Thursday, February 05, 2009

A Conservative Take on Health Care Reform

By Dennis Sanders

I've told this story a few times, but I will tell it again:

In November of 1996, I fell ill. It started as a flu which became pneumonia and then a massive infection. The end result was that I was in the hospital for two weeks as they tried to get the infection under control.

At the time, I didn't have health insurance. I was 27 and working for a coffee chain that did provide health care, but when you are working for 6 bucks an hour, paying what seemed to be a large amount for health care seemed out of the question.

What I did have was a plucky nurse practitioner. I was going to a local clinic that worked with low-income communities worked on a sliding fee. The nurse practioner was saw that a I had an astronomical white blood cell count (which means I was fighting the mother of all infections) and decided I needed to be admitted to the hospital. My first thought was how I was going to pay for it. Not to worry, she said, a way would be found.

And a way was found. She was able to get me in contact the Minnesota Department of Human Services and was able to get Medicaid, the federal program for the poor, to pay for a chunk of my hospital stay. I could recover knowing that this was taken care of.

Even though as a Republican, I wince when people start talking about single-payer health care, my illness and how it was paid for taught me two things- that health care is an important issue and that government has to have some role.

The fact is, we need to think about reforming our health care system. Too often though, conservatives have tended to put their heads in the sand on this issue, talking about how we have the best system on earth and about fears of socialized medicine. But ignoring the problem is not an answer. As more and more Americans lose their jobs or see their premiums rise, they are looking for answers and if the GOP doesn't have an answer, they will go to the people who have one-namely the left with its single-payer system.

So, Republicans need to come up with solutions. What are the options?

Jurgen Reinhoudt gives a fairly good rundown of several health care systems in Europe that might give conservatives ideas on how to reform our system. Contrary to popular opinion, not all Euro-health care is single-payer; some use a mixture of private and public incentives to achieve universal health care. It's well worth the read, but I will jump ahead and tell you that the system he favors (as do I) is the Swiss health care system. That system is somewhat similar to what has been done in Massachusetts in that the health care is more consumer-driven than what we have.

We come, then, to the Swiss system. It is a system that deserves the attention of every American interested in market-based health reform. Regina Herzlinger, McPherson Professor of Business Administration at Harvard and the “godmother of consumer-driven healthcare”, wrote in late 2008:

“The country of Switzerland has universal coverage, costs that are 40% lower than ours and that inflate at lower rates, and an excellent health care system in terms of outcomes and resources. The key to their success is that the Swiss system is consumer-driven: consumers buy their own health insurance from more than 90 private health insurance firms. If they cannot afford it, the cantons subsidize it. If they are sick, they pay no more for their health insurance than the well (the Swiss insurers risk-adjust each other). Consumer oversight insures value for the money better than oversight by governments and employers.”

For conservatives, who generally favor market-driven solutions, the Swiss system has achieved a great deal on the demand side, by placing the consumer front and center and getting employers out of the way. Whereas in the U.S., health insurance is commonly tied to employers, and whereas many Americans find it unaffordable to purchase individual health insurance policies (in part due to heavy state regulations), in Switzerland the whole health insurance market revolves around individual insurance policies. Swiss citizens can choose from one of hundreds of reasonably priced, competing insurance plans from dozens of competing health insurers. They may choose a high-deductible plan, a low-deductible plan, or an HMO plan.

In a way, health care is purchased in Switzerland like we purchase auto insurance in the US. People have to buy an isurance plan and if they are not able to afford one, then the state steps in with a subsidy.

Reinhoudt thinks there are drawbacks, namely regulation that requires a basic benefits package and lack of information on doctors and clincs vis a vis performance. While one can frown on regulation (and I do), I think there has to be some regulation in order to help control cost and ensure coverage. I do consider health care to be a business, but in someways it isn't like buying say, auto insurance, but somewhat like a public utility like light and gas. There are publicly traded companies that are providing light and keeping us warm, but they are subject to certain regulations because they are vital to human life. Same goes for health care; it can be a business and it should be, but it is also a common good vital for human life and cant' be totally subjected to the whims of the marketplace.

That said, this was a worthy article and I hope more Republicans read it. We have to come up with a conservative solution to health care or else get ready for single-payer, US-style.

Dennis Sanders is a pastor living in Minneapolis, Minnesota. He has worked on centrist Republican issues for years, including stints as President of the Minnesota chapter of Log Cabin Republicans (a gay/lesbian advocacy group) and Republicans for Environmental Protection. Dennis blogs at NeoMugwump and happily lives with his partner Daniel and serves two cats, Morris and Felix.

1 comment:

KMR said...

Hawaii had similar health care insurance to Massachusettes. But late last year Hawaii had to abandon that type of insurance because people who could afford to pay, were scrapping their private health insurance and signing up for the government one. Hence, it became too expensive for the Hawaii officials to continue this subsidized form of health care.

Why would anyone pay for healthcare, if the government giving it out free?

I agree health insurance is too expensive and we have to look at ways to make it cheaper. But government run health care is not the way to go. There must be someway we can make it compettitive as auto insurance.