Tuesday, May 12, 2009

HR 676 - The Good and the Bad - Part 1

HR 676 is a popular attempt to expand Medicare to all Americans. It is greatly supported by unions and health care professionals. It is greatly opposed by insurance company executives and shareholders, as well as free-market ideologists. Based on the outcome data from the "real world experiment" of other industrialized nations implementing similar systems, it is relatively clear that HR 676 has some good and bad attributes. I will start discussing these attributes in this post, but will probably have to finish in subsequent posts.

"All individuals residing in the United States (including any territory of the United States) are covered under the USNHI Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual’s social security number shall not be used for purposes of registration under this section."

This is the basic summary of the whole bill. This entitles everyone in the US to health care. No more 46,000,000 uninsured Americans. No more millions of bankruptcies due to medical bills (half of all personal bankruptcies). Fewer people waiting for acute conditions then going to the ER, which means better work productivity and lower health care costs per person.

Notice also that this includes Guam, Puerto Rico, and potentially illegal residents. Though there is evidence that illegal residents use less health care than citizens, they still use health care (usually the ER), often without paying for it. This may provide an incentive for them to use basic care and preventative care instead of emergency care, which will save us all money in the long term.

Speaking of the long term, I am compelled to point out that giving poor women access to prenatal care, and poor children access to basic and preventative care, may save our society billions in services for kids with chronic conditions. Babies born underweight tend to have so many more problems in their lives than healthy babies, and that is typically preventable.

One possible problem is that people that are currently dying (the US has the worst infant mortality among its industrialize cohorts) may instead survive with chronic conditions. That would increase long-term costs and lower net quality of life (drastic effects on caregivers, reducing mothers' lifespans by up to a decade due to stress), but I cannot confidently predict what the rates would be. Also, some people believe in keeping everyone alive as long as technologically possible despite quality of life, so this point has a very subjective and controversial value. How to weigh this into the decision-making is difficult and unclear.

"Individuals and families shall receive a United States National Health Insurance Card in the mail, after filling out a United States National Health Insurance application form at a health care provider. Such application form shall be no more than 2 pages long.

Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a United States National Health Insurance Card and have payment made for such benefits."

So, the first time you show up, you get services under the assumption that you qualify, and you fill out a 2-page form to get your card for the future.

Unless service providers are checking that patients' identification cards match the application forms, there is little to prevent fraud. Oh, wait, what would be the motivation for fraud? Everyone gets free care in this system.

To be continued...

No comments:

Post a Comment