Health Care

I went to an amazing policy breakfast the other day on health care. It was hosted by the Maxwell School and Public Agenda and featured Drew Altman. Because of the breakfast, I am now a huge fan of Public Agenda (a group I knew nothing of before this) and I expect I will be paying more attention to them in the future.

Basically, the breakfast did a great job of highlighting the real differences between McCain and Obama's health care philosophies (and by extension the difference between Republicans and Democrats) - which is different than talking about their plans. Neither are likely to have their actual plans passed, so understanding their philosophies is more important.

Before I get into that though, Drew Altman made three important points that I want to mention. First, he said surveys show that people are more concerned with making health care more affordable - with being able to pay their bills when they receive health coverage. Percent of people with health insurance isn't as big a concern (except how an inability to afford coverage would affect them).

Secondly, he said that what we have seen recently is that as costs are increasing, health plans are charging higher deductibles and providing skimpier coverage. This is likely to continue unless something major changes.

Finally, he talked about what he thought was mostly likely to happen. He thought it somewhat unlikely that there would be an immediate major shift in health care policy. Instead, he predicted small changes that would build on the Children's Health Insurance Program or maybe a bigger program that moved towards universal coverage but would be phased-in if the economy improved.

Now, the major differences between the parties on health care:

Republicans:
-Want to move away from the employer-based system
-Believe a market-based approach can make health care more affordable
-Want less regulation on coverage
-If people have control over their coverage and knowledge of the real costs of their care, they will make better decisions and waste less money (health savings accounts are a move in this direction)

Democrats:
-Want to build on the employer-based system
-Want to move towards universal coverage
-Believe we need to regulate levels of coverage
-Buying health care is extremely complicated and public cannot make decisions about coverage

After hearing this, I think I came down on the side of Democrats. First, I think health coverage is a right not a privilege. Also, while I think we definitely need to do what we can to make health care more affordable, I don't know that I trust the market for this - especially if there is less regulation. Choosing health care coverage is a really complicated decision that involves many factors, some of which the buyer doesn't even know to consider. People will have to make decisions about deductible amounts, choice of doctors, and detailed levels of coverage for treatments. It's not that I think the public is stupid, but that there is naturally information asymmetry that the insurance companies can and do exploit.

Here is where my mind splits though. Above I said I think we need to make health care more affordable. I don't really trust government to be able to do this. The problem is that markets are often more efficient (not always, but often) but definitely not fair. Since so much of health care is about fairness (ie ensuring everyone has adequate coverage), markets cannot be trusted. But without some market pressure, we won't be able to afford to provide coverage for everyone.

I obviously need to do some more thinking about this. I think there is a lot of bad information out there (one-sided pieces like Michael Moore's Sicko for example), and I have not found much good information aside from this breakfast panel. There are some serious questions out there that I haven't heard good answers to yet, like: What are the real strengths and weaknesses of some of Europe's single-payer universal coverage systems? How much do they cost? Why are there extreme variations in costs between states that don't match variations in outcomes?

This is going to be a huge issue no matter who is elected. Costs are rising rapidly and for such an advanced country we have too many people who lack coverage. I will definitely be coming back to this issue. (After all, I didn't even touch on the lack of access to preventative medicine for people without coverage or the overall health of our country.) This is all I've got for now though.