Health Care. It has been a raging debate for years. We are seeing our first real deal health care plan that might go into effect. Finally, some people would say. Others would say that it's going to bankrupt us. Still others would say that government run health care would be awful. So, what's going on here, and how can we navigate this crazy, twisting world? Let's start with the last argument, and work backwards.
Being military, I get to deal with government run health care all the time. I must say that my experience with it has been pretty awful. I broke my foot once, and was told to wait there while the doctor writes a profile and gets me a boot (minor fracture, and a boot was enough for it). 3 hours later, I found out the doctor went home for the night. No boot, no profile (where I work, they make you run and do calisthenics unless you have one), and no one I could talk to that could get me those things. That was fun. Or waiting in the room for the doctor to come in for an hour. Or having knee issues that are later to be found to be legitimate, but at the time being told that it is not a big deal and to take some Vitamin M (our term for Motrin. They hand it out like candy). Yeah, there are a million stories I could tell about government run health care, but that would get kinda tedious and boring. So, the gist is: it has sucked for me. But, at least I have health care, and there have been some scary emergency room trips that I haven't had to worry about the bill for (not to mention the birth of my son - that bill would have been killer!). And that is nice.
But, that certainly isn't the best medicine in the world, and we here in America tend to assume that we can have the best (or we believe we already do). How do we keep the level of quality we already have, but still get health care access to all? And how do we do it cheap? Well, that was supposed to be the job of Medicaid, but that cheap part doesn't seem to be working. And the quality part doesn't seem to be working either. For those of you unfamiliar with the system, I will try to explain as best as I can (this is a VERY bulky and complicated system that even the people working inside it can't seem to navigate properly - just part of the problem there).
Drinking the 'Caid
When you first go to get on Medicaid, you are evaluated to see if you meet their super-stringent financial requirements. Probably the worst part of the whole ordeal is that it is a system that is designed to keep you poor once you are in it. If you save money, then they will kick you off Medicaid, and there goes your insurance. If you start making too much money (say minimum wage full time - here is Georgia's for example, varies by state) they kick you off (which I kind of understand, but there are many circumstances where you can make a decent amount of money and still need Medicaid - like your employer doesn't offer health insurance, or you have to wait a certain amount of time before you can participate). They seem to make sure that if you are going to be on this, you are going to stay poor. No overlaps, no ween off programs. That seems to be an issue in itself.
If you meet requirements, then they give you a physical. After that, if you have any problems, they send you to a generic doctor that they approve. And that doctor must refer you if you need any kind of specialist. That doctor doesn't get paid much for the work they do, and the specialist agreed to take whatever Medicaid said they would pay (which changes each year - most doctors who do this are starting their own practice and do it to drum up business. Once business is up, these docs lose interest in doing a good job for these referrals. As always, that doesn't apply to every doctor out there!). So, you have a general doctor who doesn't care referring you to a specialist who doesn't care. Sounds like a great combination that will definitely get people the health care they deserve! This is a VERY basic overview, and there are many more wheels and cogs that go into this process. Like all the paperwork you fill out, the fights with the Medicaid office to actually pay the bills when they come in from the specialists, getting assistance to get to the doctors (some could be half a state away), making sure that the doctors understand and document EVERYTHING that is going on with you, and it goes on and on and on. Try doing all of this when you are disabled, drugged up, and tired of dealing with the system.
The other problem with it is that it is expensive. It is a very bulky system after all, and anything bulky is also expensive. Over $350 billion annually. On average, that is over $5,000 per person on Medicaid per year. The average family only spends around $13,000 per year on health insurance. So, why does the government pay $20,000 and gets worse service? Convinced we need some kind of health care reform yet?
Doing it Smarter
Why aren't we doing things smarter? Isn't there a way we can get poor people health care without going bankrupt? Isn't there a way to make sure that we maintain care for those who most need it? I think there are some things we can do, but it will take effort and a lot of people willing to sacrifice. Let's make another of my fun lists:
1. Switch from government-run super bulky system to just paying premiums at a leading insurance company. This seems like the most obvious way to save some money. I don't think I need to cover this too much.
2. Start allowing people on this to have a savings. Encourage a savings. Tell them that they won't have to do a copay if they can keep $1000 in the bank. This way we alleviate having to bail them out for other things, and allows them to take care of the things that most leading insurance plans would require them to spend money on. This would also teach them that saving is good, and possibly lead to them getting off of the program (because they no longer need it).
3. Which brings me to my next point. We need to come up with good incentives for people to get off the program. Some people can't and will never be able to, and that is fine (I am willing to pay my tax money to help those people out). But those that are capable, should be working to get off of it. As of 2007, there were 58 million on Medicaid in one form or another. That means 1 out of every 5 Americans is receiving it. That is too many, and we should not tolerate those that can get off of Medicaid sitting on it. It should be a temporary solution for most people.
4. We need to work with health insurers to help bring down costs. For helping with Medicaid, we could offer a small tax break, the ability to advertise that you help the poor, and some free advertising from the government. We could also send billions in business your way. That should help with some convincing. Also, we should do it like we do any other government contract. You bid for it, and may the best bid win. That should help keep the cost down.
5. We need to get some outreach programs (and this is not just for Medicaid, but for all of our social programs). Accept donations to help pay premiums. Reach out to educators to teach those on these programs how to manage finances. Have the nannies from all of those popular TV shows help these people learn how to raise their kids. Have professionals show someone how to run a household. Get doctors to teach people when it would be a good idea to go to the hospital and why preventative care and healthy living are so important. Get the financial services industry (to help restore a good name to them) to teach people how to run their finances and what kinds of investments and loans are out there and what they mean (and what they are used for). In essence, teach people how to live (either that or require at least 2 years military service - I know I have gotten those lessons over and over and over again). This is probably the most important.
In the end, we need to do a better job of getting and keeping people off of those programs. They are in place as a failsafe - and they need to be there - but we cannot just use them as a good alternative to working and getting these things ourselves. I know that I thank God that I was born into a country with these programs, as I have family on these programs in situations out of their control. If these programs weren't there, I don't know what they would have done. They would be pretty desperate and desperate people do crazy things. I would rather my tax dollars get involved before the prison system does. I just think we can and should be doing better.
Saturday, April 9, 2011
I care, you care, we all health care