I’ve been critical of President Obama and his approach to health care reform, but when asked \u201cwell, what would you do?\u201d, I’m stopped in my tracks. The more I learn about the whole situation, the more befuddled I’ve become about it. I have voiced my dissatisfactions on this blog with the current American health care system; about how terrible it is to deal with insurance companies, about how the government (especially Medicare) is too inflexible, and about how doctors are being forced to give you too much care in some places (e.g. tests and referrals to specialists) and too little in other areas (e.g., getting to know who you are and how you really live; and with that knowledge, finding ways for you to improve your health and avoid disease). And of course the rising costs of health care continue to diminish our nation’s economic recovery prospects, and is taking a lot of families down in the process (with uninsured and insured but uncovered health care bills). But as to coming up with a solution — I’ve been at a loss. TILT.<\/p>\n
However, I had a revelation about it today, a road-to-Damascus experience. I figured that I’d share it with the world, for whatever it’s worth (probably not much). It struck me that we really don’t have any competition in the health insurance market \u2013 even though that’s the one place in the system where a competitive market could do the most good. As with most people who have health insurance (other than Medicare or Medicaid), my insurance is provided by my employer. I don’t pick out my plan; I take what the company decides to provide me with. (Yes, we can choose between 2 different providers; but we can only change in limited circumstances, and the plans are pretty similar anyway). My company decides which insurance company will provide my insurance, and what the features of that plan will be. I hope that the company is thinking about the importance of keeping me and my fellow workers healthy so that we can continue to work; but for the most part, my employer is concerned with controlling costs when it selects an insurer and a plan. It doesn’t really think about my particular needs. <\/p>\n
Imagine if we all got our autos that way. Your employer decided on a type of car for you and what its features would be. If they were nice, they’d give you a choice of two cars; but again, both have pre-defined features, not much difference. They pick out that car based mostly on price, and selected some features that the average employee would like (or wouldn’t totally hate). They wouldn’t be too concerned with how it performs or how reliable it is once you get it; they just need to provide their employees with some kind of car, because present employees and future prospective employees have come to expect it. Too bad if you need four wheel drive or want to pay more for extra safety features (as with Volvo), or you craved fancy styling or you wanted the model that broke down the least (e.g. Toyota). You would be stuck with the average car, like it or not.<\/p>\n
If that’s the way that everyone got their cars, then the car manufacturers wouldn’t offer much variety; they’d make something that was pretty average, and nothing else. They wouldn’t put effort into sales features like air conditioned seats (i.e., stupid stuff that people still like) or improved safety and reliability features (the important stuff). And that’s what we see in the health insurance industry. They don’t produce products meant to serve the individual; they make one-size-fits-all products for employers. Thus, it’s not surprising that health insurance gives lousy service to the end-user. The insurance companies deny claims arbitrarily, they make you wait on the phone for hours, they make things confusing, and they nail you for big money if you go to the wrong doctor or wrong clinic for a test, because you didn’t read their fine print properly. <\/p>\n