Morton J. Marcus, an economist formerly with the Kelley School of Business, Indiana University. His column appears in numerous Indiana newspapers.
Several readers have asked for my take on the health care bill passed by Congress. For what it’s worth:
The Patient Protection and Affordable Care Act (PPACA as it will lovingly be known henceforth) is a major step forward. It widens the door to health insurance for those with pre-existing conditions, for employees of small businesses and others currently not covered. This was achieved in the face of great opposition from health industry forces that stand to lose some of their economic power. In the fight to defeat PPACA, many lies were told and too often believed by decent people.
The U.S. will continue to rely on employer-financed polices written by private insurance companies. Small companies will be subsidized to offer their workers health insurance. To supplement these we will expand Medicaid.
This approach maintains the existing, unsatisfactory insurance system we have had for three generations. We could have private companies that process payments to health care providers, root out fraud, and limit misuse of the system. These need not be insurance companies. Do we want insurance or do we want health care?
The trend in medicine seems to be recognition of how we induce our disorders and how we inherit tendencies for them. The insurance companies would like to match our insurance policies to our behavior as well as to our inherited characteristics. That’s why they want to know if you smoke or if your father had heart disease. Knowledge reduces their risks and protects you and me from paying the bills of high risk people.
That’s why, when we applaud insurance for people with pre-existing conditions, we should understand that those of us without such conditions will pay higher premiums. Insurance ties us together. To some folks, insurance is a means of avoiding responsibility.
The essential questions have not been answered by the current health care legislation. Since we cannot provide unlimited services to all, we will need Sarah Palin and her “death panels”. That is, we will require explicit standards of care which reconcile the scarcity of resources with the expectations of the sick and their families.
Which is it to be? Will we have universal service available to all and paid for by all? Or will we have a health care system based on individual needs and individual savings? Is there a middle way?
The new legislation is another step toward recognizing our interrelationships.
If we focused on the individual rather than the society, your behavior and your genes would determine your premiums. You would be free of the pregnant women in your office and their innumerable sniffling offspring. No longer would you pay for the hypochondriac retiree who virtually lives in the doctor’s office.
The question is: Can we turn our backs on those in need who cannot provide for themselves? The civilized, compassionate answer is NO, but the rhetoric of individual responsibility cries YES WE CAN.
PPACA also does little to curb the growth of health care costs. For too long we have seen the health care system grow obese, fed by the virtually unrestricted flow of funds from the public and private sectors. We now have hospitals that are indistinguishable from resort hotels; we see medical offices and professional incomes beyond the dreams of modestly avaricious attorneys. The insurance companies have been conduits for these funds, absorbing their share for their self-glorification.
Little in PPACA increases consumer choice. The insurance oligopolies will persist. The hospital empires will expand. The medical profession will continue to block recognition for lesser mortals who are competent to provide selected medical services. Nor will medical schools restrict the numbers who would be highly-paid specialist while the need for general practitioners goes unanswered.