Perceived problems with affordable health care
Perceived problems with affordable health care
Where to start? It's just not possible to reorganize a seventh of the US economy without stepping on some toes.

Conservative ideologues are convinced market forces can control health care costs better than government, and state governments can innovate better than the federal government. They see the reforms as inefficient, intrusive, burdensome, likely to increase costs, and a huge transfer of wealth from "job creators" to the less deserving.

Liberals are disappointed by the failure to pass a single-payer, Canadian-style plan. They see it as a selling out to the insurance and drug industries, and fear it will fail to control costs.

Providers fear more government involvement, because of cost controls (lower Medicare reimbursements to docs, DRG payments to hospitals, more patients under Medicaid for starters). They fear comparative effectiveness research will expose some of their most lucrative drugs and treatments as cost-ineffective. New compensation systems rewarding providers for keeping patients healthy present the same problem as teacher pay based on student achievement--the docs cannot control patients' unhealthy lifestyles and home lives.

Employers fear higher group health insurance premiums, increased administrative expense and fines for not providing compliant health plans (or any health plans). The well-insured fear losing their current coverage, while the uninsured fear being fined for not carrying compliant coverage.

People generally resent paying insurance premiums. Until one is on the receiving end, insurance looks like transfer payments--healthy folks subsidizing others' unhealthy lifestyles, childless and small families subsidizing large families, young workers' subsidizing elderly retirees, etc. Some healthy, affluent people would prefer medical savings accounts and high-deductible plans. Some healthy low-income people would prefer to go uninsured and take their chances.

People are so misinformed about how how much rationing occurs under their private plans, and how well single payer systems work in other countries, that they believe the special interest propaganda about waiting lists, rationing and "death panels". They do not appreciate the difference between prioritizing services by cost-effectiveness, rationing necessary services, and just plain rationing people by income level under the GOP's voucher plan.

Bev Chaney

The story of Canadian health care