TW: Things have calmed down somewhat on the health care front. Legislation of some sort will get done. I side with those in the incrementalist camp. Something is better than nothing and something will nudge the can down the road. When pondering what I support, I tend to get twisted reconciling what I would do if working in a vacuum versus what I view as politically feasible. Rather than getting hung up gaming the politics I will just enumerate some themes after having spent much time pondering the challenges.
I am netting out on making sure universal coverage (or something close) is created, nothing more, nothing less for now. Health care reform must ultimately include measures to "bend the cost curve", "ration health care spending", etc. etc., but few of those measures will be enacted into this current bill. This makes some sense. Universal care and costs measures are related but separate issues. As cost pressures increase, more and more folks will succumb to the donut hole which exists in American health care. If universal care is not enacted, the hole will gradually enlarge and become a de facto default source of rationing (even more so than it already is) within our system.
This piece from Time a couple of weeks ago struck a chord:
"Patrick Gilbert, an uninsured lumber company worker in upstate New York, is in a predicament that President Barack Obama and congressional Democrats believe they can solve. Gilbert and his wife have two children, but he says that on his family's $50,000 annual income, he can't afford the $600 monthly premiums for his employer's coverage.
"If I could find some reasonable insurance for about $100 a month, then I would do that," says Gilbert, 38, a lymphoma survivor who lives near Lake Placid. "Something reasonable, not with high deductibles. Something fair."
The House's health overhaul proposal would allow Gilbert to obtain family coverage for $250 a month, with the government picking up the rest of the premium costs. While that subsidy would make insurance more affordable for Gilbert, he could still be stuck with huge medical bills if he or his family members got seriously ill. In the worst case scenario, Gilbert could end up paying $4,400 in co-insurance and deductibles on top of $3,000 in annual premiums — adding up to 15 percent of his family's income."
TW: Gilbert's dilemma is real but exposes the utterly unrealistic expectations of some. There is no insurance plan for a family of four (inc. a lymphoma survivor no less) that costs $100 per month. Gilbert could probably pay $100 per month for the rest of his life and not re-pay the treatment he received for the original lymphoma much less cover himself and the rest of his family goinig forward.
Health care is expensive and getting more expensive as technology permits life to be extended and in many cases quality greatly improved. Thirty years ago, Gilbert's lifetime health care expenses might have been greatly lower because he would have been killed by the lymphoma.
So what does one do with the Gilbert families in America? The status quo is to leave them dangling hoping for good health, perhaps hoping for some charity or waiting in long queues whilst clogging our acute care facilities where they must be treated by law?
Health care is becoming more and more expensive for many reasons including the fact that it can do more and more. Yet folks incomes are not increasing fast enough to keep up with the health care increases. Our society has a choice: figure out how to systematically provide health care for all or systematically reconcile to the notion that many working poor and increasing numbers of middle class folks will suffer from inferior health care and in some cases die. Right now we have a messed up hybrid which is failing increasing numbers of folks. Not the poor so much (Medicaid) and certainly not the elderly (Medicare) but many stuck in between.
Universal care will be expensive, very expensive but ignoring this growing donut hole is just wrong. Will tough choices be necessary on the cost side? YES!...but lets get universal health care done then maybe the Republicans will get serious about working together to address costs because right now they would prefer the donut hole continue and grow rather than work on cost solutions.
On a related note this is a useful link from WaPo outlining key health care reform issues:
http://www.washingtonpost.com/wp-srv/special/politics/8-questions/index.html
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