Sunday, April 12, 2009

FIRESIDE CHAT: Health Care Reform

The Obama Administration has advocated renewal of efforts begun under the Clinton Administration to reform healthcare in the U. S. As conceptualized, reform includes a host of issues, prominently among them the issues of how much healthcare should be made available, to whom it should be made available, and how it should be financed. At one extreme is socialized medicine, with countries such as the United Kingdom and Canada adopting it. Experience with socialized medicine has been mixed, with problems including long waiting periods for appointments with physicians and inadequate quality of care. Private physicians have filled in, for those who could pay, effectively creating a stratified system with at least two tiers based in part upon social attributes that proponents of reform typically would reject as being appropriate under an ideal, egalitarian healthcare system as envisioned.

At the opposite extreme is a healthcare system based solely upon a private-pay (including private-insurance) model. In private-pay models, financing for medical services is on your own dime, or on the dime of your insurance company, which gets its dime and more, constituting its profit, from you. The essence of an insurance model is the concept of risk pools, in which high-risk individuals are identified and either excluded or forced to pay more for insurance coverage. The gold lies in low-risk pools, consisting of people belonging to groups that statistically make below-average demands on the healthcare system. These especially include employee groups, because employees are healthier on average than those not employed, a phenomenon well known in public health as the ‘healthy-worker effect’.

When a private-pay system encounters public policy, a fundamental conflict of interests rears its ugly head....


Copyright © 2009 by The Center for Health Risk Assessment and Management, a Division of RAM TRAC Corporation