Dallas, TX –
I love open enrollment season. It's that time of year when employers allow you to sign up for health insurance - if you're lucky enough to work for an organization that offers affordable insurance.
My favorite part is imagining what unexpected medical expenses we'll face next year: another surgical biopsy? A trip to the ER after a car wreck? Maybe a bout of drug-resistant staph? We guesstimate, then run the numbers, trying to remember every dollar we spent so far this year and compare it to what we think we might spend next year under the various plans.
This process drives me crazy. This is the greatest medical system in the world? We've had three health plans in four years. But our situation is far better than being among this country's 46 million uninsured residents.
That rising number of uninsured Americans, and the continued increase in healthcare costs, has finally forced politicians in Washington to start confronting the problem. Presidential candidates are issuing reform proposals like a preacher hands out Bibles.
I long for a simple, over-arching plan that I could actually understand. Given the complexity of healthcare, and the way insurance costs are entangled with our tax code, that may be too much to ask.
Voters can, however, try to figure whether a candidate's healthcare reform priorities match their own. Is the candidate trying to expand access to affordable care? Control costs? Encourage patient autonomy? Improve Americans' overall health?
These are all worthwhile goals. Some are interdependent. For example, if we don't control costs, even fewer people will be able to afford basic healthcare.
I like the idea of lumping as many people as possible into the healthcare insurance pool, to spread the risk as broadly as possible. Right now, the only people who are promised healthcare are the elderly and the deeply impoverished - two groups that tend to be in worse health than average Americans. Why does the government cover those while private insurance covers people at lower risk?
Also, health insurance should be decoupled from employment. It's not as if illness only strikes those who work at large corporations. Kids get sick. People who are laid off get sick. Small business owners get sick. Employers shouldn't be expected to provide health insurance, and they shouldn't receive tax benefits for doing so.
So-called consumer-driven health plans have the worthy goal of making people more aware of how expensive medical care is. They allow patients to save a little money by doing things like managing chronic diseases and adopting healthful habits. That's good.
But I'm not sure patients are in the best position to decide which treatment or test is necessary and which is useless or inappropriate. We should be spending more money to study those sorts of questions - are newer, more expensive drugs really better than older, cheaper ones? Is physical therapy more effective than surgery? Doctors need financial incentives - and legal protection -- to adopt those best practices. And a ban on pharmaceutical reps handing out freebies would help, too.
This country's population is growing and aging, so healthcare spending will continue to increase. If we reform wisely, more money could mean more care for more people, not just more expensive care for some.
Jennifer Nagorka is a writer from Dallas.
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