Sunday, March 22, 2009

U.S. should require mandatory individual health insurance, major columnist says

Today, Sunday March 22 2009, The Washington Post ran an analysis by Ruth Marcus, “Crunch Time for Fixing Health Care,” link here.

Marcus argues several points, but the one that stands out is accepting the idea that the federal government should follow the model of Massachusetts and make some kind of y health insurance mandatory for all individuals. She argues that this is a compromise point: both unions and insurance companies and even employers as a whole favor it. Mandatory health insurance might help American manufacturers become more competitive in the long run.

So, then, “I am my brother’s keeper.” The healthy will help pay for the costs of those unlucky enough (or imprudent enough, or both) to be unhealthy. Marcus urges a kind and gentle implementation with modest penalties, but it will be hard to structure.

She mentions automating medical records – I think this is a big issue, personally, with coordinating prescriptions and other procedures – but also mentions that deciding what to cover will become a big political boondoggle. We already have a lot of experience with this painful area with Medicare, where we struggle with end-of-life extension and treatments.

That brings up a big point about how medicine is evolving. With all the talk of healthful lifestyles, diet, smoking cessation, and cancer screening, there is still a major portion of medical experience with patients who will require a lot of care and personal attention. I look back on the experience with HIV and AIDS and see that there has indeed been tremendous progress in not only extending life but in getting people back to work and in control of their own lives. We have not had the same kind of progress with the elderly, however. And we have many invasive and radical treatments, such as transplants, that depend on the sacrifice of others, especially family members.

Social conservatives will inevitably figure this out – that family “unit cohesion” is going to have an effect on what treatments can be covered under universal coverage plans. The demographics of today’s society, in the West, do not bode well. Although Bill Clinton maintained, recently on CNN LKL, that Canada has been able to cover essentially everything (in a single payer environment) while waiting lists can be long.

She takes a middle road on letting employers use pre-tax dollars to cover employees, saying that there could be caps.

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