Wednesday, April 29, 2009

(Re)Stating the Obvious: Health Insurance vs Health Care

If you don't ask the right question, you're never going to get the right answer. Similarly, if you don't address the right problem, you're never going to find the right solution.
If health insurance is supposed to pay for health care, then there need to be adequate providers of that health care in the first place. Simply requiring everyone to have health insurance (and requiring insurers to take everyone regardless of health, circumstance or personal choice) does nothing to resolve the underlying shortage of folks who actually deliver the care ostensibly financed.
That seems fairly obvious to most, but then most aren't former college professors or community organizers. And that's exactly the problem with the current administration's grand vision of health care: if there's a shortage (and there is), then how do you provide it to everyone who needs it (you don't).
Which brings us to the real crux of the problem, an ongoing (and increasing) shortage of both specialists and primary care physicans:
One proposed solution is to bump up Medicare reimbursements, but that's met with considerable resistance from the doc's themselves: since it's essentially a zero-sum game, increasing PCP reimbursements would cut into the specialists' income.
And, of course, Medicare itself is slowly, inexorably going broke, which one would think might be a wake-up call (but of course, it hasn't been).
Another proposal (which we've heard before), would be to (somehow) increase the supply of doctors [ed: really? How quickly can we clone them?]. That, too, has met with resistance from, you guessed it, physicians; more doctors means more available care (theoretically), but does nothing to reduce costs.
Quite the conundrum.
So we have a health care system with significant problems, but we're looking at changing the health insurance system to address them. Why does anyone think that makes sense?
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