nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Monday, February 7, 2011

We Don't Need No Stinking Health Care Mandate

We've all been hearing about the constitutionality of the individual mandate in Health Care Reform.  NPR asks a few experts whether it's really necessary. (NPR Shots, Feb 7)

The government made the case that without the mandate, reform could not be sustained.   The uninsured would be freeloaders on the rest of the country, and premiums from the large group of the young and healthy were essential to pay for the care of the critically or chronically ill. 

The assumption of necessity was never openly questioned, although I've written a few things that suggest it isn't necessary, and so have some others.

NPR, from it's Lefty-but-painfully-trying-to-be-neutral stance, presents alternatives that all sound pretty cruel.  Suggestions that those who choose to opt-out of insurance would have to wait for the next round to enroll, or pay an extra amount for being delinquent.  It's all built around coercion as an ideological  and compulsory punishment for not falling into line.

But there are non-coercive ways to afford health care reform without punishing choice, or overcharging those who are ill and can't afford coverage.

Take a look at what NPR discusses and then I'll show some different alternatives.  Maybe a combination of policies from both groups makes most sense.

What an accomodation could do is keep us from a Consitutional battle that will either expand--in an unprecedented way--the power of government to direct our lives, or abandon health care for all. as unaffordable.

NPR (experts Jamie Court, Paul Starr, and Len Nichols):
 "You could offer discounts to people who sign up early. You could increase premiums for those who delay," he says. "Medicare actually does this."

"...if they choose to remain uninsured, he says, "you won't be eligible to opt back in and get any of the benefit of the subsidies or use new health insurance exchanges or buy without pre-existing conditions exclusions."
"...if people don't buy insurance when it is first available, "if you ever try to buy insurance again, you'll have to pay three times the market price, and we will put a gold sticker on your forehead and say to all hospitals, 'You do not have to treat this person; this person has forfeited their right to uncompensated care.' "

"Make the states do the hard work. Lawmakers could withhold federal funding in the health law unless states require people to have health insurance.
Just like the penalty under the mandate, these all punish people for choice.
By contrast see these suggestions:

Eliminate the employer-based tax deduction, and the individual health tax deduction.  At first, you might think this raises taxes on the worker.  No.  It gives the worker wages that the employer was keeping from them to pay the government.  Also, we have a progressive tax system; without a deduction, the wealthy will pay more.  Estimates are that this will generate several hundred billion dollars in revenue, while giving employees more income to spend for themselves (or on health care).

Put pressure on insurance rates to stay competitive by opening up the market, as it now is for car insurance.  This will eliminate New Yorkers paying 3-4 times as much for the same coverage as a resident of Columbus, Ohio, pays.

Pre-fund Medicare (as in pay ahead) and reset the age.  Quit expanding the entitlement through printing money.  Medicare was designed back when the average life expectancy was 62.  It's now 78.  Pass a law that says Congress can't raid the Medicare fund for pork and other earmarks.   Then we can live within the budget.  Right now our young adults are paying for the old folks, and the river will run dry.

Never curtail innovation by setting cost/benefit limits.  Reward innovation.  Other countries have stumbled by denying new care that has cost thousands of lives.  They only started paying for treatments after citizen protests.  How many died in Canada, New Zealand, and GB because these countries said that Herceptin for non-metastatic breast cancer was too unproven to justify the $55,000 cost of treatment?  Patients' needs are unique, not consistent with a computed average benefit.  In summary, get the government--who sets reimbursement rates--out of the business of deciding what care is best.

I won't go over tort reform, Medicare fraud, and all the other things you've heard about.  Those are sources of funding that can contribute to covering us all.  Tort reform works in my state, and no patients are harmed without plentiful compensation.  We just don't waste resources on frivolous suits.

The governments with big, coercive systems are running out of money.  They don't get as good care (despire arguments to the contrary:  yes, they get great care for common ailments, but their cancer survival rates are poorer).

So which approach sounds better?

And we don't need an individual mandate for either approach...or a combination of both.

Doc D

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