Jerry,
Thanks for the thoughtful response. I agree in some areas and disagree in others.
First of all, I wonder if State regulation of insurance is the answer. It seems like it would be more difficult for companies to compete if there were a mish-mash of regulations to follow. A company that wanted to compete nationwide would have to adapt to fifty different sets of regulations. Seems like that would greatly add to the cost and complexity, which is where we are right now. Also, what happens is that companies would tend to concentrate in those States that had the most lenient regulations, leading to what they call a "race to the bottom" to the States with the least regulation. This is why most corporations incorporate in Delaware -- it has the least restrictions. I think this would result in fewer companies competing in some areas, leading to monopolies and less consumer choice thereby negating the advantages of a free market system.
At the same time, I understand that federal control of anything is not ideal. Medicare/Medicaid is a prime example. I would prefer to see private control of the industry, but with federal regulation and oversight. Having said that, my mother was on Medicare/Medicaid for the last few years of her life and I had no complaints about the treatment and care she received. But I understand there are a lot of problems and abuses in the system. And I also understand your concern about quality of the plans available. Still, to someone who simply can't afford any insurance, there is no safety net. Too many families are going bankrupt because of this. We need some kind of national solution for families who can't afford insurance but still need medical care.
Just about every European country has instituted some sort of Universal Health Care system and most of them are rated higher than our health care system by the WHO, so I just can't believe that we are incapable of doing this in an effective manner.
Your statement that "few american youth choose to go to medical school anymore" is just patently false. According to the
AAMC, the 2007 medical school entering class is the largest ever. Overall, medical school enrollments have increased more than 7% since 2003.
The problem, as I see it, isn't that salaries are being cut. It is that the cost of the education is skyrocketing. Perhaps that is an area that needs addressing. Better financial aid for medical students would allow doctors to make a good living with less income because they didn't have so much debt service. Just something to consider. I do understand these issues on a personal level, as I spent $50,000 going to Law School (mostly in the form of loans), only to come out making $30,000 a year. I know it is much worse than that for medical students.
Another problem, I think, is that salaries for specialties like surgery or anesthesiology are so high, that fewer doctors are going into general practice. And that is really where we need the bulk of them. As the baby boomer population ages, they will place an even greater demand on the medical profession, and that is part of the concern I think about having a shortage of doctors.
There are health policies available from AAA companies that provide for very high deductable and little or no pre-existing conditions exclusions. Deductables are typically $7500 for an entire family and costs of the policies range around $3500 per year for a family of 4 without maternity benifits.
So what you are saying is that these families, if they had a hospitalization, would have to pay up to $10,000 out of their own pocket before the insurance even began to kick in? How reasonable is that for Joe the plumber?
My wife and I don't work, so we pay for our own health insurance. Our coverage costs over $7,000 a year, with a $500 deductible and this is only for Major Medical coverage. We pay for all the regular doctor visits and small stuff ourselves. Can I just say: OUCH! If I weren't wealthy, there is no way I could afford it. Just think about that for a second. In the past five years, I have paid $35,000 just for insurance coverage! How could any average Joe afford that? Then you stop and think about all the professions in our country that don't provide insurance benefits: sales clerks, waitresses, landscapers, small businesses that can't afford it, etc., etc., and you start to see the magnitude of the problem.
We desperately need a solution to this problem, so that people can get basic medical care without going broke. McCain's plan doesn't seem to be a solution. His tax credits are not near enough to cover the necessary insurance costs at current rates. And his whole idea of keeping costs low is to let the free market (aka competition) do that. Well, that has worked so well already, which is why we are paying through the nose for insurance right now. And as you pointed out, it does nothing for indigent care. Honestly, I don't know whether Obama's plan would ultimately be any better. Either way, these proposals are dead in the water anyway. Once Congress gets ahold of either of them, the lobbyists will have them so screwed up that nothing good can come of it. That's a shame, too, because our nation really needs some form of Universal health care coverage.
Ultimately, I just think Obama is more interested in actually achieving something positive on this issue. I think McCain is just giving it lip service because it is an election year. His record in the Senate leads me to believe that health care reform really isn't very high on his agenda, nor is making health insurance affordable for the middle class.
(I'm joking, of course)
