Is the proposed Heath Care Reform the right thing?

Something quick about my views on the health care debate. I don't want to be mistaken for somebody who is against the plan just because it is pushed by the Democrats, or that I think poor people don't deserve good care. I'm not sure that the solution which is being proposed is the right one.

Part of what I do for a living is to analyze problems in software. In particular, when we see a problem, we don't just jump into fixing what we can see - first we determine if what is observed is actually the problem, or just a symptom of the problem. Most of the issues that people see with Microsoft Windows are actually symptoms. When your web browser crashes it rarely is because of a defect in the web browser - its because of a defect in another piece of software that destabilizes the browser, causing it to crash. Finding the actual root cause of the problem can be very difficult. I've spent weeks tracking down traces of issues to get back to what really happened to cause what was observed.

My biggest fear is that we (as a nation, and the political leaders in Washington D.C. in particular) haven't taken the time to look at the root cause of the problem. What are the symptoms that we can observe:

1. Health care is too expensive - people generally cannot afford care unless they have insurance. Both doctor visits and medicine can be extremely expensive
2. Health insurance is too expensive - unless you have a good job and an employer that pays most of the premiums
3. Some people go bankrupt trying to pay medical bills, or don't get the treatment they need and die because they don't have the money
4. Hospitals are closing in some areas (going bankrupt or losing money and closing for business reasons)
   

If you've spent much time looking at this, these are all related. Because of (1), (3) happens (people can't pay for coverage, or go broke paying). (1) leads to (2) - the money collected in insurance premiums has to cover the expenses, or the insurance company goes bankrupt. If medical costs increase, insurance costs increase. (4) is a side effect of (3) - enough people that don't pay and the hospital has to do something, maybe leading to (1). As insurance companies try to fix (2), they pressure doctors and hospitals to lower their rates which also may contribute to (4).

A lot of reasons have been given for why health care is so expensive:

• Greed - the doctors need those big homes and private club fees...
• Uninsured - people without insurance can't afford care, so don't pay, and the charges for everybody are raised to compensate - when I pay the hospital I'm paying my bill and part of somebody elses
• Legitimate office expenses - the people working in the doctors office need to be paid, and they (like everybody) expect to get more money every year
• Illegitimate office expenses - things that are maybe also symptoms of the problem. Doctors now need to have staff dedicated to billing and handling insurance claims. Malpractice insurance keeps going up. Paper work and bureaucracy (HIPAA anyone?) lead to more paper-pushers needed everywhere.
• Illegal aliens are using medical resources and not paying
• Space aliens are making everybody sick...

OK, maybe the last one isn't a real reason. I do know that the doctors office we were going to in Illinois went bankrupt and was bought out by a larger health care organization. I do know that Illinois has extremely high malpractice rates, high enough that doctors move their practice to Wisconsin. I also see that my insurance company knocks off 30-70% of what the doctor bills - money which he won't get paid and can't charge me for. Either the doctor was really padding his bills, or he's losing money on insured patients.

The goverment's solution? To create a new bureaucracy and make sure that everybody gets Health insurance. This is at best a band-aid on the symptom - we make sure that everybody gets to contribute to make sure that everybody has insurance to pay the outrageous medical bills. And, we need to pay more taxes to staff the new bureaucracy which will govern the insurance plans. No real mention of how health costs will be brought under control - as new government regulations come in costs are likely to go up as more staff is needed to manage the insurance twists. We aren't addressing why medical care is expensive, only making sure that everybody is insured and able to pay for it - while possibly also driving the medical profession out of business through lower negotiated rates.

This band-aid is only asking for the problem to ooze out of a different area - if health costs are not controlled, then health insurance costs will continue to grow - and with the government backing insurance for all that will hit you and me in the pocket. We just push off the problem to a later time.

Maybe some part of the debate should be about how to reign in the costs of providing health care - how can the cost of doing business be reduced for doctors? Can malpractice insurance rates be reduced through meaningful tort reform? I don't want to prevent people from getting redress for negligence on the part of a doctor - but I don't want them suing over something that the doctor had no control over either. Is health insurance the right approach to take in the first place - whether public or private? I don't have the answers - but it sure looks to me like the Congress has chosen a solution, whether it is the right one or not, and are going to enact it whether I like it or not. It isn't clear that the solution addresses what the real problem is, instead of providing a temporary band-aid.