Sunday, September 6, 2009

Advocating for universal health insurance

Some of you long term readers may wonder if I've had a change of heart after reading my last blog advocating government run health care or the public option. Especially if any of you read the entries in August where I compare government insurance to cash for clunkers and the French health system. In those cases the objection was to government incompetence estimating the cost of a federal program requiring an ever increasing tax rate to fund it or a poorly run system that requires long waiting times for patients to see a doctor and poor reimbursements to physicians.

But is the private health insurance industry doing a better job? Patients have procedures delayed if not denied while waiting for approval from insurance companies. Our premiums go up every year while their CEO's enrich themselves and their shareholders. According to Highline Data Analysis, the total health insurance industry revenue in 2007 was over $400 billion, having risen 8.7% over the previous year. The health reform bills in Congress attempt to cap the cost at $1 trillion over ten years. Let's say we are especially generous and want to give universal health insurance at a cost of $2 trillion over ten years. That is only $200 billion per year. If only half of the health insurance industry survives and the money instead goes to the government for unversal care, costwise we would still wind up even.

Or if nearly the whole industry is subsumed by the federal government and the premiums that otherwise would go to the insurance companies instead goes towards a tax on everybody to pay for health insurance, like the current Medicare tax withholdings, then the feds will have over $400 billion per year to expand coverage. That's $400 billion for opening new hospitals and health clinics to alleviate long lines and waiting times. The time and money wasted in dealing with multiple insurance companies for reimbursements and treatment approval is a savings that is difficult to quantify but real. The peace of mind people have knowing they will have insurance regardless of employment or pre-existing conditions should also factor into the cost equation.

Ironically some of the biggest objectors to a truly universal public option are the unions, normally a stalwart of liberal Democrats. One of their biggest accomplishments is the employer covered health benefit. The unions have been the most vocal about taxes on health benefits, even for "cadillac" plans costing tens of thousands of dollars per year, never mind that those plans are usually reserved for the reviled corporate executives. If universal coverage existed, the need for corporations to spend billions on employee health insurance disappears and the unions' raison d'ĂȘtre is diminished.

So there you have it. The key is that everybody should have peace of mind when they get sick, not worrying about denials of treatment or policy cancellations by their insurance company. Subsidizing people to buy insurance will not change the industry's current practices. As physicians we should all be out front advocating for our patients. The money is already there; the nation is already paying more than the cost of universal coverage through our insurance premiums. The cost is also carried by the writeoffs doctors and hospitals make because they can't collect on treatments for the uninsured. If this sounds wishy-washy, well it's my blog and I'll say it if I want to.

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