Tuesday, June 16, 2009

Health Care Reform: The Symptom

"Treat the disease, not the symptom" is good advice for solving any problem, but it's especially pertinent when applied to Health Care Reform. One of the first things I learned in engineering school was the art of problem solving. Step one of solving a problem is to identify the problem, and this is often more difficult than it sounds. What is the problem we face with health care in America? It's not the quality of the health care we receive: various surveys show that between 70-85% of Americans - including those without health insurance - are happy with the quality of their health care. The symptom is that we have millions of uninsured - but that's not the problem either, it's a symptom of the problem. I'll get to the problem in a following post, but first let's examine this symptom in more detail.

The US Census Bureau has a widely-cited statistic. There are 47 million uninsured or underinsured individuals in America. That number includes millions of illegal immigrants, but that's beside the point. 47 million is 15% of the population, so 85% of the population has full health coverage. To further define the symptom, let's examine that number - 47 million - in greater detail. The same US Census Bureau statistics found the following - and these statistics are never cited by proponents of health care reform:

- 38% of those 47 million people have income over $50,000.

- 20% have income over $75,000

- 75% of those 47 million people become fully insured within 1 year of becoming uninsured.

- 44% become fully insured within 4 months of being uninsured.

Those last two points are the most important. They signify the truth about the symptom: there are 47 million uninsured in America at any given moment in time, but it is a rotating group of people: 75% get insured a short time later. While it's not ideal to go without health insurance for several months, it is by no means a huge problem that requires a drastic solution. In truth, there are only 11 million people in America who fall through the gap between our current government programs (medicare and medicaid) and the private system to become "permanently uninsured". That is 3.6% of the U.S. population.

Let me reiterate, the symptom is this: 3.6% of the U.S. population falls through the gap between private insurance and our existing government programs. Three-point-six percent - and some fraction of those simply don't want health insurance.

People fall through the gap for a variety of reasons, but the most common is that their income is too high to qualify for medicare or medicaid, and private health insurance is too expensive for them or denied completely because they have pre-existing conditions that make them too great a risk to insure.

At the same time, a far less serious symptom is that 12% of the American population is temporarily uninsured at any given time. Again this can happen for a variety of reasons: getting laid off from the employer that was providing you with health coverage, falling on tough financial times and not being able to afford an individual plan, turning 25 and no longer being covered by your parents' insurance, or moving to a new state where your old insurance company doesn't operate (that happened to me) and taking some time to find a new one. While any of these is an unfortunate situation to be in, they are hardly catastrophic, because the odds of one requiring major medical care during the few months of being uninsured is very low - and the fact that all the people within this category become insured within a year implies that they made it through without ill effect.

Now we have identified the seriousness symptom. If we were to just treat the symptom (ignoring the underlying disease), what would be the logical course of action? Find a way to provide health insurance to the 3.6% of the population that is permanently uninsured, and if we want to go further, find a way to provide temporary - for a duration of less than 1 year - insurance for the 12% that is temporarily uninsured.

Do you think an appropriate treatment for this symptom would be the dismantling of the private insurance system that provides the highest-quality health care in the world to 96.4% of the American population, the creation of a multi-trillion-dollar government-run program, and the other various ideas proposed by Obama and the Democrats? Or do you think that is overkill and even totally off-target, like performing open-heart surgery (which might kill the patient) to fix a broken leg?

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