Thursday, August 5, 2010

Today I am a Missourian

The first week of the month and $324 flies out of my bank account to Blue Cross for Medical Insurance. Medical increased by 30% ($100) this year – even amidst all the brouhaha about Anthem’s rate increases assisted President Obama’s quest to remake the Health Insurance of Americans.

Missourians voted Tuesday 3-to-1 to opt out of the President’s mandatory health insurance plan. What is the best way to provide Health Care to Americans? That question is different than deciding on the best way to provide Health Insurance to Americans.

I have run many businesses and know that the cost of providing health insurance is significant ... the most volatile expense to budget for. There simply is no other expense line that increases 15, 20, 25% per annum while the provider simultaneously decreases services delivered.

Several years ago I was implementing a restructuring of a small business. After a yearlong experiment where employees were charged 30% of the cost of insurance - the owner wanted to return to the halcyon days of providing 100% employer paid health insurance. I resisted under the assumption that it would be prohibitive. Nonetheless I worked with our broker to identify a plan that would save even more premium dollars, allowing for 100% coverage, yet provide an increased level of care. The solution’s potential drawback was that it was a Managed Care program and employees had to go to their facility and give up their current doctors. There was much concern and resistance.

A few months into the new plan the financial condition of the company was strong, productivity increased, people were happier and healthier. Providing 100% coverage even became a key distinguishing factor in recruiting new staff. The competitive marketplace proved to be a tremendous success!  Chalk one up for capitalism.

In May 2005 my father suffered a brain stem stroke, spent 21 days in the ICU, the maximum "allowed" days rehabilitation facilities and then came home. Almost a year ago, after more than four years at home, we transitioned him to a Nursing Home. During his time at home we spent every dollar Dad ever saved or inherited. He spent ever dollar to provide for his Physical and Occupational Therapy and Home Health Aides that Medicare and his Health Insurance wouldn’t cover. Once penniless I spent six months facilitating Dad’s entry into the Medicaid program, a critical part of this country’s safety net.  Chalk one up for socialism.

As a card-carrying Libertarian who generally believes that limited and effective Government is what the founders intended, I am at cross-purposes with myself. It’s like switching between Fox and MSNBC.  Philosophically I passionately believe that if we as a nation remove every regulation, rule and restriction that has been placed on the Health industry (since Richard Nixon started regulating the industry in 1972) that the free market would correct many of the ills that affect Health care today.

What’s the solution? I generally eschew compromise – finding a practical solution to complex problems that please nobody 100%. That’s what I think “ObamaCare” has attempted. I’m afraid it’ll be a disaster. In this instance I think we need an extreme – one or the other – no compromises.

We need to either get out of the way of providing superior medical care in a true free-market environment and remove all regulation and let it be a free for all. New not-for-profits will thrive in this environment helping the poor and needy. The rich will spend more and innovation will yield extraordinary discoveries and efficiencies. House calls will become good customer-service once again. Americans will get to compare prices for procedures and facilities.  Some people will be left out of the system and be hurt, some terribly. That’s the consequence (and essence) of capitalism.  Good for the majority and for the economy.

The other extreme is that we say that human health is not something to be profited from, that it is a fundamental right as citizens. The practical application is that doctors, hospitals, clinics are open to all. No bills. Some rationing will occur (as now) but the vast majority of needed services will be available.  Costs will decrease as patients will be served with what they need rather than what can be billed. Insurance companies would go out of business and tens of thousands would lose work. Millions would be healthier. Large numbers of homeless would come off of the street and be treated for mental illness. Some sort of tax replacing the Medicare tax would ultimately fund it...not so good for the economy but great for nearly all.

There is no compromise between these two. We either as a nation believe in free enterprise and apply it to every area of the economy or we say that human health is not a profit center and a healthy citizenry is vital.  I’ve had too many experiences of managing companies and budgets as well as my own family situation to know which is “right.” What I do know, however, is that today I am a Missourian. Mandating insurance isn’t the answer – because it doesn’t address the cost or access to health care. Co-pays and deductibles are still stringent. And mandating every American to buy a service seems wrong to me. As we navigate to find the best solution today I will eat right and excercise.  Really.

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