Monday, January 31, 2005

Health Care and the Middle Class

It seems clear that Bush wants to destroy the middle class. Why he wants to do this is bewildering given our comsumer based economy. Who is going to buy the products that bring profits to the big corporations if the masses have no disposable income? I guess the Republicans aren't thinking that far ahead. They just want to do away with minimum wage, relegate the elderly to poverty and undermine a health care system based on shared risk. Far from working to get everyone properly insured, this administration is working to make sure no one is insured - at least not with the kind of insurance that makes early detection and preventive medical care part of the package.

The Los Angeles Times reports on this issue in its article, "Healthcare Overhaul Is Quietly Underway" by Ricardo Alonso-Zaldivar.

Emboldened by their success at the polls, the Bush administration and Republican leaders in Congress believe they have a new opportunity to move the nation away from the system of employer-provided health insurance that has covered most orking Americans for the last half-century.

In its place, they want to erect a system in which workers — instead of looking to employers for health insurance — would take personal responsibility for protecting themselves and their families: They would buy high-deductible "catastrophic" insurance policies to cover major medical needs, then pay routine costs with money set aside in tax-sheltered health savings accounts.

Elements of that approach have been on the conservative agenda for years, but what has suddenly put it on the fast track is GOP confidence that the political balance of power has changed.
Critics say the Republican approach is really an attempt to shift the risks, massive costs and knotty problems of healthcare from employers to individuals. And they say the GOP is moving forward with far less public attention or debate than have surrounded Bush's plans to overhaul Social Security.

Indeed, Bush's health insurance agenda is far more developed than his Social Security plans and is advancing at a rapid clip through a combination of actions by government, insurers, employers and individuals.

Health savings accounts, known as HSAs, have already been approved. They were created as a little-noticed appendage to the 2003 Medicare prescription drug bill.

Of course what will happen is that poor people will continue to use the emergency room for primary care and middle class people will put off going to the doctor until there is a serious problem.

A typical catastrophic health insurance plan carries an annual deductible of about $1,600 for an individual when purchased through a large employer. That means the worker pays the first $1,600 of healthcare expenses each year. By contrast, under the more comprehensive, employer-provided health insurance programs common today, the company begins to pay after about $300 in expenses have been incurred. Deductibles for families are considerably higher under both types of plans.

"There's an issue about whether these things will work," Rodgers said. "[But] we could end up coming back 10 years from now and everybody will have high-deductible plans and [health savings accounts]."

Sen. Ron Wyden (D-Ore.), who agrees with Bush that individuals should take more responsibility for controlling health costs, is nonetheless skeptical that HSAs, coupled with high-deductible insurance, will prove workable as a substitute for the present system."

I think the American people are going to want more of a safety net than the administration has been willing to commit to this far," Wyden said.

Still, catastrophic health insurance is gaining credibility as a policy option.

This article was also picked up by Smirking Chimp and I found the following post among the comments:

The company we work for is doing this now. This year, we were forced to enroll in a healthcare plan that "gave" us a debit card with $3000 on it to cover all our family's healthcare costs for the year. We are responsible for shopping for the best prices and services with no help from the insurance company or our health care people at work. When we asked how we are supposed to know what prices are fair and reasonable when we go to the doctor, no one was able to answer us or give us any lists of costs or information. We basically were told it was up to us to figure it out by calling around.

We asked specifics to try to get an answer. For example, what if our kid gets a bad ear infection? Do we try to get him in to see his doctor and let the doctor decide if he needs to be admitted to the hospital for IV fluids and antibiotics? Or should we go straight to the emergency room? Which is more economical? Their answer: That's something you'll have to find out. We don't know, and it's not our job.

On our first two visits to the doctor this year, check-ups, the doctor's offices weren't even able to tell us what we'd be charged for our visits.

Nationwide? Loooovely. That should be a real nightmare.

I do not know how to say this more clearly: this is not right. Morally, this is not right. The rich will always be able to afford the best of medical care. And I wonder if Congress is going to drop its comprehensive medical coverage for its members in favor of catastrophic insurance only. This whole enterprise is one more plan to force the working and professional classes into subsidizing the obscene profits of the big corporations and the equally obscene salaries of their CEOs.

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