Health Insurance
I have been without health insurance since July 2007. Crazy, I know. I was also without health insurance from about January 2005 until January 2007. The only reason I had insurance in between was because I went to Australia for a semester and had coverage as an overseas student.
Gretch and I have been trying to arrange health insurance through a somewhat local provider (actually in Mattoon), but we seem to have had trouble contacting the man possibly handling our potential account. Yeah, real specific and certain, I know.
Anyway, in the midst of all this, there is of course the supposed debate about health care reform going on in America. I called it a supposed debate because, honestly, I am not hearing much actual debate. What I hear is the President telling Congress to pass the reform that he wants. The Republicans are saying that the proposed plan is bad, but they have as of yet to offer a viable alternative. The Democrats are saying that whatever President Obama wants, President Obama shall get. Of course, not all of the Democrats are saying this, but there are enough that those who are not don't make much of a difference.
As the members of Congress are preparing for the summer recess, I decided to take some time to email my Representatives and my Senators and share my concerns. These concerns essentially boil down to this: I don't like the idea of nationalised anything that can and should exist in the free market. Nationalised elections? Yes. Nationalised military defense? Yes. Nationalised roads? Well, sure, I suppose I'll agree to those. Anything else? No. And this is especially true for nationalised health care. It is one thing to offer limited health care to those who are without. But we already have that. Two offerings, actually. They are known as Medicare and Medicaid. Medicare for the elderly, Medicaid for the poor.
So why are there so many (possibly 45 million) without insurance? I don't really know. Several people have offered their thoughts on this, including Larry Elder, who discusses it here, here, and here. Whether he is totally correct or not, I'll leave up to you. Regardless, there is one thing I do know: a whole lotta people would be a whole lotta happy if the government would get out of our business and let business do business.
I have done some research on health care reform, and have found that the best option would be for the government to stop imposing regulations on everything. If an insurance company is crooked, you know what happens? The company stops getting business. And if it keeps getting business, then those who fall for the crooks probably deserve what happened to them. Yes, I know that is mean, but I think that we need to use the market to support the best and reject the worst. That's what the free market is all about.
But some people will argue that we have to have some regulation. I don't agree with that, but then, I am a Capitalist. So what about a happy medium? What can the government do to support health insurance without taking over health insurance? A passing glance at Massachusetts gives us a good idea: set up an individual mandate. Tell people to get insured, or they'll be taxed. Encourage companies to offer insurance by giving them tax breaks. As a business owner, there is nothing sweeter to me than a tax break! And for those who don't have employers who provide insurance, or who are not eligible through their employer, we can offer something, in much the way Massachusetts has done so.
I don't think the Massachusetts plan is perfect, but I do think it is much better than what is being proposed. I also think that everything is moving much too fast for real debate and discussion about the options. And for everyone who says, as Sen. Roland Burris said to me in an email response, "Hundreds of economists, health policy experts, and others have studied our healthcare system for decades, and broad consensus exists on many of the main points of reform. During this session of Congress, both the House and Senate have held countless informational hearings and worked deliberately on solutions since early January" I say this: Congress has not been working on solutions. They have been working on a solution. President Obama's solution. I want to see what other ideas are out there before Congress makes a decision."
We'll see what happens during August when the Representatives and Senators from across the nation go home and talk to the constituents about this issue.
Comments
If the worth of souls is great, then so is the worth of a perfect, working carcass, without any signs of wear and tear. We don't like aging or death or pain or the bother of sniffles, and if a person loses an eye or a leg, we like gadgets and therapies that will restore that person to as close a working order as possible--and remove that unsightly mole while we're at it.
All of this requires drugs and machines and skills and a huge infrastructure to support and supply the doctors. Oh, and we'd like all of that for free because...health care is a right, dagnabbit!
It is long past time to cull this great herd of ours, and I'm sure the day is coming.
What we need to do is to create a health care system which is focused on reducing the need for health care (i.e. preventative medicine, mixed with the preventative medical policies), while at the same time reducing and subsidizing where feasible the implementation of the bells and whistles.
I wonder if the actuaries have developed tables that calculate what a life is worth. If you need a transplant when you're 50, you're worth the trouble, but not if you're 65, so go find a corner and die quietly.
Since you're a capitalist, tell us what you think would happen to the health care industry if it was run on a completely capitalist footing - supply and demand.
