The Finch Formerly Known As Gold

28 October 2003

Just don't get sick

As the saying goes, the American system of health care is the second worst in the world, with all the others tied for first; both left and right find it a suitable target, though the right tends to be somewhat more forgiving because, after all, it's making money.

James Joyner has the gumption to utter the S-phrase:

I support a single payer system in theory, but have no idea how to implement it while still preserving innovation, freedom of choice, and some degree of cost efficiency.

Government as gatekeeper — well, you know how effective they are.

The insurance industry as gatekeeper — well, you know how effective they are.

So, if we're stuck between a rock and a hard place, which way do we steer? Before we answer, Bruce would like an answer to this:

Right now, as the system stands, you quit your job and you lose your benefits. This means that you go through a period of time where you have no access to health insurance unless you pay for COBRA, which is extremely expensive.

Why is that in this day and age, your access to a doctor is determined by your employment status? It seems like an anomaly in the market system. You don't lose your car insurance when you lose your job.

Of course, you don't buy your car insurance through your employer, either. At least, you shouldn't.

But it's a valid point. There are vendors of individual health-care policies, but the prices would make your nose bleed, and the bleeding is probably not covered. The usual arguments for group policies — economies of scale and such — make some sort of sense; still, there's something a trifle disconcerting about ten or a hundred or fifty thousand people all having the same coverage, when no two of them have exactly the same needs.

So would I be better off if I could persuade the powers that be at 42nd and Treadmill to leave me out of the group policy and pay me the $3500 (I'm guessing) a year directly? Maybe. In only one of the last five years did my actual medical expenses exceed three grand. Of course, this doesn't mean that they will continue to remain relatively low. But it seems like a reasonable argument for a policy that kicks in only at very high levels — $10,000 deductible? — backed up by some form of savings, perhaps the Medical Savings Account that Democrats, by and large, have resisted.

This sort of scheme would work for me; it would probably not work for someone making $6.25 an hour. I think Bruce would agree that we would be better off if each of us had more individual say in the shape of our health-care coverage, though he seems to be thinking more along the lines of a co-op:

The collective power of free agent insurance buyers will force greater accountability by having the flexibility to shop around in the market.

Still, it's a market-based solution he's proposing, which a single-payer system isn't. I am concerned that whatever collective he envisions, be it a general cooperative or an affinity group, will be faced with some of the same issues facing employer-benefit systems, though it's generally a lot less common to be tossed out of an affinity group than to be thrown out of work.

One thing seems certain: we're not going to have the patchwork system we have now forever. Either health care will become less of an obstacle, or the government will come up with some fairly godawful proposal to take it over, just to shut us up. Let's hope that the system is amenable to improvements while it's still alive.

Posted at 8:02 PM to Political Science Fiction


thanks for your remarks. I was asking more questions that proposing answers. I don't know what the solution will be or should be?

Health care, to me at least fits into that category of "human needs", like shelter, food, transportation. Which should be available in order for each person to live a full and healhty life, all other material needs can be at teh whim of the market, but some things need to be guaranteed. The 40+ million that live without insurance are being denied an essential tool to living a productive life.

Sure I can go to the emergency room and get care, but that doesnt help me until i'm on death's door, which I would rather try to avoid, which means seeing a doctor now and then.

I dont mind paying for a doctor, I dont think it should be free, but now that the prices have been driven so high (to force people into insurance?) its next to impossible to get care in the event that you have a serious illness. And sometimes finding out is worse than not knowing, what with, "pre-existing condition" clauses that can keep you uninsurable once you know your sick?!

The cost of insurance for employers has forced them to limit what they offer, which has led to our current crisis. The system is fatally flawed and things like runaway lawsuits are symptoms of a failing system, not the cause.

I have lots of thoughts on this, and I would love to see greater discussion, thanks CG.

Posted by: bruce at 11:14 AM on 29 October 2003

I would say that the availability of what you call "human needs" should perhaps be guaranteed (emphasis on the "perhaps" because I haven't given this whole "guaranteed goods and services" meme more than the thought necessary to ask what gives anyone the guaranteed right to a claim on the fruit of another's labor).

