Health Care: Understanding the Policy Discussion and What Women Want

In the 2008 presidential election, healthcare is a leading issue for women.  Across their blogs, women are making it clear that they know our system to be broken and they want changes and solutions.

Unfortunately, despite a collective desire for a solution, we are offered a bewildering array of complex and confusing policy options which are further obscured by the application of sound-bite labels.

I hope to clarify what some of the healthcare policy options are and on Monday Morra Arrons will bring you a post sharing what the candidates' stances are on these options.

Healthcare vs. Health Insurance

Healthcare refers to the system of delivery whereas Health Insurance is currently the primary method by which healthcare is paid for.  Prior to the advent of health insurance around the 1930's, patients paid doctors and hospitals directly for providing care.  As medical treatments and technology increased, health insurance developed as a method of paying for higher cost treatment.  Payment of health insurance premiums became primarily employer-based as employers offered health insurance as a benefit in lieu of higher wages.

Health Insurance

Health Insurance is a for-profit system by which companies seek to collect more in premiums than they pay out in benefits in order to make a profit.  All insurance companies seek to minimize risk which creates an incentive to determine risk and not provide coverage to those who are deemed risky or to charge very high premiums.  In the case of health that means those who are more likely to become ill.  (Read here for the story of Patsy Bates who was just awarded $9 million to be paid by her health insurance company after they dropped her coverage when she was diagnosed with breast cancer.)

Universal Healthcare

Universal Healthcare refers to the concept of every American having access to the healthcare system regardless of how the system of payment is structured.  Universal healthcare is often used as synonymous to "single payer."  This is inaccurate as most universal healthcare proposals do not call for a single payer system but rather offer different ways of providing individuals the ability to purchase private health insurance policies.

Single Payer

Single Payer is the term for the notion of all healthcare payments coming from a single source, namely the federal government.  Medicare is a form of a single payer healthcare system.  Patients are treated by private physicians whose fees are paid by the government.  This is the model used in Canada.

Socialized Medicine

This term is loosely used so it is difficult to define.  However, the primary negative vision it is designed to conjure up is the idea of government employed bureaucrats delivering patient care.  In this scenario doctors would be government employees and hospitals would be run by government employees as is the case with the Veterans Health Administration rather than by various for profit, non profit and charitable groups and organizations (versus the idea of their fees being paid by the government as in Medicare).  However, as the term socialized medicine is often used to refer to any form of government involvement in healthcare, it is often used as a critique of the concept of a single payer system (or as it is sometimes called, "Medicare for all" ) and the prospect of a Canadian style system.

The term "Hillarycare" is also loosely used as a catch-all term for any government involvement in the provision of healthcare.  It is important to note that the proposals developed by Hillary Clinton in 1993 are not the same policies she now proposes nor did Hillary Clinton ever propose a single payer system.  Therefore this term is essentially meaningless as it is used and not pertinent to the current debate.

Additionally, the term socialized medicine is used to paint a picture of government bureaucrats making decisions about what treatments doctors can provide to patients and how courses of care can take shape. Whoever pays has a strong say in these choices so, yes, under Medicare, the government makes decisions about what procedures are covered and how much is paid for them. Under the system of private insurance it is corporate employees who make those same decisions. The only way those decisions would be left entirely to made by the individual in conjunction with their doctor is if everybody paid directly for services and that was the only system of payment for medical care.

Rationing

All healthcare systems require some form of rationing.  One common misconception in discussions of healthcare approaches is that only single payer systems such as those in Canada and the UK require rationing.  Our current system rations care by limiting care to those who can afford it as is evidenced by the denial of care, unwillingness of insurance companies to cover those with pre-existing conditions, the increasing loss of the provision employer-based insurance and tens of millions of Americans without health insurance.  Any changes to our system of healthcare will have to involve a hard but necessary national discussion about how we will limit care whether it be limits on end of life care, expensive treatments or limits on access to elective procedures such as joint replacement.  No system of healthcare can promise that every person can have any treatment immediately at any cost.

So what do women want?

BlogHer's Voter Manifesto shows that women want to know how candidates propose to ensure that all Americans have healthcare.  Recent polls show that 2/3 of Americans want a single payer universal healthcare system.  None of the remaining major candidates are offering that solution therefore it is incumbent upon us as women voters to ensure that they hear our voices and that we demand clear and complete explanations of why they are not offering what we want and why their solution is superior.

Further Reading:

The Logic of the Health Care Debate (a progressive perspective) from The Rockridge Institute
MOMocrats on healthcare
Public Opinion: Health Care and Election '08 a slide show from the Kaiser Family Foundation
Toward Free-Market Health Care by Grace-Marie Turner of the Galen Institute for The Heritage Foundation

And a small sampling of women sharing their healthcare stories - please add your voice in the comments or link to a story you think is important to hear.

Pretty Lady "Fie on 'Health Insurance'! Fie!"

Kyla at The Journey "My daughter's policy is being canceled and she is being denied for private insurance coverage."

PunditMom "Do My Parents Deserve Health Care?"

libelletage "Here Is My Soapbox: A Message On Universal Healthcare"