Recent health care events are so contentious that it makes me wonder how far down toward first principles we’d have to go to find common ground. Could we maybe agree on what the chief problems in the US health care system are? Let’s try. I’ll go first.
1. Fifty million uninsured. That’s 16%, or 1 in 6 Americans, with no health insurance. It’s estimated that 45,000 Americans die every year as a direct result of being uninsured.
2. Private health insurance industry abuses and inadequacies. This includes dropping your coverage when you become ill. It includes the practice of not covering “preexisting conditions.” It includes charging women more than men. It includes the practice of denying random legitimate claims knowing that a certain percentage of the denials will not be challenged. It includes the practice of imposing annual and lifetime caps on policies. It includes incentivizing in-network physicians not to treat patients. It includes the practice of using over 20% of our premiums for overhead, executive bonuses and advertising instead of for actual care.
3. Cost. And by this I mean something very specific. The price tag on items like doctor visits, prescription drugs, hospital stays and medical equipment is just too high. Higher than anywhere else in the world. It isn’t that we use more of these things, it’s that they cost too much.
I could list many more issues, but I think these are the big ones. Any reform that significantly improved these issues would be terrific, am I right? If it insured the presently uninsured, curbed industry abuses and brought down costs wouldn’t that be a pretty decent piece of reform?
I’m sure that there are people who think–somehow–that I am wrong about this. So fire away. I’m hoping for lots of interesting comments.
1. At least half of those forty million could afford insurance. If we use a number like 20 million that require some sort of government voucher to pay for health insurance or health care, I’m with you. That’s still a big number.
2. One major reason that common ground is hard to find is that the parties and the media have invented this thing called “health care.” This thing is not really a thing. It’s a bunch of things. Some of them are insurable and some of them are not. Some of them are subject to market forces and some of them are not. The new system might be slightly less shitty than our current system, but we could help way way more people if we embraced a system that let people buy market-responsive healthcare items on their own, had insurance companies to cover things that are insurable (meaning things that are RISKY), and had government cover things that are not insurable like preexisting conditions, and also have government provide vouchers to allow poor people to buy the first two things.
Perhaps lots of uninsured people could afford insurance. Surely some could. But it shouldn’t be optional. Unless they’re multimillionaires, they’re what Mitt Romney calls “free riders.” They take a gamble, pocket the winnings if they’re lucky, and leave us holding the bag if they’re unlucky. If they won’t do the right thing and get insured, then they should be penalized.
I get the distinction you’re making about what is risk and what isn’t. I get that you think the word “insurance” should be reserved for policies covering serious illness and injury, not routine care. I’m prepared to concede that that is probably a more correct way to define insurance. But I think it muddies the water instead of clarifying it to start using terminology differently than the way people ordinarily use it. And besides, whatever you call it, I don’t agree that routine care should be an out-of-pocket expense. Why? Because a) any expense great enough to encourage people to bargain shop is certainly great enough to discourage people from getting the care in the first place which would be bad for health outcomes and probably not very cost effective in the long run. And b) I’m not convinced that people know enough, or ever will know enough, to reliably discern what is serious and what isn’t with regard to seeking medical attention. Without that information they cannot really be a rational market actor.
Health care cannot ever be a purely market-driven enterprise. Not so long as we think it’s important to regulate the products and services therein. And not so long as we think it’s important to subsidize the poor and the elderly. I don’t see those things changing any time soon.
Your ideas feel to me like a whole lot of complicated gymnastics for the purpose of preserving some kind of laissez-faire ideological purity. Especially when you consider that no one in the entire rest of the world is doing things that way and, while they have their own problems, they certainly don’t seem to be having the one’s we’re desperate to solve. Why should we try so hard to avoid every single successful example in order to try a completely untested one? And while I’m not aiming this comment at you in particular, when conservatives or libertarians say they want to let the private sector work its magic on something it usually means they don’t give a shit if it works for everyone or not.
It’s not the severity of something that makes it insurable. It’s the likelihood of it happening. For example, giving birth to a healthy baby is expensive, but it’s super common, so it makes no sense for an insurance company to cover it. If it’s not risky, it’s just splitting the check. On the other hand, giving birth to an unhealthy baby is unlikely (and also more expensive), so the costs of care associated with that are completely insurable. It makes perfect sense for 100 couples having babies to share the risk of being the 1 or 3% that end up having a sick baby.
“Health care cannot ever be a purely market-driven enterprise.”
I admitted as much. But I think I was pretty clear that a LOT of it can be. The best example we have now is lasik eye surgery. It’s generally not covered by insurance. It’s life changing for a lot of people–at least as much as a lot of things that ARE generally covered by insurance or medicare/medicaid (like glasses?). And it has drastically gone up in quality and down in cost over the last decade. I think that the same would hold true for like 30-50% of the stuff that falls under your “health care” umbrella.
“And not so long as we think it’s important to subsidize the poor and the elderly.”
I would absolutely support some kind of voucher system to allow poor and elderly people to purchase health care items or insurance, as I said.
“Especially when you consider that no one in the entire rest of the world is doing things that way and, while they have their own problems, they certainly don’t seem to be having the one’s we’re desperate to solve.”
I don’t want their problems, OR our problems.