One obvious thing is that the rich would have better health care than the poor. I think another thing would be that scores of hospitals and doctors would go out of business immediately leaving millions without access to care.
Then maybe, at some point in the future, enterprising, out of work doctors or poor med students from India would begin to work their way into the nooks and crannies, doing basic care in return for whatever the patient could pay.
Perhaps set price systems would evolve: twenty bucks for a set bone. Five hundred bucks for a bowel resection (colostomy bag free if payment in cash in full is presented at the time of the operation!)
Somehow placing health care on a capitalist footing feels ghoulish because these are lives we're discussing. We value life in this country too much to throw the ones who can't pay to the wolves: ironically, however, it's become so overweening that is exactly what's happening.
Frankly, I'm inclined to blame the insurance companies for this because they are the ones raking in cash for years before someone gets sick -- and doing what with it? Feeding into research? Investing in better and more hospitals, doctors or nurses? Sponsoring drug research? Or piling it into vaults and rolling in it? I don't know.
http://theferrett.livejournal.com/1318447.html
I would be interested to hear your thoughts.
On the other hand, I believe that health insurance should cover the basics, so that the costly things will be rare. That is what the push for preventative care is all about, and I am totally for that.
What I have tried to state, and tried to reiterate in my Health Care Revisited post, is that I do not accept the claim that the only way for health insurance to be affordable is if we all pay into a government-run plan. I don't want my taxes to go way up, and as a business owner, they will. And I don't trust my government with my health care because, to be perfectly frank, my government sucks at managing. Period. Too many cooks fighting over the spoon stirring the pot.
What I do want to see is affordable health care for all. Various plans that allow the consumer to choose the care that he/she needs and/or wants. Changes to tort laws and the Interstate Commerce Commission's regulations on health insurance. I feel that there are many options out there beside the single-payer, public option that Pres. Obama wants.
So, in summum: I want to see health care reform that makes affordable coverage a reality. What I do not want to see is the federal government screwing everything up with a costly plan that most people simply do not want. After all, the latest polls indicate that at least 55% of Americans are happy with what they have!
For instance. Medicare. My wife splits time between a "free" clinic (not exactly free, they also take patients that have private insurance, but a large number of their patients are Medicare/Medicaid) and a regional hospital. The insurance reimbursements they get from Medicare do not even cover their costs. That's right, the greedy doctors not only do not get, they actually lose money on these patients. How many of those patients pay the remainder of the bill? I'll let you guess. And no, the hospital doesn't get to forward unpaid bills to a collection agency.
Now don't get me wrong, I truly think it would be heartless to throw these people out on the street. But think of this from an economic standpoint: how do doctors make up the lost money? You got it, they have to raise rates on everyone else. Just like if people regularly shoplifted $1000 items from Walmart, daily, what do you think would happen to Walmart's prices? Complete this basic economics question, class: Walmart's prices / your medical bills would (a) go up, (b) go down, (c) stay the same.
Now, let's have a mandate where everyone is on insurance, and a large number of these people are on the public option, which we can only assume would be run similarly to Medicare/Medicaid. More people go to the doctor than currently go. Question #2, class: when demand rises, prices (a) go up, (b) go down, (c) stay the same.
One of the big talking points in the reform proposals is to disallow insurance from denying claims from pre-existing conditions. Obviously insurance companies aren't currently doing this, or there would be no need for legislation. Why not? Obviously, they would have to pay more claims that way. Question #3, class: when production costs of a good increase, the price of that good (a) increases, (b) decreases, (c) stays the same.
Again, don't get me wrong. Universal health care is a noble goal, but morality simply does not factor into economics, and wanting it to be so is not going to change that. Prices are going to go up, or health care will have to be rationed. It's a harsh reality, but I don't see any way around it, nor have I seen any explanation from reform advocates that addresses this.
I fully realize that I'm not proposing any solutions here (and that my post is getting extremely long) but I return to the question "Is doing something better than doing nothing?" Only if you consider higher costs for medical care better, or rationing based on... (what? money, like we do now? political connections? the social value of your life, like the Margin Wight suggested?) Surely some kind of reform is possible, but it's going to take more creativity than I have, and it's going to have to put emotional arguments aside in favor of the decidedly amoral principles of economics.
On a related note, Maggie Gallagher wrote a column a few weeks ago with some concrete examples of some of these economic principles called "Uninsured Like Me."
"the greedy doctors not only do not profit,..."