Thursday, December 23, 2004

Bush's health insurance reform is about protecting wealth, not health.

I think there's an important point to be made about George Bush's healthcare agenda and I haven't seen anyone else make it yet. Basically, George Bush is trying to turn health insurance from a health protection plan into an asset protection plan--move insurance from securing health to securing wealth.

George Bush's key initiative for the uninsured are Health Savings Accounts. The way these work is that basically, you buy a catastrophic health plan in case you get really sick and you put some money aside in a tax-free investment account for your smaller primary-care health expenses, like doctor's visits and prescription drugs.

There is some great rhetoric about how this will let people "take control of their health spending" and be more "personally responsible," but nobody's real clear on how this is supposed to make healthcare more affordable for working people. If you're really sick your insurance company will still pay for everything, so there's no money saved there. All we can really expect is that people using HSAs will be more "personally responsible" by saving their money instead of going to the doctor for checkups, taking prescription medications and other preventive and primary care stuff.

But most experts agree that we need to make low-cost primary care more, not less, accessible. You know, the whole "an ounce of prevention is worth a pound of cure." Even Bush believes this, so it's quite bizarre that he's pushing plans which make it more expensive for people to get primary care. Furthermore, the way the healthcare system works, we can expect the price of healthcare to actually go up (PDF) if healthy people switch to catastrophic policies. So we're not making healthcare more affordable, we're not making people act more responsibly--what's going on here?

What's going on here is a massive disconnect between the Bush administration and the reality of most people's lives. Most people could get catastrophic insurance today but choose not to. They choose not to becuase in most cases catastrophic insurance doesn't protect health, it protects wealth.

Most people believe that if they become sick, hospitals and doctors will still provide necessary care. This is wrong, but most people believe it. Therefore, most low-income working people won't buy catastrophic insurance. They recognize they may have to declare bankruptcy if they get sick, but heck, they may have to do that anyway. Why waste money on insurance?

However, better-off people will buy catastrophic insurance because their concern isn't whether or not they'll receive care, it's whether or not they'll have to sell their house (or their yacht) in order to pay for it. They're not willing to take the risk that a health crisis may bankrupt them.

And that's the key point here. The people who need a "traditional" health care plan are working people who need it to help them pay for doctors' visits, prescription drugs, and their kids' asthma medication. They need health insurance not to protect their assets, but to access healthcare. And as stated above, as more people move into a HSA-type plan it will get harder and harder for working-class families to afford traditional health care plans, and fewer employers will provide them. So it will be harder for working people to access health care. But, of course, wealthier people's assets will still be protected, and at a far cheaper price than before.

When you turn a health insurance plan into a tax shelter, you undermine the health care system and you make it harder for working people to afford the care they and their families need. The point of health insurance should be to protect health, not wealth. George Bush and the Republicans don't get that. And that's a problem.

16 Comments:

Anonymous Anonymous said...

I didn't really pay attention to what Hillary Rodham Clinton was doing about 10 years ago with her attempt to overhaul the American health care system. However, between her efforts to fix what I didn't realize was a problem, and the mass of confusion that has entered my consciousness as "the American health care system and crisis, I get the feeling that the real problem runs far, far deeper than any of these recent proposed solutions go.

Already, I've figured out that doctors, for all their talent and motivation, are not really the smartest people on the planet. They're just overworked, over-educated cogs of the health insurance industry. Well, insurance companies are money-making businesses, just as wholesale sales of automobile parts is.

So, the idea that the health care industry is separate from wealth is nice, but probably not true.

If that's the case, then the old-school ideal of a doctor who works for the sake of the health of his or her patients and the reality of what doctors must do in order to satisfy their obligations to insurance comopanies don't jibe well.

Is there a way to make our ideal of what doctors are supposed to be a reality?

That'd be a solution to the American health care situation worth being excited about.

-Taro Yamashita

3:08 PM

 
Blogger theorajones said...

Fair point. I've got a lot of opinions on how to go about real reform, and you're right, it's got to be much more sweeping reform than the average Joe realizes.

But my point here wasn't so much "take the money out of healthcare," becuase I think that's impossible. The point was that Bush claims his plan will help insure people's health by making it easier for them to access care, but when you look at the details, it's pretty clear that this plan will make it harder for poor folks to access care while making it much easier for well-off folks to insure their assets against healthcare-related bankruptcies. It's not a critique I've seen anywhere else, so I wanted to throw it into the mix.

Thanks for your comments, and stay blue.

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