Jonathan Birge
Ok, I know I promised no more useless political banter, but I think I’ll grandfather in follow-up posts to old articles. A while back I wrote about my “conspiracy” theory that Obama pushed through a health care reform bill that he knew would be struck down as unconstitutional, to set himself up for a rewrite of the reform to be a UK-style single-payer system (which would be constitutional, since there’s nothing wrong with the government forcing you to buy stuff from them).
So far, the first part of my prediction has come true, at least in the sense that the bill was struck down, and struck down pretty hard. Of course, we’ll never know what Obama was really thinking, but I maintain that by far the most likely scenario is that he knew full well it would never pass muster. The man is extremely smart, especially for a politician, and he was a law professor. I’m certain he knows that having the Federal Government mandate that private parties enter into a contract is grossly unconstitutional (not to mention the mother of all slippery slopes). I could buy that Pelosi didn’t see this happening (she looks constantly surprised to be wherever she happens to be) but I can’t believe Obama didn’t.
I think if there is one flaw in their plan, it’s that Obama didn’t see the midterm elections going as badly as they did. That’s too bad. As I argued in my original post, single-payer is really the only way to handle health insurance that makes any sense. Forcing private insurance companies to take people they know are sick is insane. Forcing people to buy something from somebody as a condition of their very existence is patently unconstitutional, and always should be. (To head off the people who point out we are required to buy car insurance, that is a condition of driving on public roads, not being alive and American, and no car insurance company is legally forced to provide insurance to somebody with 27 moving violations and two vehicular manslaughter convictions.)
The idea that people should have a million dollar PET scan machine at their disposal health as a fundamental human right is intellectually bankrupt, but that doesn’t change the fact that it may nonetheless be the Right Thing to do if we can afford it. We can, at least for now, and so unless we’re going to let people go without care needlessly, the only way to get everybody health care that makes any sense is single-payer. I challenge anybody to propose an alternative solution that provides all citizens with quality health care but doesn’t open a pandoras box of legislative legerdemain required to enforce access.
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2 Responses to The plan is coming together nicely. Almost.
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Jon, I don’t want to get into a full-on healthcare reform furball with you, but I do have a couple of questions/points.
It seems to me that in the – I hesitate to call what happened in the run up to the passage of Obamacare a debate but it’ll do for shorthand – debate over healthcare reform there were some reforms that were never really discussed. Or at least not very seriously. Perhaps they are too much of the rearranging the deck chairs on the Titanic sort, but I’d like to know what you think.
First, purchasing insurance across state lines. If I live in a state like New York or California or Maryland, that require a bloated bag of coverage requirements, why shouldn’t I be able to buy a plan from a company in Wyoming that will offer me more of what I need? If I don’t want a plan that covers viagra or birth control, why shouldn’t I be allowed to buy it?
Second, and this is intertwined with point one, why don’t we have more choice in the types of plans we can buy? Why shouldn’t I be able to buy a high-deductible plan that covers catastrophic accidents or disease? One of the most ludicrous concepts is the idea of a co-pay on a routine physical examination. Do you have a co-pay with your car insurance provider for oil changes (i.e. preventive maintenance)? Of course not.
Third, health insurance should be divorced from employment. I am sure I probably don’t need to tell you what happened here. Congress gave companies a tax break on what they spend on employees’ health insurance. True to form when you subsidize a behavior, we got more of it in the form of co-pays. I think we should be more aware of the cost of insurance, not less. Right now I don’t care how much a test costs that my doctor ordered, or what a prescription costs since I am only going to be shouldering a very small portion of it. I would like to see my employer pay me more in salary and then – combined with reforms mentioned in points one and two – let me go out and buy a plan that makes sense for me.
I think we need more choice and hence competition. We have more choice in cell phone providers than we do with insurers.
Sorry for the delay. I still don’t have notification set up correctly on this new site. Anyway, I agree that if we’re going to keep private insurance we should do everything you say. It’s insane we have a private system but have so many restriction that we lose much of the advantages of private industry. We have little choice, overregulation, and costs so hidden from consumers that the invisible hand of the market is pretty much tied to the point of being useless. We essentially have all the worst features of a private solution with all the bad things about centralized government solutions.
Having said that, I stick by my assertion that insurance is one of the few things that actually is best handled by government. Note that I said insurance, not health care. I think the government should just handle a single payer insurance scheme, not run the hospitals like they do in Britain. We can still have a layer of consumer choice, and I support the idea that things like routine visits and less than catastrophic things should be out of pocket. This would help contain a lot of expenses.
Here’s why I think the rest should be single payer: health care is about as unique a situation as you can get, and many of the good things about competition either don’t work well in health care, or come at a cost that I can’t abide. Healthcare is something you need rarely, and when you need it, you don’t have time to “shop around”. Unlike car insurance, health insurance is unavoidable. You can choose to not drive a car, but I hope you can agree that a civilized society just isn’t going to let people writh around on the street when they break their leg. So, given that we’re going to help them, we have a social need to make sure this is done in an orderly and fair manner. However, the truth is many people are bad risks, and no private insurance company should be expected to cover them as a rational decision. Like drunk drivers or the blind who can’t get car insurance, lots of people are essentially insane risks to cover with health insurance. This is the fundamental problem, the way I see it.
The insurance model assumes pooled risk of a random probability event. Health care is not that, by any stretch. Some people are so clearly at risk that no sane insurance company would willingly cover them at a rate they could afford. So, either we let these people die painful deaths, or we strong arm the insurance companies, completely violating any notion of private health care and causing no end of unintended consequence. Do you really like either solution? I don’t. It’s Lord of the Flies in the first case, and the shitty Public/Private nightmare we have now in the second. So, I think the only solution, which also sucks, but sucks less, is single payer.
Basically, the bottom line is that we, for better or worse, have opened Pandora’s box by developing so much medical technology that we can easily spend millions of dollars fixing a single person. Now we’re in the position where everybody needs insurance to have a shot at the best healthcare, and yet a large percentage of us are obviously going to require that at some point. I’m sorry, but that situation is pretty clear cut to me the more I think about it: either you have the government handle the wealth transfer to pay for it or you have lots of suffering. But at the end of the day, somebody is going to get forced to pay something.
The reason I think single payer is better than micromanaged private insurance is that I think the micromanagement required is so high that all the private industry can do at this point is get in the way, creating inefficiency and acting as essentially a middle man. That is to say, we really already have single payer in some sense, you just don’t know it because a large portion of your insurance rates go into creating a huge infrastructure dedicated to creating the illusion of a private industry.