Over the past few weeks I’ve had a few exchanges with people on the right side of our health insurance debate, lively and informative to be sure. I certainly don’t have all the answers, but I know the general direction we need to go. And it’s not where we are headed – Barack Obama and Max Baucus will take us down the path of corporate subsidy, hoping, as the old saying goes, that a few sparrows get fed via the cow’s intestinal path.
We’ve been round and round, so I’ll jump to my own conclusion – there should be a mixture of mostly public and some private, and the wealthy, who have the least to lose, should be able to buy whatever care they can afford. But a basic level of care should be available to everyone, paid by the tax system, so that those who cannot afford care get it. There ought to be diminishing co-pays. The French have a nice system, making people who can afford it pay up front, to be reimbursed later. That seems to deal effectively with the moral hazard.
That’s where I’m at. I await the Democratic-inspired boondoggle about to be visited on us. I and my fellow travelers will be blamed for whatever evil comes of it. Let me say in advance – the Democrats are as much beholden to the medical and insurance lobbies as the Republicans, and will not solve our problems without payment of a huge royalty to them. It will be no different than Baucus’s Medicare D, wherein a huge subsidy was thrown at the pharmaceuticals so that some might trickle down to ordinary people.
In the meantime, I encountered two lost souls of the right, two people up against a brick wall. Their philosophy had dead-ended them.
From “Max Bucks”, at Missoulaplis, in a thread containing 127 comments:
I am someone without health insurance. I pay cash for all my medical services. I am not a “free rider.”
From “Lt. Ripley” at mt.pundit, in a much shorter thread:
Yes, the specter of death and destruction looms over all of us… but it’s called LIFE. When you get into a car, you face the possibility that you may die. Life has risks. You cannot remove them all, nor do I understand why you would want to. Your health is part of that risk.
And I do completely understand. You do not know me. My ideals and principles are formed because I have experience and knowledge of it. What would I do if I faced a life threatening disease, and the prospect of huge bills? Well, either I do not accept treatment and die… or I do what I can to pay the bills that my treatment requires. Either way, it’s up to ME.
At some point, we all die, Mark. You can mitigate that somewhat by good preventative care (which I practice) and by looking ahead…. by mentally and financially (if you can) preparing for whatever life throws at you.
If we all paid for what we used, and paid for it directly to doctors, hospitals, etc, then we would be facing lower costs and better care. If we all faced those costs OURSELVES, you would see people educating themselves and using more preventative care. Whenever I am sick, or one of my children, I don’t first head to the ER or even the doctor. I research what it is, watch symptoms and decide if there are things I can do myself. If I need to, THEN I head to the doctor. If he/she suggests a certain treatment or course of action, I find out what that entails, what risks may occur if we don’t do it, and find out costs and difficulty.
Both of these gentlemen are driven by the “rugged individualist” model, and assume that either via savings or loans or family charity that they will survive any medical emergency that comes along. But they are free riders. Ripley takes it even one step further – he says that he would end his own life if he could not afford treatment. So too, I suppose, would any heroic character in Ayn Rand’s Atlas Shrugged,, that damned demonic novel that has inspired this type of thinking.
Anyway, neither Max nor Ripley understand the nature of health care. At the coffee shop I frequent is a bowl to collect offerings for a young man in Billings who was beaten senseless in a bar fight. His surgeries and reconstructions cost over $2 million. This, for a man who can probably barely afford his truck. You might say he brought it on himself, but what if it were cancer, or something only Dr. House could remedy with last second heroics? The point is, it’s beyond our control.
And that’s the bottom line – health care emergencies hover over us like the Angel of Death. Any one of us can be afflicted, and every year a small percentage of us are. This year there will be 500,000 bankruptcies in the U.S. due to medical costs. That specter haunts us all. We’re all vulnerable.
Max and Ripley have dead-ended. Their philosophy took them as far as it could, and left them high and dry. They are now faced with an ugly truth: We depend on one another, we help one another. Private charity is one means, and government is another. Each has its place. In Bob Cratchit’s world, there wasn’t enough private charity to go around, so only a few got help. In the modern world industrialized countries have used government to achieve widespread health care, and have done so effectively.
In the United States we’ve got one foot in Cratchit’s world, one in Tommy Douglas’s. (He’s the founder of Canada’s Medicare, and was voted the greatest Canadian in a 2004 CBC-sponsored poll up there.) We are leaning Tommy’s way, but there’s still too much resistance for an effective remedy to take hold.
Obama has won, Baucus has proposed reforms. It’s going to get much worse before it gets better. It’s time for cowboy foreplay: Brace yourself, honey.
