Yesterday I attended about an hour of a presentation at the Lafayette Public Library on potential changes to Colorado's state laws re: health care policy. Last year the state legislature created a blue ribbon panel on health care. They solicited conceptual proposals and filtered down to four for detailed analysis. The meeting yesterday gave an overview of this process and was meant to be a forum to solicit comments and concerns.
Senator Brandon Shaffer and a couple members of the 208 Commission, as the panel is also called, heard from a range of people. I was intrigued at the points that were raised, and felt sympathy for the folks who have messed up scenarios regarding their specialized needs and their struggles to get proper treatment. The saying "All that matters is your health.." kept popping into my mind.
The key issues I heard include:
- The distinction between access and coverage
- How coverage should be funded (by whom, really)
- Whether health care should be tied to employment (making employers the vehicle instead of the individual)
- The impact of illegal immigrants on the system
- Getting the profit motive out of health care
Having this philosophical argument is crucial. I'm turning over in my head the notion of health care as a "right". If I think of the right to free speech or similar concepts, these do not involve a financial impact. This is decision of governing that allows for certain behavior without some kind of suppression. If I think of the right to a speedy trial or other more mechanical rights, to me these seem to involve a policy decision that does involve costs we presume are part of our overall justice system, and as such the machinery we set up should cost the same, per person involved, once it it set up.
But health care as a right presumes that every last medical option and indeed even experimental options should be provided to every person whether they are ill from an accident, genetic bad luck or extremely poor personal lifestyle choices. This philosophical debate will have to address the notion that some illnesses are simply too far out on the limb for society as a whole to be responsible for treating. I don't know where that line is drawn, and what an awful place to be right outside it. But how else, truly, can it be as public policy? And why should anyone assume society will break the bank to take care of them? It's a great ideal, but can it really work that way on a grand scale - that everybody's health problems are treated to the maximum technology available? This elephant in the room is what Sen. Shaffer and his colleagues must tackle. A daunting task.
Yesterday I heard the notion of a two-tiered system, that would provide some kind of minimal blanket coverage for everyone, and then other procedures would be covered by some other kind of ability to pay. I think pragmatically speaking public policy has to lean that way. I can't see how every person's illness can be covered by everyone who isn't ill paying in. How is that sustainable? (These FAQ's address some of my questions.)
And a key side note - where does an emphasis on wellness come in? The legislature just changed the law in Colorado that allowed insurance companies to provide premium discounts to healthier (fewer claims) groups, as this was deemed discriminatory against the groups with ill people, who could be charged up to 10% more. If you can't charge the people who are actually sick more, and you can't give those people staying healthy a break, how can this work? The structural generosity of coverage for everyone has to be tempered with some kind of incentive and benefit if you stay healthy. Whether it's good luck, genetics or proactive behavior, if you're healthy, you're healthy. Such healthy people will get pretty bitter about paying for the unemployed overweight chain-smoker's third bypass operation.
I sincerely hope the legislature will answer the right/privilege question and draw up clear expectations (and limitations) for the coverage everyone deserves/will get in terms of society paying for it. Once we know the "what" we're paying for, then can we argue about how to pay for it.