October 16, 2007
O'Neill's Bad Bargain
Former Treasury Secretary Paul O'Neill is a decent man. As documented in Ron Suskind's book, "The Price of Loyalty," his intellectual honesty forced him to quit the Bush administration two years into its first term over its economic mendacity. It was a harbinger of the national security mendacity to come.
He's back this morning with an op-ed in the New York Times outlining his grand bargain on health care. In brief, it's the Republican plan. Everyone should have to buy catastrophic health insurance, with individuals on their own for basic care. Help on that basic care should only go to the poor. His one nod in a liberal direction is his preference for a national pool for the catastrophic plans.
This is a prescription for reducing the U.S.'s already inadequate levels of preventive care. Forcing people to absorb first dollar coverage will do nothing to encourage people on the road to chronic disease (smokers and the obese, for instance) to change their behavior. It would do nothing to screen the population to find the 20 million Americans with untreated hypertension so they could be given generic drugs and counseling. Ditto for people with high blood sugar on the road to diabetes. And the nation's cancer screening rates will remain low.
The catastrophic insurance model assumes the major health care fear facing most Americans is the threat of unreimbursed hospitalization for accidents or major, unforeseen illnesses. Wrong. About three-quarters of all health care spending goes for the treatment of chronic disease. Wherever one puts the cut-off point for the catastrophic plans, it assures that millions of people with heart disease, diabetes, Parkinson's, and a host of degenerative disorders will be spending that level each and every year before their "insurance" kicks in. Chronic disease is not a one-off event.
Unfortunately, there is a superficial appeal to plans like the one outlined by O'Neill. If you are healthy, wealthy and unconcerned about the overall state of America's health, it could save you a lot of money.
Posted by gooznews at October 16, 2007 08:44 AMIf you are healthy, wealthy and unconcerned about the overall state of America's health, it could save you a lot of money.
It's ALWAYS about the money, isn't it? Until Americans wake up and realize that we have a HEALTHCARE problem, not a health insurance problem, nothing much will change. The poor, after all, are viewed as expendable. If they don't receive timely, adequate health care, and as a consequence die--isn't that a good thing for the more fortunate?
Posted by: Melody at October 16, 2007 09:04 AMI am a fiscal conservative. I think if we mandate catastrophic policy ownership, there must be some price control on premiums. You are so very correct that it won't change a thing with regard to our nation's citizens over-all health. The Government already insures the sickest part of the population - the elderly and the disabled through medicare. It is preventative care, encouragement to eat right, policy making that encourages community development in a way that allows for the incorporation of walking as exercise and transportation. Screening and education for early detection of chronic disease and something nobody mentions - we have terrible health illiteracy - 90 million of us don't understand medical literature which is usually written above the 9th grade level. Those 90 million, many college educated, read below that level. This type of illiteracy costs us 58 billion dollars per year in excess costs due to poor compliance with therapy.
Forcing people to buy insurance benefits insurance companies, but not our citizens. We need to make our citizens healthier, treat them earlier, and focus on prevention. Then our upwardly spiraling costs can be brought under control.
20 years ago a former employer called us all in and said, "I want to be able to continue to keep catastrophic illness or accident from wiping you out financially, but with the rising price of insurance I can't cover all of your doctor visits. So we're raising the deductible and the co-pay. The good news is, should something terrible happen to one of your children, you're covered for everything after the deductable."
I think he made sense. Why should routine doctor visits be covered? And when they're not covered, why do we call it a crisis?
Posted by: Chuck McKay at October 19, 2007 12:12 AM