Piece of Mindful 
Senators (I’m so sorry; President-elect) Obama and Baucus have the health care system America needs, but won’t get. Because they, and their colleagues in the Senate took care of themselves first, they have no real health worries, no bills to pay, outlandish pensions free postage, and no interest in the welfare of their loyal subjects. All this grandeur delivered on a silver platter heaping with tax dollars. Creeps!
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But a basic level of care should be available to everyone, paid by the tax system, so that those who cannot afford care get it.
I like this, but implementation has been tough. The problem is defining a “basic level”: the tendency is to give everyone everything until no one gets anything. Tennessee put all their medicaid money in a fund for basic care for all. Activists in Tennessee kept going to court and expanding what the program would cover until it was broke.
His surgeries and reconstructions cost over $2 million.
Part of the problem is that there is no differentiation in the level of service. We have little “shade tree” surgery. Medical service is ultimate top shelf, with added charges to cover the various parasites, like deadbeats and plaintiff attorneys.
I like what Lt. Ripley laid out. We can either pay our own way, or do it collectively. I don’t see what makes one morally superior to the other. They both require some management to work.
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We’ve never defined “basic level” because we’ve never intended to offer basic care to everyone. Once we do, we’ll define what needs to be defined.
State programs like those in MA and TN suffer from the initial hit as people who have delayed or foregone care come into the system in a rush. At that level, it can bankrupt. I would expect a similar onslaught of initial expenses in a national system.
Lt. Ripley exposes the flaw in the private insurance model – he is healthy and doesn’t want to participate in a public system. He wants only to pay his own way, and won’t be able to when emergency or serious illness visits him. He’s a free rider. It’s part of the phenomenon called “adverse selection”. Far from having an answer, he’s a large part of the problem.
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So adverse selection is the root of all evil. I suppose abusers like smokers, drinkers, needle exchangers, bath house groupies, who now know they can party on, have no part in the problem.
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False dichotomy?
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No, I’m just defining some “free riders”.
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Not if they pay into the system. Smokers are rated on health insurance policies.
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OK, paying smokers are nonfreeriders, especially if they pay more for the risk they take. But what about the nonpaying risk takers?
For example, the sad story about the bar patron could have included his lifestyle choices. Suppose he spent every afternoon in the bar and when he drinks he becomes angry. His drunken rage resulted in his injuries, injuries that now the more responsible will pay for.
I’m all for contributing for the truly unfortunate. Paying for free riders making bad choices will always be a mountain of objection you’ll have to conquer.
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Swede – Max Bucks and Lt Ripley are classic free riders. When they get cancer or have an auto accident, they will not have enough to cover their illness or injury, and it will be on us.
Lifestyle choices are another matter. Do you ski? Drive on ice roads? Ride horses? Are you overweight? Do you eat fast food? These are all things our health care system has to deal with – type II diabetes is a huge problem. The guy who got beat up in the bar could have easily have been gay, and beset upon by homophobic cowboys. His fault?
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Mark, kindly remember that it is in Swede’s interest to promote the idea of risk-bearing. Republican politics of fear is outwardly focused on the ‘free-loader’, specifically to get the rest of us to care about the unfairness, and then say that maybe we ought to do something about it. The next thing you know, Swede will be screaming his privileged white ass off about Democrats being commies and Hitler. It’s a ruse. Tired, threadbare, but a ruse nonetheless.
His ultimate gambit is to keep largess flowing to him, and denying that he owes anyone for it.
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Geez – I never thought he was that devious. I thought he was just misguided.
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Max Bucks and Lt Ripley are classic free riders. When they get cancer or have an auto accident, they will not have enough to cover their illness or injury, and it will be on us.
I suppose we could hold them to their word. Non-participants should have on record how much they can pay before care is cut off.
The guy who got beat up in the bar
Maybe we should bill the assailant(s).
We’ve never defined “basic level”…
We are trying. Oregon has a deal going on. One task of HMOs is/was defining a basic level. I was pointing out the difficulty here, where no one wants their concern to go uncovered, pretty soon everything under the sun is part of the basic level, and we get viagra for all.
Lt. Ripley exposes the flaw in the private insurance model…It’s part of the phenomenon called “adverse selection”.
Insurance is generally for catastrophic, non-recurring events. If you have a chronic condition, you’re not really buying insurance, you’re buying a way to fund your condition.
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You’re right guys. What an incredible over privileged Scrooge I’ve become. Go ahead Tiny Tim, get out the big spoon and fire up the BIC, nothing spells temporary rehab like a warm hospitable bed with clean sheets.
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Fred – you’re simply defining insurance in a way that satisfies your philosophical demands. Most of the industrialized world disagrees with you.
Swede – you are indeed part of the problem. Fortunately, you are part of a small minority, supported primarily by the insurance and pharmaceutical industries and opposed by the general population. Greed is good, and on your side.
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