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Health insurance and the faulty premise

Tuesday, September 11 at 5:59 PM

This Speakout has not been edited.

By Donna Feldman

While politicians and social activists are busy trying to rejigger our existing 1940s system of health care insurance into the 21st Century, it helps to step back and see the big picture. The entire conversation about health insurance in this country is predicated on a faulty premise. This was summed up perfectly in a recent Online Letters Discussion by someone who wrote: “The best (single payer system) appears to be Japan - everyone is covered and ... they have a higher life expectancy and the lowest infant mortality rate”. By this definition, health is something handed to you by the healthcare system. It is not something you create yourself. It is something you get from doctors. This is false.

Japan, ironically, is the perfect example of a culture and cuisine that facilitates health. Lifestyle diseases are, so far, uncommon. The Japanese don’t buy health from the healthcare system. They have lower expenses and higher life expectancy because they have healthier lives. They don’t use the healthcare system as much because they don’t need to. By contrast, in the U.S. the growing obesity rate is a symptom of a sedentary culture and deranged cuisine that promotes ill health. We use the healthcare system to fix these problems, and the cost for this fix is rocketing out of control.

As long as our view of healthcare is based on the faulty premise that health is something we buy with health insurance, then the system will eventually collapse. No amount of tinkering with the current system will solve the problem, because the current system facilitates and rewards unhealthy lifestyle choices. We need a system that rewards healthy behaviors.

The so-called Blue Ribbon Commission for Health Care Reform in Colorado has come up with 4 nitwit plans that will not fix the problem. They are all predicated on the faulty premise that health is something you buy from doctors. It doesn’t matter which plan they pick - it will fail, and you can take that prediction right to the bank. Invest in companies that invent new sleep apnea machines, new knee and hip replacement systems, new diabetes drugs, new ways to open coronary arteries and new stomach-stapling devices. If it has to do with lifestyle diseases, the demand will be insatiable, because all these plans reward disease. Healthy lifestyle choices are rendered financially irrelevant.

What would real reform look like? First, it would never, ever include employer-based health insurance. That 1940s relic should be abolished. Health insurance should be purchased from insurance companies. Everyone should be able to choose which plan and which deductible suits them. The premiums should be fully tax-deductible. Insurance companies can devise ways to reward health. We would have a system that rewards individuals who take responsibility for their own health What about people who can’t, or won’t, buy their own policies? The first time such a person shows up at a clinic or medical facility, they will be instantly enrolled in a public, bare-bones insurance program: limited services, generic drugs, long waits, treatment by doctors-in-training. This option should be open to anyone, from a dishwasher to Warren Buffet. Fund it with taxes on items that contribute to lifestyle diseases: gasoline, cigarettes, couches, big screen TVs, video games. As for taxing supposedly unhealthy food, that idea is a non-starter. Sprinkle a few vitamins or some fiber onto the “unhealthy” food and, voila, a “healthy” food is born.

Exhibit A: vitamin-enriched soda. We don’t need to encourage products like that with perverse taxes.

This plan would work. Unfortunately the political will to dramatically restructure health insurance doesn’t exist. Politicians are too cowardly tell their constituents that health starts at home, not in the doctor’s office.

Donna Feldman is a resident of Louisville.

READER COMMENTS

Agreed, for profit agencies need to be removed from U.S. health care (insurance companies)

Posted by Froward on September 22, 2007 07:52 AM

Falling on the ski slope or slipping in the shower are accidents. Sitting watching TV or playing on the computer while eating unwholesome foods is a deliberate choice.
Comparing the two is compat\ring apples to oranges.
I agree with Ms Feldman that health does not come from the doctor's office (unless it is to get a check-up or a preventative procedure, such as a mamogram. I just would not leave health insurance in the hands of insurange companies. As long as they are "for profit", I am afraid they may only acccept clients who do not have chronic diseases or are born with problems. Thanks for a novel look at what is wrong with our healthcare system.

Posted by Joyce Svoboda on September 20, 2007 08:53 AM

First you would trust insurance companies when they are the culprits that created this health care mess to begin with? I would say politicians and republicans are scared to admit that much more than our “unhealthy” lifestyles.
Second you would tax couches, big screen TVs, video games.? Why not lift tickets? Skiing is dangerous too. Insofar a video games would you tax those that require whole body movement? How about hiking boots? There is a hazard there in twisted knees and ankles. Or taxing soap? Falling in the shower is a hazard too. Lastly what about childhood leukemia or forced hospice? Surely couches have nothing to do with childhood cancer. Or if someone is 85 had a good life, diagnosed with terminal prostate cancer. Decides he does not want to ebb away lingering in a hospice. Then is forced to, by the county he lives in. who pays? My dads insurance company refused to. Blaming health care cost on lifestyle is shortsighted. Truth is, life itself is hazardous.

Posted by Froward on September 19, 2007 07:02 AM