President Obama has said countless times throughout his presidential campaign and his presidency that the time for change is now, and that health care is his top domestic priority. What we're looking at here is a possible individual mandate, which is arguably the major element of the bills that will affect all Americans. However, based on the soft fines imposed on those who opt out of the mandate (as low as $250 per person annually), it doesn't really strike me as an incentive for those who prefer to not be insured to go out and jump into the boiling pot of health insurance. The bottom line here and the real root of why this individual mandate will likely pass is that insurance companies need the 45+ million uninsured people to join the pool of those insured to off-set sky rocketing premiums. But digger even deeper here, we uncover the nasty, hush-hush topic of rationing health care. Certainly it is one of the most sensitive topics brought about throughout the debate over health care reform, but something I haven't addressed in my blog until now.
When President Clinton first proposed rationing health care in the 1990's, the idea was met with hostility and high emotion as people couldn't fathom putting a price on someone's life. But the situation we're looking at now is that one in six dollars spent in the U.S. is on health care, and health insurance premiums are increasing at a rate four times faster than wages. Four times! Additionally, we are in fact already rationing care already based on the high cost of care and prescription drugs. People are making decisions based on how much a doctor or hospital visit costs. Is it worth the $25 co-pay to see my doctor while I have a cold and the $40 on the two prescriptions, or just wait it out. In recent years, I tend to just wait it out, take a sick day and save the $65. On a much grander scale, millions of American's are faced with the decision of whether or not to pay to get their diabetes medicine, or buy groceries for their family.
The majority of money spent on health care each year - about 70%, is spent on care for the elderly and end of life care. That's not to say that 70% of people with insurance are elderly, it's in fact the opposite; a small minority of Americans absorb the majority of health care dollars. Research results have proven that compared with other developed countries around the world, The United States doesn't even come up in the top five or even 10 in terms of mortality rates and quality of care. At some point, as crude as it sounds, there needs to be a value put on one's life. Should hospitals and insurance companies spend more time and money on a 80 year old cancer patient to receive medication that would cost $30,000 and would prolong their life for a couple more months, or spend it on a costly transplant surgery for a teenager who has decades more to live. What if that cancer patient were your grandmother? What if that teenager were your son? Not an easy decision to make, but at this point in time, since those decisions aren't being made and money is being spent with some element of moral hazard, we have to look at the results on how it's affecting the bigger picture - sky rocketing costs of health care and the quality of care for millions of Americans that's compromised as a result. Should it be the government making these decisions and advising on how to ration? No, which is why I think the mere mention of this by the Clinton administration left them dead in their tracks. But what some researchers are finding is that by implementing some sort of third party regulator to identify what is too costly for insurance providers to be spending on a given case, costs for health care as a whole tend to flatten out and people actually become more conscious about the decisions they're making about their own health, if it means they have to pay for certain things out of pocket.
The moral hazard that we've seen in recent decades with health insurance is that actual costs of doctors visits and hospital stays and medications are not clearly communicated to consumers. All they know is how much their premium is and when they have to pay a co-pay. Consider this: if you injured your knee playing flag football and needed and MRI, have you ever considered calling around to the hospitals in your area and asking them how much they charge for an MRI? Likely not. The reason I ask is that each hospital has difference prices they charge, which are all dealt with behind the scenes between the insurance companies and the providers (hospitals, doctors), so you aren't in a position to call around to make sure you're getting the best deal, the way you would if you were shopping for a car or a contractor to remodel your kitchen. And that's where the moral hazard comes into play. If Americans were put in a position to be more conscious about what services they're getting and play an active role in their health care by paying for fees out of pocket, perhaps they would be more inclined to lead healthier lifestyles. Some researchers have actually gone so far as to suggest that citizens should be required to obtain catastrophic health care insurance, but all other routine, non-catastrophic costs be paid for out of pocket. Though it is a radical idea, it's one that's worth thinking about.
While my intention for this last blog post was not to scare you or depress you with the sad state of health care in our country, I do want to open your eyes to the fact that at the end of the day, no matter what health care reform legislation passes, you are in control of your own health and your own life. In the words of Michael Pollan, "eat less, not too much, mostly vegetables." As long as we're faced with increasing health care costs, we might as well take action and combat them with impressively healthy lifestyles. Of course watching what you eat isn't the only thing one should focus on to be healthy, but it's just something to get you started as you wonder, "how can I make a difference in this big mess of rising health care costs?" It is likely that some form of health care reform will pass through the White House in early 2010, so prepare yourself for, well, very small changes that will likely only affect specific groups of people and types of insurance. While it has been incredibly interesting to follow the policy change as it passes through the Senate and the House, I've come to realize, as long as politicians are in charge of my health care, I might as well take as much of that control back and determine my own health destiny, and you should too.
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