One proposal is to allow health insurance companies to sell policies across state lines in order to foster greater competition int the market. Although well intentioned, this idea is fraught with problems. Under the current system insurance companies must adhere to the regulations of each individual state and must be licensed to operate in each state within which they do business. Each state has the right and ability to regulate the industry in their own state as they see fit. Much is made of states rights. Would this new "interstate competition" not trample on those state rights? Would a company operating out of Georgia and selling policies in Michigan be subject to the laws of Michigan or those of Georgia? I have not heard this question asked or discussed. Until this question is asked, discussed and answered I don't see it as being a viable concept.
Different insurance companies can reimburse one doctor at different rates for the same procedure. Likewise, hospitals have to negotiate reimbursement rates with each company they accept. This is insane. This creates a vast and expensive bureaucracy that wastes money better used on patient care and is, I believe, ultimately unsustainable. A single payer system would be a better option but practically unworkable given the present climate in the country.
Growing up under the Canadian system, I wish we had it here. Everyone is covered and no one goes bankrupt because they get sick. The system is not prefect but it works and the vast majority, even if they complain, would not want a private system for anything.
Contrary to popular opinion, Canada does not and never did have a national or socialized health care system. Rather, it has a national health care policy. Each province has its own insurance system and those provinces often squabble over inter-provincial reimbursement rates. Health insurance is socialized but health service delivery is private. Doctors and hospitals do not work for the government. Canadians have more choice of doctors and hospitals than many Americans do. HMO's tell you what doctors and what hospitals you have to go to and what procedures they will pay for. Canadians have no such restrictions. The insurance system has no say over your treatment.
What the US needs is a hybrid system. Pre-existing condition exemptions must be eliminated. Doctors must not be able to be over ruled in treatment decisions by anyone except their patients. Annual and lifetime limits to coverage have to go. Policy cancellation due to illness must be banned and Copays, deductibles and coinsurance must have reasonable limits so as not to force anyone into bankruptcy. The entire structure and concept of risk pools in the industry needs to be reconsidered.
The idea of insurance is to spread the risk out over as wide a pool as possible. The idea of taking the sick and those at high risk and placing them into a separate pool from those who are healthy defeats the entire concept of spreading risk. Instead it only serves to concentrate the risk. This may not be a popular idea but it is a fair idea.
Many European countries use private insurance companies but rates are regulated for basic coverage and companies cannot make a profit on those policies. Their profits are made on supplementary policies purchased by those who want them and can afford them. Surely this is a concept worthy of consideration. I really find the idea of making huge profits from the illness of another human being repulsive. Earning a reasonable living is fine and expected but billions of dollars of profit for shareholders who provide no service to patients is just wrong.
We need federally regulated minimum standards but State regulated standards of practice within their borders. Larger pools spread costs out and result in more fair premiums for all. The more people who are covered the greater the risk is spread and the lower the cost to the consumer. Lower premium costs will allow more people to participate and continue the cycle of reduced premiums for all. Those who, through no fault of their own, still cannot afford to purchase coverage must the be taken care of by a level of social coverage. Just as we can't allow people to starve to death and provide food stamps, we have a social and moral responsibility to provide for the poor in a responsible way other than the emergency room.
I have heard that the constitution does not provide for federal guaranties of health care but I tend to disagree in part. To "promote the general Welfare" must include personal welfare and ones health is surely part of that.
I have also heard that heath care is not a right because it is not mentioned in the constitution. Healthcare as we understand it now did not exist two hundred years ago just as many of our other rights were not originally mentioned. Although I believe the preamble makes a case for it to be a right, the amendment process still works and perhaps the right to healthcare should be formally enshrined and the naysayers silenced.
Ultimately, a federally supported, state run single payer system would be a more efficient and cost effective one but, given the realities of the present environment it is not workable.
Government regulation does not mean and never has meant socialism. Free enterprise should not supplant fair enterprise and fairness is all I am really proposing.
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