The Health Care (Insurance) Gap

First, let’s get this one thing straight, because a lot of the astroturfers and even reporters and politicians are not getting it. Health care is when you get sick and the medical profession fixes you up, or some version of that. How good our health care system is becomes a matter of how good the medicine is. We in the United States and in Europe, Canada, etc. have pretty good medicine, though there are impediments to quality medicine built into our political and social systems..

Heath care INSURANCE is the system for paying for the medicine. The current discussion in the US is about health care INSURANCE reform. The United States might (or might not) have the best freakin’ health care system (the medicine) in the freakin’ world, but it has one of the suckiest health care INUSRANCE systems in the world. And that is what we are trying to fix.

There are two major kinds of cracks in the health care INSURANCE system. One is the uncovered or uncoverable (because of economics or because the insurance companies just don’t want to). The other crack, and the one that about half the middle class falls into, and the one that should have galvanized the politically powerful in this country, is this one:

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Comments

  1. #1 Dan J
    August 28, 2009

    Can we count on the Republicans to allow facts to stand in the way of their ideology? I’m not finding much hope, unfortunately. It’s really, really pathetic, and I’m at a loss as to what more to do about it.

  2. #2 JL
    August 28, 2009

    CRAP! After a great build up, I am disappointed that the Read More pointed to someone else’s blog rather than continuing on with Greg’s wisdom on this issue.

  3. #3 Bob Calder
    August 28, 2009

    Thank you Greg. Very clear expression but you might have pointed to the blog of someone whose job was lost due to too many sick days, having unaffordable COBRA. I don’t suppose suicides blog though.

    Insurance companies have put themselves in a standoff situation where picking up populations of sick folks would put them in a very weak competitive position. They can’t get out by themselves and their marketing methods promote the status quo. It’s not as if they can’t make money. Insurance functions no matter what is in the bag.

    On the other hand, what can you say about delivery organizations that hire specialists who alter a database to bill all bedpans as “sterile” so as to get twice the payment? It isn’t exactly a lie, but by the time they are delivered, it is not exactly true.

  4. #4 Greg Laden
    August 28, 2009

    JL: Sorry, I usually don’t use that format…

  5. #5 Alan Kellogg
    August 28, 2009

    Medicaid is administered by the individual states. Medicaid in California (aka Medi-Cal) has set fees it pays for services rendered. Those fees do not pay for the services rendered. Any doctor accepting Medi-Cal patients loses money thanks to the low payments and the paperwork Medi-Cal requires before it will reimburse the provider.

    Because I depend on Medi-Cal to cover the cost of my health care there are services I can’t take advantage of. Services that won’t accept Medi-Cal because Medi-Cal won’t pay enough to cover them. My medical care is already being rationed by a government program, don’t think it can’t happen to you.

    Talk with medical professionals in your town, ask them about your state’s Medicaid program and the fees it pays for services rendered. Ask them if Medicaid where you live covers the cost of medical treatment or not. Don’t be too surprised if the answer is, “No.”

  6. #6 Miss Cellania
    August 28, 2009

    Medicaid in Kentucky is wonderful. I have a family of six. One is on Medicare, two are on Medicaid, and two are on K-CHIP. All provide excellent services, much better than the insurance I had when I was covered under an employer. Then there’s me, I’m the one not covered, so I don’t get new glasses, pap tests, or dental checkups, and if I get sick I have to use my credit card to even get in the front door.

  7. #7 Stephanie Z
    August 28, 2009

    JL, you are not fascinated by my deathless prose? I’m hurt. Hurt I tell you. (Also slightly tipsy, but someone broke out the Macallan cask strength tonight. Did you know it evaporates before properly hitting your tongue?)

  8. #8 travc
    August 29, 2009

    Sorry to get pedantic (not really), but your distinction between the healthcare system and health insurance system is really wrong. There is an important distinction, but you are putting the line in the wrong place!

    Health care includes availability and delivery. A country has sucky heath care if only the aristocracy can access it. The aristocracy might have great health care, but the country, no.

    Health insurance reform assumes we have a health insurance system. That isn’t even necessary to have a health care system. (Yeah, you can play with the definition of insurance to expand it beyond recognition, but the point is clarifying the issue.)

    The US has pretty good healthcare providers (doctors, nurses, ect). We have pretty good medical technology. In the aggregate, we have crappy and inefficient delivery of those resources. That is a bad healthcare system. Health insurance reform *may* be one of several different ways we could improve it.

  9. #9 DuWayne
    August 29, 2009

    travc -

    Then please tell us – what are these several other ways to improve the system, that don’t involve what amounts to public health insurance?

    The problem of paying for services is an availability and delivery problem.

    Alan Kellogg –

    I would rather have limited options, than no options at all. I can’t afford insurance and were it not for the fact that as a student, I get care through the school clinic cheap – I would be in a lot of pain – as it is, I have been spending a great deal of money just to stay on meds. Now that I am using clinic services it will be much more affordable, but that doesn’t translate to a comprehensive coverage situation.

    I would be absolutely thrilled to have medicaid level coverage. Not having to live in fear of what I will do if something horrible happens – not having to fear racking up more massive hospital bills, should I need emergency care – I would happily accept some rationing for that peace of mind.

  10. #10 travc
    August 30, 2009

    DuWayne,
    I’m being pedantic and contrary (as usual), but since you asked…

    Health insurance implies a fee-for-service model, which is not even close to the only option.

    We could, for example, have all medical practitioners be salaried public employees who provide services without regard to payment.

    Hell, there could even be a ‘medical priesthood’ who support themselves on donations (and owning valuable land and spiritual blackmail). Works for the Catholic Church ;)

    One could call these forms of insurance, but that is really stretching the meaning of insurance.

    Insurance smooths out some of the edge conditions with a market based allocation of resources (such as “the house always wins eventually” effect). However, markets are not the only way to allocate resources. In some cases such as natural monopolies, commons, and I’d argue healthcare, markets don’t work well even in theory.

  11. #11 Greg Laden
    August 30, 2009

    travc: You are mmaking a three part distinction (not moving my line). A: Medicine, the art and science b: the delivery system and c: the way to pay for it.

    It is incorrect to say that B (the delivery system) is inefficient. I say this becasue about 20 years ago it was decided that the delivery system would become privatized and the units of decison making would be broken down to look like small businesses … and the HMO was born. Market forces then went to work and made the delivery system perfect, or nearly perfect.

    Or did I miss something?