Fixing the Broken Health Care System
Health insurance has become a leading obstacle to small business and family farm prosperity. Small business and family farm entrepreneurship are the most promising approaches for creating an economic future in rural communities. But we must overcome the health insurance obstacle.
Toward that end, the Center for Rural Affairs signed on to a set of principles for federal health reform developed by a coalition called Health Care for America Now. The principles stress three points:
Quality affordable health care for all Americans – The current system is not working for many hard working people who struggle to make ends meet. The problem is particularly severe in rural America, where the self employed and those who work in small business are often uninsured, underinsured, or at risk of being priced out of coverage.
Reform should ensure that the smallest businesses and their employees have access to the competitive rates charged the largest businesses, through either private plans or a public plan. Some still won’t be able to afford the full cost, and a system should be devised to assist with a portion of the premiums according to need.
Finally, reform should ensure no one is denied or priced out of coverage by preexisting conditions. The very concept of insurance is that we each pay something to ensure that none of us is financially destroyed or worse due to catastrophic circumstances.
Choice, Competition, and Quality – The best way to protect the quality of health care is to preserve choice and competition. That is the American way. And it is the only practical approach. Americans well served by their current insurance should not be forced to change coverage.
Preventative Care and Personal Responsibility – The best care is that which keeps us healthy. We will never keep the cost of health care within reason unless we do a better job of preventing sickness.
The current system is often counterproductive in that regard. Those who cannot afford health care often avoid preventive care and checkups for fear of the cost. But when they get really sick, they seek treatment in the one place available to those who cannot pay – the emergency room. That is the most expensive place for care, and we all end up paying through higher medical bills and insurance premiums. The better approach would be to pay up front to prevent sickness.
Equally important, we should do more to encourage and promote healthy behaviors that prevent sickness. And more health research should be focused on how to stay healthy – instead of focusing the lion’s share of medical research on developing treatments.
Fixing the broken health insurance system is the right thing to do. People should not die because they cannot afford reasonable care.
We believe the principles above provide the guidelines to develop practical reform that preserve the current system where it is working, while offering additional choices for instances in which it is not working.
Agree or disagree? Send your opinions to Chuck Hassebrook, chuckh@cfra.org or 402.687.2103 x 1018.
Insurance competition is bad for you
Competition and choice between doctors and health care providers is wonderful and appropriate. Unfortunately, most insurance companies have preferred providers, meaning they limit choice and limit competition at the consumer level. The more competition we have between insurance companies, the less competition we have between doctors.
The only efficient way to get universal health insurance is have a single unified risk pool, meaning that we Americans should all be in this together. Competition between insurance companies means breaking up the risk pool into smaller and smaller fragments. It means that insurance companies compete to insure healthy people and avoid insuring the people who most need it. This is variously known as cherry picking, cream skimming, the race to the bottom, or adverse selection. No country has ever successfully regulated this process.
Therefore no country with universal health care has truly competing insurance companies. They know better. When you support competition between insurance companies, you are opposing universal health care coverage.
As for people being afraid of change and preferring to keep their existing insurance: most people are satisfied with what they have because they have never made a major claim and never realized how many ways insurance companies have of avoiding covering you when you most need it. A majority of bankruptcies in this country are people who were pushed over the edge by medical bills, even though they had health insurance. Most of them thought they were safe.
Protecting existing insurance policies is politically clever in the short run, but it's bad for the country in the long run. Despite having good intentions, the Center For Rural Affairs and Health Care for America Now have come down mostly on the wrong side of the most important domestic issue facing this country. You ought to reconsider.
David Burress
Ad Astra Institute of Kansas, Inc.
Health Care "Choice" is a Republican Talking Point
I was disturbed to see this line included as a health care "principle."
I'm not sure why that should be. In fact it strikes me as rather regressive and likely to lead to a two tier health care system where rich people and people in good health opt out of the social insurance model to save money or purchase a different level of service. This is most dangerous insomuch as it reduces the political will to build a functioning public health care system. When those with means, who are also those with political clout, are simply able to buy their way out of the system, the motivation to create a robust system that works for all evaporates.
Add to that what David says above about this having not worked elsewhere, and I conclude as he does. I am disappointed that you have chosen to take this path in the health care debate.
THE TWO "CHOICES"
Mr. Burress nails the problem. Choice in doctors is critical and important. Choice in insurance providers is not, and in fact leads to a fractured insurance pool which undermines efforts to reform the system. Unfortunately the HMO boondoggle of the 1990s, with its utter lack of choice in doctors, is now exploited by those opposed to a universal insurance system. They successfully blur the line between the two "choices" to help maintain the status quo insurance system.
We need health care reform and family farmers probably need reform more than anyone else.
food tax to reduce insurance costs
I feel a tax should be levied on any food that has known poisons added such as aluminum, aspartame, fluoride (see http://charles_w.tripod.com/fluoride.html ), sulfite, and etc. or essential nutrients subtracted. I am certain this would cause an improvement in our country’s health when processors corrected the situation or, if not, when less of it was purchased. If a tax were placed on food that has had essential nutrients removed the improvement in health would be dramatic. A fringe benefit would be to enable the heavy Medicare tax to be reduced,
We talk endlessly about better health insurance. Insurance is a marvelous invention, but there is no excellent substitute for not getting sick in the first place. In any case, if everyone is healthy, the insurance premiums will go away down as a side effect no matter how they are instituted. With the extra money we could then start to pay down that miserable national debt and with the extra time enjoy ourselves.
In the mean time, you can at least see ways that you or some one you love who has rheumatoid arthritis or heart disease can counter the loss of potassium from current junk food in this articlehttp://charles_w.tripod.com/arthritis9.html .
the most important principle
You fail to even mention the most important principle of health care reform. That is coverage must be universal. You do say "health care for all Americans" but that is followed quickly by "access to competitive rates."
"Access" to "purchase" health care at any rate even when it is subsidized for low income people will always fall short of being truly universal care.
Politicians in Washington who have pockets lined with insurance company money will always try to tell us we have to start from the place you propose. It is our job as citizens to demand better.
Health reform
First, I appreciate each of you taking the time to post thoughtful comments on the article I wrote.
I agree strongly with Mr. Johnson that health coverage must be universal. That is what I intended to convey by coverage for all. The most important objectives of health finance reform should be to provide all American access to quality health care that they can afford.
I don't think it is a given that a "single payer" system run by the federal government will provide the best health care most efficiently. I conceed the argument that their are potential efficiencies from having just one insurance provider.
But there is also a downside. Bigger is not always better. Some big bureacracies are unresponsive to people's needs. Competition puts pressure on all providers to be responsive. The key is ensuring that a public system is there for everyone, as a backup, to ensure universal coverage. I believe that public system will be made better and more responsive by having competing private providers.
I want to get real reform that provides universal coverage and quality care at a cost ordinary folks can afford. To win that, we need a system the American people can embrace. The American people care about choice because they fear unresponsive govenrment bureacracy. Perhaps we should listen. We can accomodate that concern and achieve what should be the primary objective in reform - affordable, universal and quality health care.
Finally, I agree with Charles who wrote that there is no substitute for avoiding sickness in the first place. That is the key to getting the health cost spiral under control. Health reform must include incentives for healthy behavior, including a healthy diet, exercise etc.
Chuck Hassebrook
Center for Rural Affairs
telemedicine can be the answer
Why is no one talking about telemedicine? Investing in telemedicine can reduce the costs and burdens associated with health care particularly in the rural parts of the country. That is the best first step to reform.
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