Ok, I am working on a
much longer post on R2, RIOS, and ESteward certification, which was finished afterwards but posted below due to editing constraints. Meanwhile, here is the 360 second explanation of the health care insurance debate, from the perspective of a recycler.
First, my wife is European and lived there with my kids for a year, and we have experience in both systems. Second, my company, with 20 USA employees, is right on the line of mandatory coverage, so we can lay one person off to avoid mandates for the other 19 (if that was our interest). Third, most of our employees are "ten foot tall and bullet-proof", twenty somethings who don't tend to want the optional health insurance we offer, and probably only need catastrophic.
I think the debated points, positive and negative, are being exaggerated. It is easiest to argue against a "straw man", for liberals to describe the positions of Rush Limbaugh, for the conservatives to debate against Michael Moore. They are playing hard football with the facts, and both sides are doing end runs and hail Marys to advance the ball. Here are some basic facts:
1) We all die someday. The closer we get to that day, the more expensive our care.
2) Since the average age of death in the USA is over 75, and Medicare starts at 65, the "public option" is already in place for the most expensive care. The public system already bit off the most expensive and difficult part of the job.
3) The cost of health care always includes a lot of "overhead". If I am a hospital administrator, and just bought a brand new emergency room for $10M, I have to pay for that whether or not people are using it. This exaggerates the claim on "non-covered" people who use the emergency room as a walk-in clinic. The question is efficient use of the emergency room, that is what "triage" is about. If the ER is empty, treating a cut finger and charging $2000 to "uninsured" sounds terrible, if you want it to, but having an empty room also costs pretty close to $2000.
To simplify the analysis, let's pretend the debate is over computer repair rather than human being repair. Assume we are trying to make every computer last as long as possible, or realistically, 15 years, through upgrades and parts replacements. The 10 year + computers we'll call "grandmas", the dual core Pentium 4s we can call "children".
Right now the system is that the government pays for repair of 10 year old and older computers, through Medicare. That is basically saying we have already swallowed the largest part of the elephant. Insuring children, the Pentium 4 dual-cores, was relatively easy and most states have adapted programs for that on their own. Pentium 3s, if they are covered, are mostly covered by the employer who outsources the repair bills to private insurance companies.
The debate is now on who repairs the uninsured Pentium 3s. Some of the P3s work fine, and therefore don't want to buy insurance, and when something DOES go wrong they are shocked at the price of a replacement stick of RAM. Other Pentium 3s have recently had a replacement or are paying insurance for repair and upgrade, and seeing their costs go up as they age.
The acceptable speed of a computer keeps changing, and the technology exists to put hard drives into a P3 which can, for example, store movies. The bandwidth makes that not a great investment, but if you put a name on the computer, like "Cindy", you can see the analogy. "Cindy used to run marathons, now she needs knee surgery." Or, "Her hard drive size is a pre-existing condition, and she cannot afford the hard drive to watch the movie."
The left focuses on the doe-eyed personalization, or poster child, and we all want to see Cindy do well. "Move that bus!", we cry, and we applaud to see Cindy with a new hip replacement / hard drive, storing WMV files. We hope that new medicines or software will provide future cures that allow Cindy to win marathons again.
The right focuses on the costs of repairing 13 year old computers, and says that if computers cost this much, imagine the cost of insuring all computers. Most repair-people are shying away from repairing the older computers already, and they hate bickering with the public insurance system over who pays the cost of the software for the Pentium 1. Most of the future will be defined by software yet to be written, like cancer cures or new genetic medicines.
The actual cost of the system will be defined by overhead divided by computer repairs.
The left is right, that bringing more computers into the repairshop will lower the cost per repair by dividing the overhead over more PCs.
The right is left with the equally correct observation, that you will wait in a longer line, because ten-foot-tall-bulletproof Ken is now covered for his broken foot and has to fill out paperwork to be covered, rather than going to the ER and running off on his bill, which allowed the hospital to overstate the costs they were not to blame for. Pentium 3s covered for new hard drives now will benefit from larger scale purchases of hard drives, but will wait longer through more administration to get them.
Uninsured people in ERs can be a pretty efficient "triage" if it is not a malingering or long-term health problem. And we already have the most expensive people (Medicare) covered. The question for me is how do we arrive at a spiritual place where people can die with dignity and celebrate the past life, like they did in Cameroon when I was there in Peace Corps. We held a "big cry" for the Pentium 2 when it passed, and a "big die" celebration and dancing six months later in remembrance of our dearly departed P2, but no one thought for an instant that death was something we were going to avoid.
The biggest problem in government is managing bills through obfuscation and "shark attack" panics (big press to extremely ill-representative problems). Referendums in places like California and Arizona bring the process "back to the people", who vote:
1) Balance the budget
2) Spend more on schools and health care
3) Cut taxes
The result is deficits and a broken currency system, followed by stimulus packages to be divvied out to lucky "connected" people. The more astute folks, like Tom Friedman, point to all the other benefits (environmental) of the EU gasoline taxes which pay for their systems, but EU doesn't have senators from western states with high miles-to-population which makes getting a gas tax harder to swallow for people not riding the subway to work. The left says the answer is rail, basically putting subways in more western states, which is probably the most asinine suggestion floating around. European populations grew up around rails, USA grew up around cattle trails, the math is different.
The left makes us want to love the P3 with cancer which was a loyal and hard worker. The right wants to blame the high cost of a hospital built in an area with declining population to define the cost of repairing that P3. It's an ugly, muddy game of football where most people only know enough to root for their home team, without knowing the names of the players or the rules.
Enough for now. It is not that expensive or difficult to repair P3s, but it is not very profitable. But it is more profitable than the Medicare system for P2s. And the bills and deficits are being passed down to the
