When a person defaults on a medical bill, that loss of income has to be covered somehow, so the health care providor raises the rates overall, so that the people who do pay end up subsidizing those who failed to pay. That results in insurance rates rising and coverage being cut. The more rates rise and the more coveracge is cut, the more uninsured people there are. The more uninsured people there are, the more medical bills go unpaid. The more medical bills go unpaid, the more the loss of income is covered by increased health care costs which in causes increased health insurance rates and more coverage cuts. It’s a nasty spiral.
The solution is to broaden the base of people paying health insurance by requiring everyone to carry health insurance. Whether that is best done through public insurance, private insuance, or a combination of the two, is up for debate, but the fundamental problem remains that there is not a broad enough base of insured people to support a system that treats insured people, non-insured people, and under-insured people.
Here in Kanukistan, we primarily have public insurance – everyone is covered and pretty much everyone pays into it. It works very well. For areas that are not covered (e.g. drugs, dental and a few other things) we have private insurance that works fairly well, but is starting to fail the same way the American medical insurance is failing. (For example, my previous employer has been unable to find satisfactory dental insurance despite not particularly caring about the rates they would have to pay. Problems have included a plan covering fillings, but not the glue that holds the filling to the tooth, and a plan covering endodontics but not if done by an endodontist.) For drugs, we have private insurance, however the key to it all is the public aspect, by which the government negotiates with big pharma to ensure low prices for patent medicines.
As far as improvement on the Canadian health care system goes, of course we want to improve it, but it is a matter of making something that is excellent even better, rather than scrambling to cobble together something from ruins, as is the case in the USA.
What it comes down to is that our government works for the people, and when it comes to paying for health care, the most cost effective way of providing it is for all the people to pay insurance, rather than only some of the people to pay insuance. As it stands in the USA, the health insurance companies are stampeding in the wrong direction by narrowing the base of insured people, but the very nature of their industry forces them to do this. It’s time for the American federal and state governments to step in and start working for the American people.
