Sounds like you have a view on offer. Don't leave us hanging.
Insurance
The entire concept of what insurance is has become so distorted in our society. In its most simple form, the idea of insurance is that there are things that are unlikely to happen that, should they happen, the cost would be too burdensome to shoulder. So an individual pays a smaller amount of something they can afford to have coverage available in the unlikely event that something unfortunate happens. Our society has drastically expanded this far beyond the principle of what insurance is. Instead of paying small amounts to cover the un-coverable, we're paying large amounts to cover not just the un-coverable things but many, many things that could, and often should, be paid for ourselves. We judge the quality of an insurance plan by how little we have to pay out of pocket -- little or no co-pays, all prescriptions covered, etc. In general, we get very anxious about variability of expenses. $400 office visit with labs every couple years? Unreasonable. $400/month premium? No problem. It's easier to accept paying a large amount in premiums (even though we don't like it) because it's predictable and expected. Having periodic spikes in payment isn't acceptable because many don't generally account for things like that in a monthly budget, so insurance becomes the easy fall-back plan. Instead of relying on insurance just for paying that hospitalization for chest pain, we also want it to pay for that pediatrician's appointment for our kid and the $4 antibiotic for their ear infection. Sure, that may work for a lot of people, but you're paying for that in your premium. When we say "people need insurance," we're not talking about something that covers catastrophic events, we're talking about an expanded definition of insurance that costs a lot more in premiums. This is why people get worked up about birth control -- or any other thing that we demand be included in an insurance plan -- they think they aren't paying for it when the insurance "covers it" at the pharmacy.
For-profit insurers can suck. As a physician I'm well aware of this. I certainly think some of their power needs to be stripped as they get away with a lot of things that we wouldn't otherwise accept from any other kind of company. But I don't believe this change should come, nor would it effectively come, from top-down legislation. It has to come from us individuals as a society rejecting this warped concept of insurance. There are a handful of things I could get behind as far as insurance regulation, such as regulations that hold them accountable to holding up their end of the deal when someone enters a policy. But the idea that good ideas should be law and enforcing that through policy? I can't get behind that.
Healthcare
We've put a man on the moon. We have access to the world at our finger tips. We have vaccines for once deadly and disabling diseases. Many forms of cancer are now treatable and even curable. Science, medicine and technology have brought some incredible advances but we have somewhat of a magical view on what can be provided by healthcare and we generalize the above findings to the whole of medicine. Our magical views of medicine contribute to our underlying belief that bad things shouldn't happen. We look at the VA scandal and reference how many people died on the waiting list -- appealing to our belief that people don't just die and, had they gotten in to see a physician that perhaps there would have been a different outcome. Every time a sociopath shoots up a mall or theater, we talk about the need for increased access to mental health care, as if seeing a therapist and a little bit of Prozac would have prevented that.
There are important things that need treatment and there can be otherwise disabling or debilitating diseases that can be alleviated or even cured with modern medicine -- but this is the exception and not the rule. The vast majority of what's coming through outpatient clinics is not that. The vast majority of prescribed medications is not that. A lot of this is fueled by
having insurance because our belief is that "someone else" is picking up the tab. Due to fear of litigation, appeasing patients and the realization that the patient
directly won't absorb the cost, the bias is always for more intervention or workup, even when the potential benefit may be minuscule or when it would change management very little. I think one of the most harmful things to peoples' health is being shielded from the costs of their healthcare. I don't mean that someone who receives a new diagnosis of pancreatic cancer should feel all the burden of that -- I'm excluding catastrophic events. It's been demonstrated that there's a correlation with the more satisfied people are with their care, the worse their outcomes. That's not a justification to give poor care, but it's important to understand iatrogenic implications of what we allow our poor understanding of healthcare to do to our population.
So we've gone from opposing Obamacare to now not just wanting to repeal it but
replace it. The whole thing is a non-starter for me. We as a society need to fix this from the bottom up -- not the top down.
