The Health Insurance Dilemma - Part 1

Socialized medicine is inevitable- all the other industrialized countries do it, and have cheaper plans, more extensive coverage, and better outcomes.  The US is good at treating disease, but a failure at disease prevention.  And all the uproar about pinkos forcing you to go to a certain doctor is propaganda.  Under socialized medicine, you can always opt out and buy your own coverage.  The analogy to Wall Street is apt- the HMOs want no regulation, so that they can cover the healthy (and privatize the profits from their coverage), while abandoning the chronically ill, who are forced into medicare (socialized risk).  And the HMOs crying cost while their CEOs takes millions out of the public health care fund is the same as the investment bank CEOs taking millions out of the public mortgage fund, while their banks demand a bailout.  The bottom line is common sense: health care is NOT a business.  The function of a healthcare system is to keep people healthy, not maximize profit while doing it.

There are two parties to blame: the drug companies and the insurance companies. The fact of the matter is, healthcare is simply not a commercial enterprise by nature and America's reluctance to see things otherwise has left enormous holes in the system where millions of people continue to fall. The drug companies focus on reactionary drugs rather than preventative because that's where the money is. Why is it ok for a drug company to spend hundreds of millions of dollars advertising a prescription drug? Isn't that money better spent on more research or - God Forbid - lowering the price of medicine? Is it not the doctor's duty to prescribe a drug anyways? The government should regulate this as they have with alchohol and cigarettes. This will be a step towards reducing costs of drugs and therfore insurance. The insurance companies have very slowly started moving towards preventative treatments but only for higher plans and mainly in baby steps such as gym credits and health coaches. This is a great start, however, we need to see more. I don't see universal healthcare as the solution as I know first hand that anything operated by the governement is incredibly slow and inneficient. However, regulation is key.  I think that the government should set up a gov't sponsored insurance for those who don't qualify for affordable coverage. It would be very easy to fund, you simply require all the private ins companies to contribute a certain amount of money in relation to the number of people using the gov't system. This would result in fewer and smaller cracks in which people find themselves without insurance, and it would encouarage ins companies to find ways to insure those who they previously would not and lessen the load on the gov't ins option. The power to fix the healthcare crisis rests with Congress. Unfortunately for us, their plate is filled with too much muck to even think about fixing healthcare at the moment.

Hi Ann,

I'm glad that I stumbled upon your blog entry here.  I blog over at the MultipleSclerosisCentral site, in addition to my own person blog.

The issue of health insurance is very important to me.  Like you, I live in Virginia (within the DC Beltway).  As a self-employed person, I purchased the very best insurance policy available to me in 2000.  Healthy enough to pass the underwriting process, I acquired a PPO policy with Carefirst BCBS. 

I was satisfied enough with this plan until being diagnosed with MS in 2005.  My original paperwork indicated that the 10% coinsurance would kick in after reaching the $1500 prescription limit.  NOT!!! 

A major limitation of Individual health insurance plans (at least in our area) is in prescription coverage.  Carefirst pays $1500 then stops.  My MS drugs cost around $30,000 each year.  That's a problem.

Ironically, I was interviewed on camera for Sicko but was edited out near final production in an attempt to get the film under 2 hours.  Basically, my story centered around individal policies, limited prescription coverage, and huge gulleys in the current safety net systems.  Bits of my story can be found here and here.  I think Sicko would have made a different impact, if stories like my own had been kept in the film.

Anyways, just wanted to let you know I appreciate your post and wanted to share a tiny bit of my insurance story.  Thanks.

Lisa

E.F. (Fritz) Schumacher, an English economist, in his book "A Guide for the Perplexed", argued that there are two types of problems convergent and divergent.  Convergent problems are those in which proposed solutions and experiments eventually converge on a single solution.  Certain inventions show this evolution quite clearly, such as inventing a human powered vehicle or a heavier than air craft.  Both the bicycle and the airplane went through many different phases and variations before settling on a common solution that looks much that same today as they did when invented.

A divergent problem as you can imagine does not settle on a single solution.  They require accommodating irreconcilable things in ways that challenge our convictions.  Divergent problems require us to know that what we believe can only be resolved by a higher level of reasoning grounded in goodness, beauty, and truth; all of which are subjective entities.  In other words, solving a divergent problem is not going to be 2+2=4, or the square root of 2.  Solving divergent problems first and foremost requires an honest and articulate discussion between honorable people.  Just ask any parent or watch any movie about families to see divergent problem solving at work.  Good luck with finding those honorable people.

Obviously health care in a society is a divergent problem.  There is no single solution because every individual has different health needs and makes different lifestyle choices.  It is similar to the discussion in education – Is it better to learn through discipline or freedom?  Well that depends on the learner. Education researchers have been discussing this topic since Plato and there is no firm solution because the problem is divergent.

This is important to understand because governments can be good at convergent problems such as linking two communities (canals, railways or highways), bring technology to remote communities (rural electrification, post office and telephone),  or other single focused problems (man on moon, Manhattan Project).  Recent events show a convergent problem and resulting solution morphing into a divergent problem; the toppling of Saddam Hussein proved to be a convergent problem but the subsequent problem of building a nation has proved to be divergent.  Governments tend to be poor solution providers for divergent problems which is why a "Manhattan Project" for health care is simply a waste of time.

Solving divergent problems in society is best accomplished by allowing individuals to make their choices and learn from the consequences of their decisions.  In this way the government does not impose a solution but provides resources enabling the individual to carry out the decision making process towards a solution set best for them.  Many governments use vouchers as a means to provide access to resources; a debate the USA is having right now with education and one that Sweden adopted years ago.

** Not just government - Insurance industry tries to provide a convergent solution to a divergent problem.

** Doctors trained in divergent problem analysis.

** Access to varied resources is crucial for solutions to divergent problems.