We have am employment-based model. We're the only one in the world. If you're lucky to work for a company big enough and generous enough to offer health insurance, you've seen your portion of the cost shifted in your direction lately. That's because it's going up due to technology, and little bit because of defensive medicine. And people expect to have the best! There is no law that requires employers to offer health insurance, so why should they? Young people have a hard time getting jobs and many don't get health insurance even if they work full time. When they get sick they often go to the ER (which is way more expensive than the PCP) and then either the hospitals writes it off as bad debt, some states have insurance companies subsidize the uninsured, or the patient goes deeply into debt. What are we going to to do make sure every American has adequate health insurance so that the costs aren't subsidized by someone else, or drive them into debt?
There are 700,000 physicians, millions of other providers, and 5,000 hospitals in the country. They want to be paid fairly (or maybe fairly +) for the care they give. We've had 2 serious attempts to build a way to get everyone covered. One was back in Clinton's first term. The second one is the ACA. How can we use these professional providers and hospitals, keep them private, and cover everyone? Every other first world country in the world has national health insurance -- not an employer-based program. I think we've got to go this way. I am sure that will be a very unpopular idea in TV, but how else are you going to rearrange the deck chairs (patients, employers, professional providers, institutional providers and insurance companies) to get to universal coverage? BTW, Medicare is a national health service. Any national health program will need tight medical policy/Utilization Review program (what's covered?, under what conditions?, who can perform the services? how often?...+more controls), and probably an annual aggregate budget shared by all providers. Right now there is no stomach for this -- only taking the ACA away.
|