Over the past several weeks I have spent a significant portion of my time dealing with health insurance issues. I have listened to presidential candidates offer their views on what is right and wrong with Obamacare, participated in collective bargaining negotiations with labor unions representing county employees, advised private individuals about options for their personal insurance coverage, advised private employers about legal mandates and options for health insurance, and counseled retirees about their medical insurance needs. On a daily basis I wear many different hats. I am a private attorney, a legislator, an employer, a consumer, and a voter. This means I have to look at health insurance and health care issues from many different perspectives. Here are some thoughts and viewpoints about this important issue:
- Health insurance is a major issue and concern for almost everyone. There is little agreement about the best way to deal with it, but everyone has an opinion about it. For better or worse that means that the government is going to be involved in the debate about it.
- Health care and health insurance has gotten extraordinarily expensive. America is spending about 19% of its Gross National Product (“GNP”) on health care. No other nation spends more than 12% of its GNP on health care. Despite spending 37% more per capita on health care, America ranks 28th in health outcomes.
- Although everyone wants health care coverage, almost no one thinks that they should have to personally pay for it. However, there is wide disagreement about who should pay for it. The most commonly suggested candidates for paying include: the government, employers, and “the rich.”
- Obamacare, or “The Affordable Care Act” (its official name) got the name, but almost nothing else, right. Today health insurance is not affordable in New York State, or in most of America. The cost of health insurance has continued to skyrocket beyond the reach of almost all working individuals and families.
- Under Obamacare the number of people enrolled in Medicaid has exploded. The federal government controls what medical care providers get paid for care rendered to Medicaid patients, and has set those rates very low. That means that the rest of us are subsidizing the care provided to Medicaid recipients.
- Medicare (the health care program for most retirees over age 65) provides much more limited coverage than Medicaid. It is offensive to me that those who have never worked or contributed to their own care get better coverage than those who have worked and contributed throughout their working lives.
Here are some suggestions for possible changes in how America approaches health care issues. Some seem like simple commonsense, while others are more controversial. They are:
- Everyone should have some “skin in the game.” Everyone, including those on Medicaid, should have to pay something for their health care and coverage. Experience has shown that we don’t value what we don’t pay for. Even a modest co-pay or deductible would have a dramatic impact on usage.
- Federal law should be changed to require that Medicaid benefits be no more generous than Medicare benefits. We should protect and reward those who have worked and contributed to our nation’s prosperity.
- Perhaps Medicaid should be limited to critical care, rather than providing Cadillac coverage, as it does at present. I refer to Medicaid as “the best insurance coverage that money can’t buy.” That’s because anyone who has any money can’t qualify for Medicaid. That doesn’t make any sense.
- Something needs to be done to rein in the huge increases in health care costs. Those costs have simply outstripped the ability of most of us to pay. For example, I recently met with a senior citizen whose annual medicine costs exceed $50,000. That is several times greater than her annual income.
I am frustrated by the current debate, with its name-calling and accusations. It isn’t providing any viable solutions. I think we need open dialogue about both problems and solutions. Everything should be on the table. What do you think?