Health care gaps

So here are some of the gaping holes or senseless proposals in the current health care bill:

1) Under pressure from Republicans, the bill has language to exclude illegal immigrants from coverage. It sounds nice, but it is meaningless. Studies estimate that some 60% of illegal immigrants have forged social security cards (easy to buy on the black market), or legal social security numbers obtained with false birth certificates (easy to buy on the black market), so how are health providers to sort the illegal from the legal applicants? Anyway, a filter doesn’t help the cost problem at all, because uninsured illegal immigrants typically go to emergency rooms for help, where they are treated for free if they can’t pay – meaning the rest of us end up paying for their care anyway.

2) The bill expands coverage by covering more lower-income people with Medicaid. But Medicaid costs are shared with the states, and in this recession many of the states are already facing bankruptcy, and don’t have more funds to put into Medicaid – in fact many can’t pay their current Medicaid shares. So all we have is yet another “unfunded mandate” from Congress that tries to solve a federal budget problem by simply moving it to the states.

3) The bill encourages the formation of insurance “cooperatives” – a sop to the Democrats who want a government-run insurance option. There is no evidence that insurance cooperatives will be successful, or that they will draw many customers. A few successful ones exist, but it is not a model that has been so successful that it has spread throughout the nation, and there is probably a reason why that its so.

Of course, if they put the government-run insurance option back into the bill, we simply have another problem – yet another new government agency with more bureaucracy and more cost. There is nothing in history to suggest that the government is any good at running such things.

4) The bill does nothing effective about capping the outrageous malpractice scams. It allocates a little seed money to states who want to “try” new approaches, but that will do almost nothing to solve the problem. Well, Congress is full of lawyers, and lawyers are some of the biggest donors to the Democratic Party, so why would Congress interfere with their well-paying work?

5) The bill includes nothing that would significantly cap or even slow the rising cost of health care. It doesn’t tinker with the incentive structure at all. Medicare and Medicaid are still the doctor’s and hospital’s “customers”, not patients. There is still little or no incentive for patients to control, or even ask for, the costs of the services they are being provided.