Monday, July 23, 2007

The S-CHIP Debate

by shamanic

Oh health insurance, how you bring out the ideological divide...

The National Review has an editorial on the S-CHIP debate, where shockingly, they call for private sector solutions. Sorry, I think I just gave away the ending.

Anyway, I wanted to pull a couple of quotes out because I think they're interesting.
S-CHIP also creates a trap for low-wage workers. Michael Cannon of the Cato Institute notes that, in combination with other welfare programs, S-CHIP levies a very high effective marginal tax rate on many such workers. If they work hard to make more money, that is, the resulting loss of benefits can put them behind where they started.
This is an interesting argument that relies on 1) insurance being part of a compensation package, and 2) the auto-deducted fees for insurance being taken out pre-tax. Which I guess they are.

It's been some time since I checked out my pay stubs online to calculate my cost, but if memory serves, I'm paying something like 10% of my take-home pay towards insurance. Don't quote me; that might be the total paid by me and my employer for insurance, but it's still a considerable sum that I'm sure both of us would prefer to keep in our pockets.

The second quote I want to pull sort of confirms that idea:
“Health insurance for kids” is a popular slogan, of course, and much of the business community is with the Democrats.
The bottom line on universal health insurance for me is cost and service. As it stands now, it takes forever to get in to see a doctor (or dentist, for that matter) even with health insurance. In a universal system, I would have to have confidence that I could see a doctor for any reason within, say, one month (currently I find it's about 3 for routine stuff), and same or next day when I'm actually sick.

Additionally, I took a trip to the emergency room about a year ago during a home improvement mishap. I spent the entire car trip there trying to navigate a series of voice-activated menus that eventually, as we pulled into the hospital, got me to a human being at my insurance company who then couldn't tell me whether the hospital I was at was "approved". I was bleeding, in considerable pain, and finally hung up on the woman and went in. I ended up with a $175 bill after the insurance company paid its part.

These kinds of nightmare scenarios (and this one is mild) happen all the time in the American health care system. A universal system would need to give me confidence that if I need treatment, I can walk into any hospital and get it. I'm fine with paying a co-pay to use the ER, but the mystery charges have to go away. I have no idea why having a nurse confirm that I'm up-to-date on tetanus vaccinations and then having a doctor instruct me in wound-washing and then having another nurse put some neosporin on the wound and slap a band aid on there should cost anyone $175, but maybe what they're really selling is peace of mind.

Anyway, a universal system that cost 8% (instead of 10%), didn't have double-digit percentage cost increases every year, provided reliable and relatively prompt access to health care providers, and didn't stick me with mystery costs when emergency treatment was required would be a welcome advance in my view. What are the odds that we could have that here?

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