of a health care system we currently have back to some semblance of decency.
Chris