OT, health insurance.
Most of the doctors I've talked with see things getting worse, and can't think of a solution to the mess.
Sure doctors can't think of a solution, that's because they're a major cause of the problem.
Tax policy initially created the problem. Health insurance cost is not deductible for an individual. It is deductible for corporations. Thus, individuals could not compete effectively with their employer. This made individuals dependent on their employer. As fewer individuals took out health insurance on their own, that drove up the insurance companies' costs even more, as they couldn't spread their risk as well.
Initially, any care provided by a doctor was deemed essential, and costs charged by doctors was taken at face value. Doctors took horrible advantage of this situation. People had zero incentive to price shop their health care. The cost of insurance for corporations went up far faster than the rate of inflation up until the 80's.
The pendulum had swung too far, and health care costs took far too great a percentage of corporate earnings. Corporate America struck back, and HMOs were their weapons. The control of the health care gradually shifted from supply (doctors) to demand (employees in the form of HMOs). Doctors had abused the former system so bad that they were powerless to stop the changes. HMOs cut costs in every way imaginable. Most of the fat was on the doctor end, and that was where most of the fat was cut. Physician earnings weren't keeping up any more.
Alas, when a pendulum swings too far in one direction, it inevitably swings too far in the other direction. While HMOs (with the authorization and blessing of the insurance companies) were taking a well deserved bite out of the physician's fat, they also took rather large bites out of the patients' fat. They went too far also, resulting in a lot of the problems that Amy J talked about. Those problems are once more driving the pendulum back in the other direction, and given that there is actually the possibility of a shortage of doctors around the corner, it will be interesting to see the next development. Odds are, one of the net results is much higher health care costs.
John, you suggested a good solution, a true free market with no tax incentives that force us to get insurance from our employer. There's a big problem with that solution, though. In the current United States, there is a belief that the poor shouldn't be subject to inferior health care or health care rationing. Any changes in the current system needs to include some sort of system that actually improves the situation for people like the unemployed and disadvantaged. A free market makes this problem worse, not better. Woodrow Wilson said it best when he called our economic system heartless. A heartless free market health care system isn't consistent right now with a populace that is unwilling to throw those less successful to the wolves. Some government program for the poor and disadvantaged along with a free market system would probably work and still might pass all the hurdles. Creation of a the huge new bureaucracy that would be needed would be next to impossible politically right now, given the budget mess that Medicare is right now. |
