Health insurance for all? Is that a good thing? What can I do to help?

June 25, 2009 4:59 PM

So, I saw Howard Dean on the Colbert Report last night. Please help me with some specific action steps regarding health care and the future of the USA.

How can I learn more about the options on the table (and the options not on the table) and how they might affect individuals (of all levels of income and varieties of occupation) as well as the general economic health of the country? Whether or not I arrive at any personal conclusions, what can I do to help the best option prevail?

I've been vaguely aware of the situation as it's been unfolding, and I've been selfishly hoping that things will work out in my personal favor. But I've never wanted it as bad as last night. And, if I'm actually going to educate myself and take action, then I want my actions to benefit the largest number of people possible, with a long view to the future of the country.

Clarification: Please don't argue for or against different things in your answers. How can I figure out the different options and do research on them myself? Is there anything besides "write my congresspeople" that I can do to help? (Especially if I, in the most likely case, side with some sort of government health insurance?)

posted by zeek321 to law & government (10 answers total)

This week's Economist has a broad outline of the challenges facing Obama et al in tackling health care costs.
posted by dfriedman at 5:01 PM on June 25, 2009

How can I figure out the different options and do research on them myself?

This is kind of a "micro" answer, but I get a lot of information about what is wrong with health care by chatting with my GP about his business, and also with family members who are in medicine. I don't think very many patients just chat with docs about that stuff. Tried it with the dentist, too - have you ever thought about the cost of all the capital equipment those guys have to buy for their practices? Great conversation starter.

Try it. As long as there aren't 50 people stacked up in the waiting room, your doc will probably get really animated. Great source of information from the people on the front lines.
posted by txvtchick at 5:39 PM on June 25, 2009 [1 favorite]

Insurees trade off regular, frequent payments into a pool of funds against the ability to have that pool pay for irregular, unlikely expenses. If this is to be sustainable, the pool must always maintain a very high probability of having the ability to cover those expenses.

Consider the effects of:

• increasing or decreasing the overall size of a pool compared to the size of the largest expenses it will ever need to cover (e.g. how does the total pool size now compare to the maximum expected payout? What percentage of the pool must be put aside for reserves? How much of the pool can reasonably be used as an investment fund?)
• fragmenting a pool into several competing pools (e.g. what can service providers charge if they have multiple pools competing for their services versus one?)
• limiting a pool's sources of incoming payment to insurees who are more or less likely to require payment from that pool
• forcing everybody to use a given pool, perhaps via incorporating pool payments into taxation
• steady drawdown of a pool via non-insurance-related payouts (e.g. to insurance company shareholders)

and come to a position on whether no insurers (i.e. individuals run their own private pools), multiple private insurers, or a single Government-run insurer is likely to deliver better health outcomes and/or reduce health-related costs.

Look around the world at what other countries are doing. Find out how they fund their health systems and look for correlations between those arrangements and gross health indicators such as average life expectancy. Find out what correlations exist between government funding arrangements and the health of those whose incomes are well over, at and well under the median. Google is your friend here - it's never been easier to make those comparisons.

Come to a position on what you think is the sanest way to organize a health system, and argue for that. Do write to your representatives.

Getting involved in grass roots lobby groups like MoveOn and Avaaz might give your opinion a bit more leverage, too.
posted by flabdablet at 6:12 PM on June 25, 2009 [1 favorite]

How can I figure out the different options and do research on them myself?

Part 2 of my answer. For more of a big picture view, it's always interesting to compare what the various policy institutes (think tanks) have to say about an issue. Here are three that have whole sections dedicated to healthcare policy analysis:

The Cato Institute's section on health care. Cato leans libertarian.
The Heritage Foundation. Heritage is conservative.
The Brookings Institution. Brookings leans left.
posted by txvtchick at 6:19 PM on June 25, 2009 [1 favorite]

Matt Yglesias has a great blog and people talk about Ezra Klein a lot, but I haven't read his blog because I already waste enough time reading about politics online. *sigh*. For some reason I didn't stop after the election like a normal person.

