Thoughts on Healthcare Reform

This is longer than a blog should be, but this is a complex issue. Read on and comment.

The core problem is an economic one…too much demand and not enough supply. Working through that is a huge challenge.
That economic imbalance will worsen as the population ages and medicine gives us the ability to extend life. We need to control that imbalance because if we do nothing, healthcare expenditures will double in 10 years, further straining an already stretched system.
National embarrassment 1: every American cannot get affordable health care coverage (this is not about people who decide not to get insurance; more on that below).
National embarrassment 2: denying coverage due to preexisting conditions.
The uninsured do get healthcare, and everybody else ends up paying for it. They just do not get routine care and show up in the ER when they are really sick and then may enter the hospital for acute care…the most expensive healthcare there is.
Saying “keep the Government out of healthcare because they will ruin it” is naïve and irrational. Medicare is not perfect, but it provides affordable and accessible healthcare to seniors. Before Medicare, poor health could lead seniors to financial ruin. I don’t think we as a society want that.
There is no perfect system. Take Canada. All Canadians have affordable health care…good. Many are very happy with it…good. But, you may have to wait an extended period for treatment of a non-emergency condition…bad. And health insurance (as well as a college education) is affordable because income tax rates are high, and there is no deduction for mortgage interest.
Employer sponsored healthcare is not perfect either. If premiums get too high, companies will just drop coverage, leading to more uninsured.
“We have met the enemy, and he is us.” Dr. J. James Rohack, President of the American Medical Association, suggested that half of all medical expenditures are behavioral and controllable. That means everything from diet to smoking to auto safety (not to mention guns).
THE MONEY HAS TO COME FROM SOMEWHERE. If you buy the premise that everyone is entitled to affordable healthcare coverage, and that people should not be denied coverage because of pre-existing conditions, you have to contribute to the discussion of how we are going to pay for this. Saying “eliminate waste” is not the answer.

There is no magic cure, and improvement will have to be incremental. Some thoughts:

There are three certainties…life, death and taxes. Make a fourth…health insurance. If you can afford it, you have to buy it – either through your employer or somewhere else. If you don’t buy insurance and need healthcare services, you get fined twice the amount of your annual premium. Yes I know this creates bureaucracy, but…
If you can’t afford insurance, society needs to help. The money has to come from somewhere, and it that means higher taxes, so be it. That is not socialism…it is social responsibility. What taxes? Hopefully not income taxes, but if need be, need be. See below.
There has to be an alternative to employer-sponsored healthcare. It is not fair to employers that they have to go out of business because they have to provide expensive healthcare coverage, even if premiums are deductible. On the other hand, if employer-sponsored premiums are too high, there needs to be a competitive alternative for workers. Private is better than public, but public is better than nothing.
At the same time, we have to make sure there is enough supply to meet the growing demand for healthcare. Doctors and hospitals have to be able to make money.
These same doctors and hospitals should be rewarded for positive outcomes. I will leave it to the experts to figure out how to do that.
Take responsibility for keeping yourself healthy and take punitive actions against those who don’t. Triple the sin taxes (tobacco, alcohol, guns, etc.). If somebody could figure out a way to tax “unhealthy” food, I would be for that. Use the additional revenues to fund healthcare coverage for people who cannot afford it.
Similarly, if you are caught riding a bicycle or motorcycle without a helmet or a car without a seatbelt, you face a severe fine the first time, and have the privilege revoked the second time. Sorry, your personal freedom stops when it endangers others. You can’t yell fire in a crowded theater because it can harm people; your irresponsible behavior that unnecessarily consumes healthcare resources endangers my ability to get affordable healthcare.
I am not big on incenting for positive action, but a psychologist friend of mine said incenting positive behavior works better than punishing bad behavior. So I suppose we need to incent certain activities.
I am a pretty liberal person, but tort reform has to be part of the solution so doctors stop practicing expensive, defensive medicine.
Electronic medical records – a no brainer. Tax credits for implementing them.

Interested in your thoughts, but keep the discourse constructive. No rantings or name-calling.