I worked for Kaiser Permanente for 18 years. It provides insurance and health care, so the incentives are more aligned. There is no incentive to under or over treat, since doctors are on salary. It might not have been perfect, but I miss it so much.
Here are some examples of why we need health care reform:
- My friend Bridget, an active young vegan who has "health insurance," but then once she was diagnosed with Stage IV colon cancer was told that her plan didn't cover $1300 a piece nausea patches or $400 a piece pain killers. I'm sorry, but health care should not be paid for by fundraising dinners and silent auctions.
- My brother. His company went bankrupt. He was told he, his wife, and one of his two kids were uninsurable because of prior medical conditions. None of those conditions are life-threatening, or even all that serious. I think he was eventually able to find some kind of policy with a $7500 deductible. In other words, all the health care is paid for by you unless you get really, really sick.
- My own family. We have a health plan through my husband's job where a colonoscopy costs about $550 out of pocket. How many people would choose to put food on the table for a month rather than have a colonoscopy? Yet a colonoscopy is lot cheaper than treating Stage IV colon cancer.
- Many people who private pay for their own insurance pay more than the cost of their mortgage. I know we would if we were paying out of pocket.
I do believe you have to require that people have at least minimal health insurance. Otherwise, the costs won't be spread over the young and healthy, because they would be the least likely to buy in. Washington State used to have (I don't think they do any more) a "must issue" plan, where no one could be denied, no matter how sick they were, but insurance companies could charge what it cost them to provide care. The only people who opted for that plan were the ones who knew their costs would be even more than the premiums. The next year, the plan would cost even more, and a dwindling number of people was willing to pay that amount. It was basically a death spiral.