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In our current system, if you are lucky, you have a profession in which you are serially employed by companies that offer health insurance for you and your family. Your employer will change health insurance providers regularly, sometimes as often as every year, because insurance companies will offer reduced rates to attract new business, and this is a way for companies to save money. Also, if you change jobs, you change insurance companies. This means that the average person will be insured by many different plans and companies throughout his life. Therefore, there is little financial incentive for a health insurance company to invest in preventive health care that will reap financial benefits in decreased heart disease, stroke, diabetes and cancer thirty or forty years down the line--since that company will not be your insurance provider then. Instead, insurers make a profit by writing policies for healthy people and excluding sick people. They do this by insuring working people (if you are healthy enough to work, you are likely to be healthy), young people, people without pre-existing disease, people with good family histories. If you change jobs and have a health problem, you will only be able to sign up for new insurance if your new employer offers an HMO or PPO (they have no pre-existing condition clauses), otherwise its high priced COBRA for you then on to your state's high risk insurance pool or Medicare for those who have really bad health problems. Eventually, everyone who is really sick---premature heart disease, end stage renal disease, AIDS--gets on Medicare, Medicaid or both, which means that the government pays for all the sick people as well as the elderly, who are also sick---really sick, since they have spent their lives getting no preventive care on their employer sponsored health insurance. At age 65, Medicare starts playing "catch up", bypassing those coronary arteries that could have been kept clean with exercise and a healthy diet and dialyzing those kidneys that could have been protected if diabetes had been prevented with weight management and blood pressure had been controlled and replacing those knees and hips that also could have been saved with weight management. The government spends A LOT of money playing catch up on people aged 65 to death. And the catch up money does not buy quality of life anywhere near as good as the person would have had if he had been the beneficiary of medical prevention and a sound heart, sound joints and good kidneys.
The net result is a lot of money goes into the profit coffers of private, for profit health insurance plans, which spend the money on CEO salaries and anything except health care. And the taxpayer pays for the health care of most of the sickest people in the US. And people in the US are sicker than they are in almost every other industrialized nation on earth. Go check out the numbers. The US spends twice as much per capita on health care as the next most spend thrift country, Switzerland, and yet our health indicators put us below the countries of eastern Europe. That is because we do not prevent disease (cheap, cheap, cheap). We apply great big fat expensive band aids to disease that could have been prevented. And those big fat band aids make Merck and Pfizer and Johnson and Johnson and a lot of hospitals and surgeons very, very wealthy. That is why health care is such an insane portion of our GDP.
Now, consider the alternative, single payer, cradle to grave insurance. It does not even have to be the government. There could be a lottery and one lucky health insurer like Blue Cross could be selected to run it. The key is that once you sign on as a baby, you are on that plan until the day you die. Suddenly, you insurer has a great new way to save money. It can prevent disease. It can encourage you to go for check ups. It can encourage you to keep a good weight and blood pressure and cholesterol and not smoke and exercise. These are cheap interventions, and they will pay off big time in the future. Since the single payer will have a huge volume of enrollees, it will easily be able to absorb those who have existing conditions---the premiums from all the well people will finance the care of the sick ones. And by keeping the well ones well, the insurer can eventually cut costs. With only a single insurance product to run---no twenty different provider lists, no twenty different sets of rules-- the overhead will be low. There will be no need to market the plan. There will no advertising costs. Everything can go into research into medical prevention and efficacy.
Now, Merck, Pfizer, Johnson and Johnson will make out like bandits in the early days of this change, as people who did not have insurance get their problems fixed. But later, they are going to lose out, as people become less ill, and American stops spending twice as much per person as Switzerland on health care. So, the pharmaceutical and durable medical goods and some other medical industries may not like the switch in health care systems and they will argue that our present system is better (because more medical waste means money in their pockets). But, in the long run, it will make us healthier and save us money.
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