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Edited on Thu Sep-10-09 01:57 AM by kenny blankenship
or what we're about to get. You could add a few others as "easily better".
The common denominator to all of the decent systems, which are as different as Socialist Medicine in Britain to Switzerland's individual mandate to purchase private insurance is that they exclude a profit taking middle man from acting as a gatekeeper to basic health care. They suppress the defining characteristic of private enterprise in the field of health insurance: profit. You can have for-profit insurance on top of basic care in any of these systems, but basic care is not for profit. Your access to the medical system is not mediated by any entity that has a financial interest in the outcome. That's the essential characteristic that keeps prices down and allows universal coverage in all these systems.
The whole problem with our health care system arises from the domineering presence of a profit taking middle man. The insurance company is a classic middle man whose sole contribution to the system is to pool people's money and then act as a gatekeeper to basic health care - a gatekeeper that keeps 30% of the draw. You can point to other problems in our system but none of them are of this magnitude. We cannot make progress on the system until we address the leading problem in it. Our immediate problem right now is that we can't bring ourselves to face this fact. We apparently STILL can't say aloud that profit motivated private business is by nature a disastrous model for the delivery of health care. We STILL can't say that what makes other people's systems work and cost less than ours, is that ours is the only one that allows the middle man to dominate the system. We talk about making little deals with it. But it cannot be persuaded to change its nature, and you can't regulate it down to remove it as a problem without destroying it. As long as you continue to assume that the middle man has a legitimate place you are prevented from reforming the cost of the overall system by your imaginary need to protect the middle man's existence. Everyone else in the developed world has figured this out but us. We don't dare even talk about it. We're constrained to say stupid shit like "we're not out to put insurance companies out of business" We're NOT? So when do we plan to get serious about this?
We will not achieve our larger goals until the insurance company is banished from primary health care - or at least until we banish insurance company PROFIT from primary care. Their incentive as a middle man is for costs to always go up! The other way they "earn" is to not deliver the care they're supposed to deliver. But they can get in trouble for that, so the main motor of their profit growth is inflation. A middle man can always make his slice bigger in a trend of rising prices. And a publicly traded middle man always must find a way to make his cut larger -or else. We will not achieve our larger goals until we extract the PROFIT CANCER from basic care delivery, but meanwhile we CAN impose hardship on millions of people in spastic attempts to make this complex, bloated, inefficient for-profit system work towards goals it was never meant to achieve and doesn't want to achieve.
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