A View From The Press Box

In Canada, one retains the right to sue when a health care practionner fails in his or her mandate.

The reason that premiums are not outlandish is the awards at judgement. We haven't hit the statosphere, where millions of dollars are awarded by sympathetic but non-thinking juries, who fail to realize that we all end up paying for such folly.

Surely a country with so many other achievements to their credit could put together a plan that synthesizes all the positives of their neighbors health plans.

First, thank you for the week-long series of blog postings. The state of our health care financing system has been a concern of mine for a long time, not least because I had to "go bare" for seven months during a long period of unemployment several years ago.

Second, where can I go see a movie for only six bucks?

Seriously, I think the system needs reform on several fronts.

Insurance premiums rise (at least in part) because the costs of the goods and services they buy rise. So, one point of attack has to be the factors that drive health costs higher.

That's probably a combination of overuse of the system by a few (not the majority, as so many free-market purists would have us believe), large jury awards, new and expensive technologies, high drug development costs, an aging population, and other factors I don't have room to list.

Any reform has to examine fair and effective ways to address those factors.

I personally reject the idea that a private insurer bureaucrat is better than a government bureaucrat. I'm not a violent person by nature, but some phone conversations with health insurer "customer service" reps have left me wanting to choke the daylights out of them.

Far too many profit-oriented insurance personnel seem to believe that their purpose should be to deny or restrict claim payments, not take care of the customer. They can do this because it's difficult for the customer to change insurers. There's little downside for the insurer when its staff performs this way.

That's not the free market I learned about when I minored in economics in college. I believe that, if insurers will not voluntarily improve their performance, the role of government in overseeing that performance must be increased.

Lastly (I don't want this post to seem eternal), we as health care consumers must have skin in the game.

Public health care is a public service, much like water, law enforcement, fire protection, etc. Therefore, everyone--even if they're young, healthy and feeling invulnerable--should have to pay something.

We also have responsibilities to take care of ourselves--wear seatbelts, watch our weight, exercise. I freely admit that I weigh more than I should, and this summer I've taken up running again to try and do something about it. This will hopefully hold down the cost of my own health care, and incidentally reduce my risk of heart disease, which I understand is none too enjoyable.

Thanks again for jump-starting the debate. I look forward to more discussion as we slog through the election cycle.

SAM RESPONDS:

My wise spouse purchases discount tickets from the local movie chain that entitle us to see just about anything for six bucks. A blockbuster like Potter might not be eligible for the discount until the second or third week, or they might charge an extra dollar to honor the ticket.

Public services such as law enforcement do not have the duty to protect the individual, but to serve the community as a whole. Same with fire protection and other public services that exist to provide a community service.

That's a major difference in providing governmental healthccare, in which we are looking at individual services being rendered with the resulting liabilities. As with any governmental service, there will have to be some sort of immunities built-in, or such a system will never work in this litigious environment.

As others have posted in previous posts and blogs, until we eliminate--or at least minimize--the abuse of the legal system in awarding huge amounts for alleged medical malpractice and injury, I agree that we won't see a viable system operating here.

To again look at the Veterans Administration, as bogged down as it can become due to lack of adequate funding, the care in most facilities is excellent.

With staffing already in place and equipment available, if time slots are available, there is no reason not to perform testing--unlike at some HMOs, who will fight to the death (sometimes quite literally) to avoid expensive MRIs and other diagnostic testing.

In my opinion, with some fine tuning and proper funding, the VA could become the model for what nationalized health care is about in America.

I recognize there has been some bad press recently on military hospitals, but you need to separate those run by the military and those run by the VA and look at the overall record to separate fact from hysteria.

My son and his family live in Germany. They have a form of national health care, and he reports that it works, overall, very well.

On the other hand, I have a friend here in California that would like to retire at age 60, but cannot due to his wife's pre-existing health conditions.

Michael Moore is mostly right in his assessment of our health care insurance system.

