Friday, February 15, 2019

Let me choose: An American trait

A version of this was published on line by the Sky Hi News February 27, 2019
https://www.skyhinews.com/news/opinion-muftic-let-me-choose-an-american-trait/

Two very hot controversial public policy issues, one appealing to the right and the other to the left, share something in common. Americans prefer to be free to choose among alternatives, especially when their personal lives and health are directly affected.   What first comes to mind is the issue of abortion.  However, for Democrats choice is a value that cannot be ignored when they shape health insurance legislation, either   Democrats will have a winning hand if they support keeping choice in health care insurance and women’s control over their own bodies.

A Wall Street Journal/NBC 2018 poll showed 71% (and 52% Republicans) do not want Roe v Wade overturned.  They want to make their own decisions about their bodies. An overwhelming majority does not want someone else’s moral and religious views or government to tell them what they cannot do in these most personal gut-wrenching decisions. 

The issue of a woman’s right to choose is a cultural, religious, health,  and moral matter, but health insurance is a quality of life, health, and pocketbook issues.   Permitting consumers a choice between private and public insurance providers, and the ability to keep their current insurance and doctor are the keys to strong public support of proposals for health insurance reform.

Over 60% polled in mid-2018 liked Medicare for All (half of Republicans and majorities of independents and Democrats), but when asked if they want to end their choice of private insurers, only 10% approved, as the Kaiser Family Foundation discovered. KFF also found, “nearly half of Republicans and majority of independents and Democrats favor an optional Medicare-for-All play. Public support for Medicare-for-All shifts significantly when people hear arguments about potential tax increases or delays in medical tests and treatment and recent polling also shows many people falsely assume they would be able to keep their current health insurance under a single-payer plan...
Another survey, reported by the Hill in early 2019 found 70% support for Medicare for All, but if a plan would eliminate private insurers ( called single payer), support dropped to 13%. 

The two issues that almost scuttled Obamacare were opposition to the mandate that required everyone to have health insurance and subscribers finding they did not get to keep their doctor as they were promised.  

There is also an ideological pushback to any national health plan.  It is a tradition ingrained in the GOP psyche. The Grand Old Party is following a Grand Old Tradition, a historically long held ideology, opposing Social Security, Medicare, and Medicaid tooth and nail and they are beginning to invoke an ideologically based opposition argument again. 
 Any public program that distributes resources from those better off to those who cannot afford basic living expenses is one definition of socialism.  In some quarters, any publicly funded program that supplants private business is also considered socialist. Republicans are already beating the drum that anything proposed by any Democratic candidate is that awfully feared word “socialism.”  It will fail as it has in the past as a political slogan when the needs for quality of life and life itself are unmet to such an extent that it is more important to individuals and families than adhering to some ideological ideal. Those current polls are evidence we have reached that point. FYI. Not all kinds of public health insurance plans eliminate private insurers as the fear mongers on the right want you to believe.

Price and costs are still a very large part of the conversation. Here is the rub. The counter-argument against allowing consumers to have a choice of whether to participate or not is expensive.    The larger the subscriber pool mix of high users and low users, the cheaper the system is for the average patient. Providing every choice consumers desire comes with it a higher price tag. There are so many variations of degrees of government involvement in health care, that the tradeoff becomes which one can we as taxpayers afford vs. what we feel we need and want.

____________________________________________________________________________
Obamacare was based on a conservative think tank plan to save the private insurance industry. They feared the adoption of single-payer national health would eliminate private insurance. Obamacare was structured to use private insurers. and it also provided the mechanism to provide a subsidy only to those who could not afford private health insurance.  Medicare also allows the use of private insurers and a great deal of choice of providers. Obamacare also provides consumers a choice of nonprofit and for-profit insurance plans providing various levels of coverage and out of pocket expenses.  It saw some impact with the removal of the mandate Trump engineered through executive order, but it has managed to keep its head above water in spite of it.

The objection by consumers of Obamacare was they did not get to keep the doctor if their choice because the choices did not include the network or provider they once had.  This was likely based on experience with employer-provided insurance.  Employers frequently changed the choice of insurance providers as they got better deals for their employees and their company’s bottom line, causing employees to find a new doctor or network. Job changes also often require a choice of different providers in employer-provided plans. 

More thoughts in a discussion from a reader who thinks national health will not work like it does in Europe because the US population is so much larger.  He would rather reform the old, pre-Obamacare system and keep the government out. Here is my answer: "Government out of medicine worked so badly and so many could not afford treatment or insurance, that is why Obamacare happened and the midterms went the way they went. . However, I am not sure how you deduced that just because a system scales up to size it de facto will not work. Medicare works so well and it is applied to the entire US that to touch it is the third rail of US politics.. Why can't it work if more subscribe to it. In fact, it should work better because the pool would include younger, healthier members, not just old people near the end of life. Ps Tort reform would have little impact..since much of it has already been done state by state. That is a fantasy and the CBO already scored it as having little impact. Agree on the lower drug costs; Obamacare permits cross state lines compacts but no one has done it because there are problems with private provider networks and the state by state control of insurance commissioners. Good luck in rocking that turf boat that has grown up with private insurance.. I am in favor of a system that preserves consumers right to choose between a private insurance plan and a Medicare based buy in.... that leaves no one out without ability to get the health care they can afford. It is not the cheapest way to go, but it fits the American psyche. that likes choice.."








No comments:

Post a Comment