Single Payer

Insurance Journal Friday carried a short AP article discussing upcoming changes to the employee insurance program.  The highlights of the revisions effective 1 January 2010 are reported to be:

• Employees must attend a free health screening, or pay a $25/month surcharge.
• If cholesterol, glucose, weight, or blood pressure issues are uncovered, employees must enroll and participate in an appropriate wellness program, or pay a $25/month surcharge.

Now, at first glance that seems like an interesting, novel approach to managing health care costs – to incent covered members to head off new preventable, expensive health issues before they emerge.

However, it troubles me on two counts:

First, the idea rubs me as being “over the line” in terms of protecting employee privacy.  Do you really want to voluntarily surrender details on your health to your boss, over and beyond what’s already necessary?  Disclosing that you need to take a sick day or seek short-term disability is understandable, but I’m not sure I want my vitals being fed to the payroll system.

Second, with health care being a major topic in public debate this political campaign season, there is a fair amount of noise from the folks who want to see state-provided, single-payer health care.  With an initiative such as the State of Alabama’s….surely I can’t be the only person who sees government-mandated medical inspections (e.g. the poking, prodding, and duck-walking associated with military induction…but for everybody) and state-run reeducation camps fat farms down the slippery slope.

I wrote a few days ago about some of the problems my wife and I are having with Aetna. However, our issues with the abuses possible in the U.S. under ERISA are nothing compared to this Canadian story from the Jewish World Review:

A Winnipeg case currently winding its way to its grim conclusion pits the children of Samuel Golubchuk against doctors at the Salvation Army Grace General Hospital. According to the pleadings, Golubchuk’s doctors informed his children that their 84-year-old father is “in the process of dying” and that they intended to hasten the process by removing his ventilation, and if that proved insufficient to kill him quickly, to also remove his feeding tube. In the event that the patient showed discomfort during these procedures, the chief of the hospital’s ICU unit stated in his affidavit that he would administer morphine.

Golubchuk is an Orthodox Jew, as are his children. The latter have adamantly opposed his removal from the ventilator and feeding tube, on the grounds that Jewish law expressly forbids any action designed to shorten life, and that if their father could express his wishes, he would oppose the doctors acting to deliberately terminate his life.

In response, the director of the ICU informed Golubchuk’s children that neither their father’s wishes nor their own are relevant, and he would do whatever he decided was appropriate. Bill Olson, counsel for the ICU director, told the Canadian Broadcasting Company that physicians have the sole right to make decisions about treatment — even if it goes against a patient’s religious beliefs — and that “there is no right to a continuation of treatment.” [...]

There is even talk of the “duty to die” and clear the way for higher-quality lives, which is why the American Association of People with Disabilities has been actively involved in so many cases dealing with the doctors’ right to terminate medical care. The rage for medical rationing in Canada, of which the Golubchuk case is but one example, derives from a desire not to waste resources on low-quality lives.

I know that when politicians in the U.S. become serious about attempting to rein in medical cost inflation, one element of any viable program will likely involve some attempt to end the drain on the system by frivolous (or “frivolous”) lawsuits.

I just hope that such plumbing work still provides some means to effectively incent care providers and insurers (or their TPAs) to exercise some common sense when dealing with consumers and their loved ones.