Health Care Debate (Part 2) Who's in charge here?

Okay, if your insomnia wasn’t cured from part 1 on Health Care, I dared to keep going with part 2.  Again, these are just my voter/citizen thoughts on the issue so far, and obviously I am not an expert in the insurance or health care field.  Like many, I am trying to decide where to place my support in solving this crisis.  My view is dynamic, changing and hopefully growing in knowledge, albeit as a informed citizen, not active politician writing the new Health Care law.

In part 1 I asked “what is health care” in your terms.  We can’t agree on a solution without a context that we are talking about the same things.  If we can agree on the idea of basic care as a moral right, rising to the point of legislating it, but I would still contend it doesn’t need to go in to the Constitution.  Basic care for all, I can agree.  We need to agree on the scope of basic care, but I think we can find those boundaries much easier than the other more complex issues of advanced care. 

For advanced care, we likely need some minimal provisions every citizen can have, and allow for people to purchase more encompassing “upgrade” insurance plans.   We have to get the talking points out of the way (tort reform –yes we need it), allow insurance to be sold across state lines (understanding the companies must comply with a national standard which will have to be established, and additionally they will need to comply with state requirements for each state they want to do business in).  

I think once a company insures you, they should be required to offer you coverage renewals every year  unless you move to an area they don’t have coverage.   This can get messy for the companies, having to continue to insure someone who is a black hole like drain on resources, so I am going to admit that is an area needing to be addressed fairly for all.  

Before I go into pre-existing conditions though, now we have reached the area where I think I have to address the lingering elephant  in the corner of the room – national government provided care vs. insurance companies.   Someone is going to say we just need National Health Care; the Bernie Sanders wet dream.  

This is the area where I am going to dig in on some folks.  I oppose ANY complete government controlled health care system period.  This is nearly as deeply embedded a belief as my belief in God.  Why you can (fairly) ask?  

I have an explanation.  When I hear about government provided nationalized health care, I think of the one area of our government where health care is provided fully by the government: the Veteran’s Administration.  You know, the agency in the news where patients die waiting for appointments or are simply ignored.  I don’t want that for anyone.  Everyone in all parties the past two decades has campaigned and worked to fix the VA.  They still haven’t.  I don’t believe it is possible to ever fix it.  Improve it, yes.  Fix it?  Nope.    Will making it infinitely larger and more complex resolve it or make the problems worse?  I’ll leave that as a rhetorical question.

Secondly, even if I could get past the first, I work for the government.  I have dedicated a career to public service.  There are some things the government does very well(police, fire fighting, military, infrastructure, etc).  They all have flaws but are basically done well. But, you have to understand nearly everything is done with the cheapest, lowest bidders on nearly every major (and minor) issue.  The exception is “insider connection” awards.  They do happen.  The news is full of those stories.  I don’t want the cheapest anything when it comes to health care.  Lastly, the one thing the government truly does well, better than ANYTHING else, is protect the government.  Yes, it takes care of its subjects for the most part.  But, look at how the system always protects itself.  That is not a metaphor or an urban legend.  It is a simple fact, like 2+2=4.  Okay, so maybe you think this is a weak reason.  I understand, just remember things like the DMV and the FCAT when championing the government.  

Now, I am going to try and explain my BIG reason for my uncertainty on the best overall solution, and tie in why I don’t want to hand the reigns over to the government for everything in one neat bow.  I don’t trust the insurance companies because they are not altruistic organizations they are typically in the business of making lots of money, preferably profit.  So, by their design, they don’t have my patient interests at heart (first), rather I believe they see me as a business need to be met.  They want me satisfied and happy, but if I am going to bleed them dry, they will by design look to terminate our business relationship.  I get that.  So, it has to be the government then right?  No, I can’t go there and now the big reason why (drum roll please…): if the government is in charge, there is no higher LEGAL authority to fix problems and resolve issues.  

If the companies stay in charge, ultimately they have to answer to Uncle Sam and his 50 state cousins.  Uncle Sam answers to … Uncle Sam.  Logically, this is untenable.  Their track record in the health care arena is abysmal.  I cannot, and for now will not, go there.  I will expend time and energy to defeat any such premise. 

Ugh, this is a slog.  I hope some others out there share some of my beliefs and thoughts here.  I don’t think I am alone on some deserted island here.  Maybe I am though.  I think we have to try and find a way to design a system which allows companies to make money, to pursue innovative research and make a profit, but maybe we figure out how to …regulate… that market to keep the profit area solid, but not OMG great.  

Where I am going then?  Maybe we need to just design a basic state run care for those with pre-existing conditions, for those who cannot afford much of anything and really try to make it WAY better than the VA.  Maybe provide a basic plan of government clinics and out patient places staffed by people willing to work in public service in return for repaying school loans is one thought.  Let the states run these, and answer to the big Uncle so there is at least one check and balance.  Make everyone pay SOMETHING for this coverage.  Sales tax maybe?  Those who can get insurance policies keep doing so, with some of the improvements listed before, and many more great ideas from people like you hopefully added to the mix.  I really think getting tuition waived and a small salary to start while residents gain their experience will help the student debt crisis some, help get more broad experience to docs and nurses.  Some great docs out there are probably willing to help design this system and maybe do a day or two every month/week/ whatever to help train these new docs and bring up the quality of care in the clinics?  

Spitballing here.  This is the kind of thinking I have on the health care debate now.  It is an area I have tried to stretch from my limited government, balanced budget, seeing England and Canada do okay, but not great on this issue world view.  It is the closest balance to some of my most deeply held beliefs, combined with a very genuine desire to get everyone the best care possible.  One day I am going to be an old fart with lots of health problems and I sure know if I just ask for “ACME Insurance” to take care of me, I will be in a future version of a dumpster one day.  I also know Uncle Sam will hand wring his way to feeling bad that I died from a lack of an appointment for 6 months, but it still won’t remedy my deceased state. So, somewhere out there is a great idea or 20 to help solve this crisis.  I jokingly said once, we should have a reality competition show where the contestants/groups come up with ways to solve problems like this and we get to vote on their TV solution and who knows, maybe like Shark Tank (I think that is the show where they compete for funding of their great ideas) we can find a winner we can all invest in. 

 

Okay, I wrote this so I would have a record of how I felt, thought and viewed this issue in the here and now.  I am open to more discussion if anyone does want to engage.  Like most political issues, I try to have a reasoned, informed and smart take, but like most of you, I have only a limited scope of information and input.  Maybe I have one, maybe not.  It is a ridiculously complex issue which truly requires context and patience.  My next blog needs to be about sports or something!!

Ironic note: Writing this while on cold meds...