I agree that the VA system can be used as a model. Their buying power alone for drugs and new technology make their system attractive. It is exactly what states should be given the ability to do. We don't need a federal system, but funding and oversight provided at the state level makes sense.

Moreover, I'd pursue a system similar to what the politicians receive, which I believe is private health insurers who lobby for that business--paid for by the state government. Who, after all, is better to extend credit to than the government?

Obviously no one insurance company can provide the best care in rural Texas and in urban NYC. So I say, allow states the ability to negotiate plan design and cost for the citizens of their state.

It is highly likely that more than one plan or company might exist from which the citizens of the state could choose. Funding would come from a combination of payroll taxes and sales tax.

However, all citizens would be covered from birth to death--do away with Medicare completely.

Obviously both payroll taxes and sales tax would be increased. But some businesses like mine would no longer provide those benefits and would transfer those dollars to my employees in higher wages. Those wages create higher income tax revenue for the state, or the deduction from their paycheck could be done "pretax."

My point is that consumers would still have private insurers underwriting, paying claims, etc.--NOT a government employee. However, the government holds the purse strings, and therefore the insurer would endeavor to keep customer service at a premium or risk losing the state as a huge client.

Insurance companies then could provide "supplemental" plans similar to what is offered as Medicare Supplement plans right now. That, for example, is what employers COULD offer an incentive to attract key employees. But basic coverage for hospitalization would be provided for all citizens.

So in many ways the free market still would be in place, but efficiencies would increase, in my estimation, from the insurance companies again for risk of losing the business.

Lastly, if insurance companies would potentially be sued by the state attorney general on behalf of the citizens of their state, something tells me that fair and accurate claims handling would be their norm.

Moreover, as your writer from Canada suggests, potentially an attorney general representing all citizens could best decide what would be a fair judgment to seek, instead of a trial lawyer trying to pay for his waterfront second home who is only representing a single client.

This is the best of both worlds, as your July 16th editorial on "Sicko" suggests.

Sorry for the length of this posting, but this isn't rocket science. If lobbyists from insurance companies are removed from the discussion, this is a problem with a simple solution.

We are a family of insurance agents in Illinois and write some health insurance. As my husband says, we derive a small portion of income from health insurance and a great percentage of complaints. We write for a stable company and good provider of health insurance.

None of us want to change the system, but somehow improve it.

My comments are simple. Why can't we have some system similar to the property and casualty auto and homeowners business?

Standard carriers write business, provide coverage and pay claims. If the property or auto/driver doesn't fit the system, they can get something from the "pool."

Yes, the premium is higher but coverage is provided. The carriers share these higher-risk policies.

I do sympathize with those who don't have health insurance. I also see many who just want everything provided for them with the best care and no premium. There is no way that is possible.

Individuals have to be responsible for their actions--smoking and drinking have consequences,
lack of exercise and overeating have weight gain and health expenses.

Some diseases are unfortunate and unpreventable, but many things we do to ourselves. My husband has diabetes and he knows he needs to eat right and
exercise or die from the feet up. Life is hard.

Could we have health care with discounts for fitness? Use standardized blood work and adjusting rates, just as we use a driver's driving record and credit score to assign premium with an auto or home policy?

I am very frustrated with the medical community for having the mentality of treatment vs. prevention. I understand they are overloaded with sick people and have to treat illness they see everyday.

However, the system should include research, and encourage lifestyle changes to prevent being on
prescription drugs.

There are also the patients who won't do as they are instructed for lifestyle changes, and they just prescribe drugs to try to offset their lack of cooperation.

Again, the patient should pay higher premium for such behavior, and those who cooperate should receive discounts.

I don't see as a society that we can afford to just provide for all needs of people without some accountability.

My personal opinion is that the FDA is killing people with aspartame and chemical additives they are allowing to put into the market. As well as drugs that are unsafe, and not to mention all the money that is associated with it.

There is certainly no quick fix. I agree in the U.S. we should have something better, but standardized health care is NOT the answer.

Standardized health care would make HMOs look fabulous!!!!