obligatory health care debate post.

The current health care system in America is, for lack of better term, borked. We all know it - sure, if you have money and / or good insurance, you can take advantage of pretty decent coverage and the quality of your care overall will be second to none in the world.

But that's not the whole story. Insurance companies are in it to make a profit. That's THEIR JOB. There's nothing wrong, at ALL, in my mind, with a business making any kind of profit they want to. The problem for me is that the way an insurance company has to make a profit is, by definition, at the cost of money AND the health of their customers.

An insurance company has at its core the obligation to cover its customers for the care which they need over time. To cover this care, they charge premiums which pay for administrative costs (salaries, infrastructure) and medical costs (doctors, drugs, etc). This is fine and good - until you start looking at what happens when the insurance companies have to make a profit. In order to make that profit, they have to cover mainly healthy people. To ensure that this is the case, they have a couple of escape clauses - lifetime limits and pre-existing condition clauses.

When a patient hits a lifetime limit- in other words, has spent the absolute maximum an insurance company is willing to pay, they're cut off. A patient whose life depends on a lifetime supply of fairly expensive drugs, such as an AIDS/HIV patient, can hit that maximum rapidly. And then what? Find another company? That's the rub - the patient CAN'T find another company because insurance companies will NOT cover people who are already sick with a pre-existing condition. I can't blame them - they'd be out of business rapidly if they actually covered people who were sick effectively. In order to stay in business, they HAVE to act like they do.

The problem here really boils down to this: providing medical care is NOT a for-profit venture. When it is, it becomes dangerous to the people who most need it. Is the solution a publicly-run system? I don't think it entirely is. I think that there IS a place for privately-held insurance, but I also think that having coverage guaranteed to all by the government makes sense as well.

My employer pays ludicrous sums of money for employee health coverage, and the employees chip in on family coverage and pay in entirety for dental and optical coverage. The total cost per year rolls quickly into thousands per year - and as a percentage of total compensation, it's getting ugly. According to our HR guy, health care as a percentage of compensation has risen from under 20% per employee to almost 35% per in the last 10 years alone, and the numbers are rising rapidly while things overall coverage levels are in the decline and deductibles are on the rise.

A public, BASIC health coverage system which would cover things like prescriptions, wellness visits, trauma care, and ongoing health concerns (cancer, etc) would be something I'd be happy to pay higher taxes for. Knowing that these things are covered no matter what would be a relief- not only for me but also or all those people who can't afford insurance OR WORSE have already been disallowed by pre-existing conditions or lifetime limits.

Having additional insurance available from private companies to cover non-necessary health issues such as abortion, plastic surgery, "life coaching", etcetera, would be a great for-profit operation which legitimately COULD be run without public detriment.

Of course, all of these things are somewhat moot without a way to truly combat the spiraling costs of healthcare itself while still providing for innovation and research. My friend Sean brought some very interesting suggestions to the table recently in an email - from modernizing the information infrastructure to the creation of base clinics instead of multiple private practices. While there might be a bit of loss of the personal touch from doctors, the efficiency improvements should not only save money but also lives. The ability to go see a doctor when you need to without having to wait for your own personal physician (which you could still do if you'd like with private insurance!) could allow people who otherwise can't necessarily make their schedules fit their doctors due to work find the care they, or their children, need.

And then there's the other problem - politics. There is no way any level of effective and common sense reform will pass the congress any time soon. Democrats are badly led (WTF Pelosi? Do you have ANY idea how bad you are at this?) and Republicans are not doing an effective job at bringing alternative ideas to the table. Worse, the Democrats aren't even showing any sort of balls. They have a MAJORITY. They DON'T need 60 votes- they have their 50 in the senate. That's a majority. Bring it to the floor. If a filibuster happens (and it would rapidly), this is THE time to bring the "Nuclear Option" to bear- a majority vote which would end the filibuster and force legislation to be voted on by a simple majority.

Unfortunately, the same Democrats who don't have the balls to bring effective legislative change to this process are the same ones who won't have the balls to bring the filibuster to a close.

As an aside- This blog post was written on an Apple MacBook while sitting at a coffeeshop with my iPhone on the table and a fleece hoodie over my shoulders. I might implode from my trend-whoreness.