Our national health care system is perfect for what it’s designed to do. What it is not designed to do, though, is maintain a healthy population. It is not designed to provide quality health care, except for a select few. It incidentally provides adequate health care for a multitude fortunate enough to have employer provided insurance.
It’s almost never employer-provided care, just employer provided insurance. Insurance that often buries the care with an avalanche of paperwork. Pay first, then apply for reimbursement is a common feature, as is denying the claim for some technicality. You left out your middle initial, resubmit. Some cover 80 percent, or less. Some have limits including lifetime, that are easily exceeded. Some limit where service can be provided, perhaps to one inconvenient clinic or pharmacy.
There are government insurance programs too: Medicare, Medicaid, Tricare, VA. Most have that same feature, paperwork first, then copay and benefit limits. Surprise! These features are explained as ways to limit frivolous claims. As if too many healthy people would over-consume health care just because it is there.
So, what is it designed to do, or more accurately, what has it evolved to do? The system functions to maximize the amount of money that flows through the insurance carriers. The motivation is to create higher billing to justify higher premiums. The more money they handle the more profits they can in turn scoop off, and the higher salaries they can justify for insiders. Some estimate that of every $1 dedicated to health care 40 percent is consumed by insurance either in the form of profits or administrative cost that has no benefit to the patient. It might be higher, but the system is so convoluted that analysis is nearly impossible. Why does a hospital bill $3.50 for an aspirin? Because the insurance demands itemized billing. It’s 10 cents for the aspirin and $3 for counting one aspirin and adding it to the itemization.
One solution would be a national health care program. The opponents argue extremely high cost ignoring the fact that almost every other civilized country manages to afford it. The difference is that they don’t have a profit-seeking insurance industry between the patient, the service provider and the payer thus eliminating the per-patient cost accounting.
To understand our health care cost problem, imagine if our public roads were pay as you go. There would be a toll booth at almost every intersection, some streets would charge more than others, some would be in better condition, some might have limited hours.
To avoid stopping frequently there would be competing companies like Easy-Pass with confusing coverage. They would need profits and would police the system against cheaters, expensively. It would not be long before the cost went up or quality compromised. There would be an expensive claims bureaucracy. Instead, we all pay tax into a fund and government builds and maintains roads. Sure, there are some over-users, and some poorer roads, but everyone benefits from having efficient transportation whether they use it directly or indirectly. It lowers other costs for everyone.
How about police and fire? Imagine if you called 911 and the first question was not, “What’s your emergency?” but, “Do you have insurance? What’s your policy number?” Before the first responder arrives, there is a clerk with a clipboard of forms to be completed. Just like hospital admissions.
National defense! We all enjoy the same benefit but we do expect those who have more to pay a fair share. Fair is hard to define, but uniformly uncomfortable to pay would be a reasonable goal.
Health care is not an entitlement. It should be thought of as public works. We can all help pay for it, and all benefit, directly as patient, indirectly as an employer with health workers who show up, as a parent not having to worry about a typhoid Mary babysitting or serving lunch.
Ken Obenski is a forensic engineer, now safety and freedom advocate in South Kona. He writes a semi-monthly column for West Hawaii Today. Email obenskik@gmail.com.