One reason for the great heat involved in the debate over health insurance is that the American rank and file doesn’t know what their plans cover, what benefits are paid and how much they cost.
A large part of the reason for this is that in our employment based health care system the same employers offer vastly different benefits for the executive segment of their work force than they offer for the rank and file.
It is one of the more pernicious manifestations of American compensation that the executive segment, with vastly higher earnings to work from receive preferential treatment from their companies and are generally offered insurance plans with greater benefits and lower relative premiums.
An indication of this can be found in Medicare, which as a public system has information open to all.
Numerous proposals have been floated for reforming Medicare to help with its oncoming insolvency, some ideas that have been floated include raising the benefit onset age, raising the Medicare tax, eliminating private benefits and increasing consumer choice.
It can be easily predicted that further increasing the benefit age from 67 would destitute a large group of people who are not in good health and whose work prospects are compromised both by poor health and by poor job prospects stemming from their age.
Increasing the payroll tax is universally hated among younger voters and may well result in a generational revolt against the system.
Cut waste- this is pure tripe, repeatd studies show that Medicare is highly efficient and effective in translating premium dollars into benefits. If the military were subjected to the corrective action, anti-fraud, and other waste cutting measures that Medicare is already subjected to, we would see lions eating with lambs and a small child would lead them.
Let patients drive- this has a populist political appeal, but is not even a responsible proposal. The number one cause of dissatisfaction with physician care is that physician's have an impersonal, i.e., clinical approach to their patient.
The let patients drive mode has a great deal of political appeal, because it appeals to our idea of capitalistic self-sufficiency and makes it seem that we are in control.
But health care insurance is not about consumer choice, if I am sick there are certain efficacious remedies and then there is everything else.
I can neither choose my disease, nor the medical interventions that will effectively suppress it.
Health care insurance must be seen as shared risk: we will all get sick and by paying our premiums we care for those who are sick now.
The deal that we have made is that when we get sick, the premium payers will keep paying and cover our bills, too.
But human nature and politicians being what they are, people seek what cannot be.
One of the main proponents of letting the patients drive GOP Presidential Sam Brownback is also promising to end cancer deaths- from the White House.