From the point of view of the chronically healthy - posted at 16:40

The healthcare debate rages on, and for the most part, I've held my tongue. For the most part, I've felt that I have very little to add on the subject. It really seems like a common sense thing to me: healthcare is not and should not be a luxury, yet it's turned into a vehicle for making money. This is bad, it is predatory, and it's very literally ruining people's lives.

I'll go right ahead and say that my experience with healthcare is very atypical. With the exception of the span of seven weeks between my 23rd birthday (at which point I no longer qualified under my dad's military plan) and going on active duty in the military, I have been under the umbrella of the military health system for my entire life. Yes, that's government-run healthcare. Sacre bleu! you may exclaim. Tres horrible! Well, as a recipient of government healthcare, over the course of my life, I have seen no increase in rates, no cutbacks in what is covered, and no payments for prescriptions - do you know anyone on the civilian side who can say that? I didn't even realize that people had to pay for healthcare and drugs until I was at least ten years old. It's something that I have completely taken for granted - I get sick, I get seen, if the clinic/hospital can't handle it I get referred somewhere else. Sure, I've run across bad doctors and bad diagnoses in my time, but I defy anyone under the civilian umbrella to say they've had pristine experiences their whole lives. Do not under any circumstances let my husband cite his life-threatening scare from last summer as an argument against government healthcare. If he had dragged his butt to the doctor three days earlier (like his wife, living three thousand miles away, had told him to do), his condition would have required more routine (i.e. non-emergent) care. But I digress.

Here's the problem with turning healthcare into a capitalist system: this is not like the mortgage crisis where people made stupid decisions and ruined themselves financially buying something that was above and beyond what they needed and could afford. Buying a house is a luxury because there are other options open to you. There is a happy medium between sleeping in a refrigerator box in a dirty alley and living in a McMansion in suburbia. The same can't be said of your health (making the obvious exceptions for elective surgeries, cosmetic treatments, etc.). The normal laws of supply and demand don't apply. Let's say you want a car. If you, say, want a Prius when gas is running $4.50 a gallon, you're going to pay a premium for that car because it's in high demand. You analyze your finances and your choices and you get the car that fits your budget (or risk financial problems - but you chose to take on the risk!!!) or you put a lot of miles on your bike. It's not the same if you go into the hospital with a ruptured spleen. a) you didn't choose to rupture that spleen, it just up and went splat. b) you can't shop around for treatments to find the method that fits your budget - you're going to be receiving the standard of care or you're going to die. c) if there's a run on spleen ruptures that week, you aren't going to be charged extra because it's the Hot New Thing In The Hospital, nor are you going to get cut a deal because the surgeons are trying to move those dusty spleen-fixing surgeries off the shelves.

Your health clearly isn't something that functions well on the market economy, so why are we trying to make it work that way? I'm not saying we should raze the whole system to the ground because it's working for the chronically healthy (who, like it or not, are kind of complicit in working the system to the detriment of the chronically ill). I'm just saying there has to be a better way. Ask anyone who is "uninsurable" - I'm sure they'd rather be on, say, government insurance rather than nothing at all.

Here's the problem though: you get everyone who has been deemed too big of a risk by the capitalist companies and put them under one umbrella, and that umbrella is going to get very expensive very fast. Hoo boy. Here's the part of my brilliant plan I haven't figured out - how do you manage those costs unless you pull in the healthy folks as well and make them pay into the plan so everyone is sharing the costs and the load? As I said, I don't want to up and nuke what we've got in place because a little competition is good - it's just that the level of competition that we have right now is toxic. So I'm not claiming to have all the answers, which is one reason I've held my tongue up to this point. It would just be nice if there was some voice of reason coming from the middle present in this debate.

Marissa commented:

I've been under government insurance since 2004, and I have no complaints about it. Granted, it's a bit of a pain to call in and let them know I'm going out of state so that they'll cover an emergency room trip for me if I need it while I'm away, but, as long as I've been going to the doctor in the last five years, I've never been turned away because of insurance issues. (Just double booking)

Chris commented:

Part of the issue is that we don't have true competition now. Health care is a highly regulated industry -- there are literally thousands of rules and regulations that govern insurance, practice, etc. Our current tax structure strongly favors one kind of plan, i.e., work-based comprehensive HMOs rather than pay for service or anything else. All doctor training must be AMA approved. Etc.

The cumulative effect of these rules and regulations -- all for the good of the consumer, of course -- is to stifle any sort of innovation or competition. Its really hard to start up a small business that complies with all the rules. So, its not surprising that the field is dominated by a relatively small number of clannish insurers and providers.

For a free market to work, everyone needs some degree of accurate information (you'll never have perfect information, but deception, fraud, and inaccuracy needs to be limited) and free will to make choices. I agree with you that healthcare is somewhat unique in that there is often strong urgency to get health services (fixing your burst appendix isn't like fixing your car's transmission) but I tend to think that MORE choice and free market will make things more efficient rather than less.

What if people were allowed to freely buy healthcare across state lines? Or small businesses were allowed to enter the industry? Or alternative remedy providers could actually legitimately compete for individual's healthcare dollars with AMA-approved docs?

Chris commented:

Oh, and to be cynical and selfish...

Statistically, I will most likely need healthcare when I'm older, around, oh, 2045 or so (assuming I am not covered by tricare...). Same as other social programs, like social security or medicare.

Right now I have very little faith that our generation will really see much of a return on any of those programs. There's just no way to afford it. Our generation will likely either face drastically cut benefits, highly inflated currency that erodes whatever benefits we do get, or delayed benefits that kick in much later in life. Bottom line is that we'll get out a fraction what we put in. I personally think of my FICA taxes as a charitable contribution because I do not expect to reap any significant benefits from social security or medicare. It may not end up being that bad but I think one can assess with high confidence that the rate of return will be negative.

Right now FICA taxes are around 15.3%... Adding another 8% for public healthcare so that I can subsidize other people for my whole productive life brings the "charitable contribution" up to around 1/4 of income (before income tax, or taxes for daring to invest or save money). How much is enough? Even the traditional medieval tithe was less than that!

So, that's my beef with the whole, "Young healthy people need to be forced to participate to subsidize old sick people, and we'll take care of them when its their turn, honest!" thing. I don't trust our congress critters to not fritter away healthcare dollars just like they've frittered away the social security and medicare "trust funds."