Wednesday, April 26, 2006

Healthcare Initiatives Fall Short

Massachusetts recently began a program that would expand health care coverage to almost everyone.  Now, U.S. Rep. has introduced a bill (Communities Building Access Act) that would try the same kind of thing.  It would be more modest, but cover the entire country.  
The bill Introduced Tuesday in Congress would set aside $45 million in federal grants over seven years as seed money for communities to design and implement local programs to provide health insurance or health care services to the uninsured. There are 1.1 million uninsured people in Michigan.

"As we all know, there are way too many Americans who do not have access to health insurance and therefore they do not have access to health coverage," said U.S. Rep. Pete Hoekstra, R-Holland, the bill's main sponsor.

"We also know that as we face this issue in health care, there's not a silver bullet to address these concerns. We need to be doing a lot of things in a lot of different areas."

Inspired by Muskegon's Access Health insurance program, the Communities Building Access Act would allow communities to leverage federal grants to create local health insurance cooperatives where the cost of care is shared by the local government, employers and employees.

The money also could be used to create volunteer specialty provider networks, in which providers discount their services to care for low-income members of the network. CareNet of Toledo/Lucas County, Ohio, is the most prominent example of such a network.

Vondie Woodbury, director of the Muskegon Community Health Project, said that these community-based solutions are appealing to the business community, which has been reluctant to embrace national solutions for fear they would be costly and require too much red tape.
As commendable as these initiative may seem, they suffer from a serious flaw.  They rely on an unreliable patchwork of solutions.  The specifics vary from place to place, and change from time to time.  As a result, healthcare providers will have a hard time understanding exactly what benefits are available, where, when, and for whom.  This will make it difficult for providers to formulate treatment plans for their patients.  

I understand what Woodbury said about the business community being reluctant to embrace national solutions.  They are afraid it would be costly and require too much red tape.  The solution is not to create additional programs that add on to the programs that are already available.  It does not make any sense to think that such an approach will reduce costs and avoid red tape.  The opposite is true.  It is inevitable that creating more programs will crate more overhead costs.  The only was to both increase overhead and decrease costs, is to limit the care that is provided.  The thing is, nobody wants to come right out and say the truth.  The truth is, it would cost a lot of money to provide unlimited health care.  The only alternative is to ration the care in some way.  But nobody wants to talk about rationing health care.  

So instead, what we have done, as a society, is to build a massively inefficient, complex system that limits access to health care by being so inaccessible and inscrutable that health care is effectively rationed, without anyone having to say that it is rationed.  

The only sensible approach is to have a universal system that provides basic health care.  If people want more, than what we, as a collective, decide we can afford, then that can go out and pay for it themselves.  If we want to expand what is covered in the basic package, then we have to decide to pay for it.  But the key is to keep the basic system as efficient as possible, with as little paper-shuffling as possible.  

If people want to pay others to move paper from one stack to another, they are free to do so, but they have to pay for it themselves.  There is no reason to use collective funds to pay for that.

Some of these issues are discussed here, specifically regarding the Massachusetts plan.