The thing is, ufornuately you can't just load up Google and become educated about what's going on because there is an enormous amount of money being spent on disinformation right now. So even if something seems authoritative, like from the American Medical Association or some other neutral seeming source, it's not. Right now the AMA is opposed to a public option just like they were opposed to the creation of Medicare.

So of course insurance companies are spending tons of money to try to misinform and scare people. And people on the left are spending lots of money to try to argue for a public option (or single payer)

Also, I don't know if I would call the bookings institute "left leaning" they are more "centrist". They don't appear to support a "public option", this transcript on their page their expert says:

Past experience suggests that Congress will not permit a federal program to have a major adverse impact on private competitors; hence, pressure is not likely to be excessive. More importantly, it is a red flag, which I suspect Democrats will give up in order to secure a measure of bi-partisan support. The key issue is going to be how to pay for the cost of extending coverage.

So on the issue of health care, at least, they are definitely not "left leaning" at all.

The Center for American Progress is probably the biggest and most influential liberal think tank out there.
posted by delmoi at 7:21 PM on June 25, 2009

Brookings does not typically take policy stances as an organization, to my knowledge, although individual authors can and do. It is the policy analysis biz, not the advocacy biz (again, as an organization).
posted by raysmj at 11:57 PM on June 25, 2009

The thing is, ufornuately you can't just load up Google and become educated about what's going on because there is an enormous amount of money being spent on disinformation right now.

Yes, thank you for voicing that! Otherwise I would have just started googling. Thanks for the ideas, everyone.
posted by zeek321 at 3:52 AM on June 26, 2009

If you're interested in finding out the nitty-gritty details policy-wonk details of what the different legislation traveling through each Senate committee is and the likelihood of each one passing, then really you want to be reading Ezra Klein's blog on the Washington Post.

If on the other hand you're more interested in understanding the deeper theoretical issues of how our system is set up, what sort of problems it's causing--less politics and more academic, I suppose I'd say--then there's a bigger variety of places to look, although it tends to be less blog-like and more policy papers about specific aspects of the system. I'd put Heritage, Cato, and Brookings (linked to above) in this category, although none of those three are particularly well known for their health work; to that I'd add the Commonwealth Fund and Kaiser Family Foundation, both of which focus specifically on reforming the health care system. KFF lets you sign up for once-weekly emails about the stuff they're putting out on specific topics (e.g., women's health) which I think is really useful for kind of managing the information overload.

Another top-notch place to look for information about problems in our system, and to get a good sense of what the big political issues around delivery reform are likely to be in any given year, you should check out the MedPAC reports every year to Congress. They're the inpartial body that advises legislators about Medicare payment reforms, but their reports generally do a fantastic job of sifting through and summarizing the best research out there and then coming up with (reality-based) political reforms to improve the system. Since their stuff is aimed at an audience that doesn't have years and years of background in health policy, it's extremely accessible and readable to boot.

I also have enjoyed Health Beat over the past year; it's written by a journalist who did a nice book on the root causes of medical inflation. She does tend to look a lot of things through the prism of her thesis in that book (basically the Dartmouth research, which has been getting A LOT of attention very recently, most notably in an article by Atul Gawande that Obama has apparently been quite influenced by). Browsing past articles of the Health Wonk Review could also really give you a start in understanding a lot of issues around health reform and our health system more generally, from a variety of perspectives, which is nice.

For your purposes, though, I'd still put Ezra Klein's blog at the top of the list. That one should go straight into your feed reader; the rest is a nice way to round out your self-education and understand and maybe get a deeper perspective on some of the more nuance-y system issues that he doesn't deal with as deeply.
posted by iminurmefi at 7:58 AM on June 26, 2009 [1 favorite]

I think you should head to the public library. The librarian would be able to find you books that people have written (there are many!) about the US Health Care system and comparisons of different systems.
posted by Gor-ella at 9:10 AM on June 26, 2009

TR Reid's Sick Around The World is a good introductory backgrounder on how other countries do healthcare, and in particular, how other countries (Switzerland and Taiwan) do health reform. He has a book forthcoming, too.
posted by holgate at 7:08 PM on June 26, 2009