
While the debate rages on, I find myself unsure of how I stand on the issue of health reform. I've had good health care all my life, the insurance plan offered through my work was top notch, and better still, I still carry it as part of my retirement package.
But I have been affected by many changes within the insurance industry. Living in a small rural corner of California I was at one time able to be on an HMO, but that plan got too expensive for the carrier to provide, so it was dropped, and we were left with only a PPO option. The HMO business model requires a high population density of low risk office workers. In the rural community you get way too many visits to the ER for chain saw accidents, horse riding falls, and other hazards of large yards.
Our local union chapter looked briefly into some type of self-insured option, which on a routine basis looked adequate. But even on this small population sample the odds were too great that someone in the group will suffer some catastrophic health care need that would break the bank.
Now the discussion is at a national level. Can the numbers actually work out that the low risk segment can underwrite the higher risk segment and remain viable? Can 100 office workers that risk a paper cut really pay enough in premiums to cover the farmer bringing in the grain for their bagel if he catches his arm in the wheat thresher.
There are hardships within the current system that are not in dispute. What no one seems to be asking is, what if this is as good as it gets?
The system now has some people with great health plans. But there are high numbers of people with no coverage. Is the new reform going to give us an increase in the number of insured at the cost of lowering the quality of health care for some.
I suppose that in my personal example, California could have stepped up and ordered the HMO companies to continue coverage in all counties if wanted to maintain a contract with the state. But the numbers would not have added up for them to maintain the same level of coverage to all. Something would have to be dropped, or at the least limited. Instead, the rural counties lost their HMO coverage and the urban clients kept their package.
I hear during this current debate that only a relatively small percentage of people will be hurt by the reform. That the majority of Americans will benefit. Why are we playing this cost-benefit game?
What I would like to see more of, is more effort to seek solutions that help all citizens. Is there something that can be done to contain the high costs of health care that help all Americans. Before we form some public health care insurance plan, why not a public mal-practice insurance plan to help doctors and health care providers keep their cost down, and allow more options for health treatment plans.
My biggest fear of this sweeping reform package is that there is no way to predict the unintended consequences that may arise. Certainly those are unavoidable in most any legislation, but a go slow, incremental approach would keep them manageable.