Prices for health care are driven by a number of factors, not least the vast reliance on technology and highly specialized tests for what used to be fairly routine diagnoses. There is some room also to blame the whole health insurance mentality as well, particularly those programs operated by the government. Another factor is, well:

The system is fatally flawed and things like runaway lawsuits are symptoms of a failing system, not the cause.

I can see how that might be, since the health insurance mentality thoroughly disconnects most recipients of medical care from the notion of cost for any part of what they receive. I just can't see why routine doctor visits should ever have come under insurance, since insurance is supposed to be for covering catastrophic needs, not routine ones. We don't buy food insurance to pay for our weekly groceries, for crying out loud.

There are a million things wrong with how health care is provided in this country, and fixing it would require basically tearing it all down and starting over.

As long as the quality and access to health care don't get a whole lot worse than they are, I'm pretty sure the support for a necessarily radical solution will simply never develop. Most people would rather complain than work.

Posted by: McGehee at 8:00 AM on 30 October 2003

And Bruce, lest you think I'm going soft:

The 40+ million that live without insurance are being denied an essential tool to living a productive life.

...is utter crap.

What you're saying, in effect, is that at some point in human history everybody was unable to live a productive life because there was no such thing as health insurance.

Posted by: McGehee at 8:02 AM on 30 October 2003

more accurately: The ability for people to live more productive lives is available now and to deny people access to that is cruel and inhumane.

(emphasis on the "perhaps" because I haven't given this whole "guaranteed goods and services" meme more than the thought necessary to ask what gives anyone the guaranteed right to a claim on the fruit of another's labor).

right, just because you own a wrench doesnt mean you should profit indefinately from everything I build with it.

I can see how that might be, since the health insurance mentality thoroughly disconnects most recipients of medical care from the notion of cost for any part of what they receive.

true, and to draw from your grocery analysis, its like going into the store and seeing $300 for a bunch of bananas, but if you have insurance its only $1.99. You dont care as long as you have insurance that the price of bananas is unrealistic. Without insurance you notice the outrageous price.

What happens, as the price of caer without insurance goes through the roof, your ability to get care without insurance goes down. So insurance becomes more valuable, and your willingness to pay more for it goes up. If you're the insurance company you want the costs to rise out of the reach of personal consumption, then you fight like hell to reduce claims meanwhile you charge higher premiums.

its a profitable scheme... but immoral.

Posted by: bruce at 1:01 PM on 31 October 2003

Insurance frustrates me because:
1. I have very little say in who insures me, the price I pay, or the coverage I get. That is all decided by my employer.
2. It's linked to my job, so it discourages me from starting my own business.
3. It usually sucks. "Oh, we don't pay for that - we only pay for things you don't need."
4. You usually have to sue them to get them to do anything helpful.

Posted by: Dan at 1:04 PM on 31 October 2003

It is still, I am told, possible to buy policies resembling those from the days when everything was covered at almost 100 percent, but the price would require both Ben and Jennifer to keep working fulltime.

42nd and Treadmill goes through insurance carriers the way NASCAR drivers go through engines: nobody seriously expects one to last a whole year. Insurers will lowball us to get a contract, and then the next year, good night, nurse.

Robert Prather, your basic hardline capitalist, says this: "The answer for the non-hospital costs is available: personal healthcare accounts (or MSAs, as I usually refer to them). Hospitals are more difficult and I don't have an answer for that. Now, anyway."

How would we drag hospitals into something resembling a free marketplace?

Posted by: CGHill at 7:31 PM on 31 October 2003

right, just because you own a wrench doesnt mean you should profit indefinately from everything I build with it.

If it's my wrench, you shouldn't be building anything with it -- unless you're renting it from me. Better still, buy your own damn wrench, you cheapskate.

Posted by: McGehee at 12:03 PM on 1 November 2003