Monday, May 11, 2009

Hopes and Fears About Health Care Reform

Major change is coming to health insurance in America, like it or not. The Obama administration has set that as a major priority, and they have the votes to do it. This may come as a shock to those of you who think of me as your token "right-wing friend," but I'm not entirely against the idea. The thing is, if we had a choice between a free-market system and the statist system we're likely going to get, I'd pick free-market every time. But what we've got right now is NOT free-market. The current system is so badly broken that change is inevitable. I just hope the change we get is an improvement.

The critics of the current system like to act like the biggest problem with our current system is the 47 million currently "without health care." I prefer the word "uninsured," as pretty much anybody can get care at free clinics and emergency rooms across the country. My own father was one of those 47 million a few years ago between the time he started receiving social security disability in excess of the limit for Medicaid, and before he had been in the system long enough to get Medicare. During that time, he spent 100+ days in Intensive Care and received emergency care worth hundreds of thousands of dollars. He's never paid a dime of it. And that 47 million number is badly inflated, too. Some are illegal immigrants. Some are people who actually qualify for anti-poverty programs like Medicaid and SCHIP but don't sign up (and if they do go to a hospital, they get signed up then). Some are between jobs. And a significant number are people who make enough money that they could afford a health insurance policy if they chose to sacrifice some other portion of their lifestyle (but they know they can do the same thing my Dad did if there is an emergency, and they'd rather have the money). I have read estimates that say that once all these folks are taken out of the inflated count, there are more like 10-15 million uninsured currently slipping through the cracks. If that was your only problem, you could devise a program within the current system that would fix their situation without a massive overhaul.

The biggest problem with the current system (at least as I see it), is that the costs of health insurance are just too darned high. For my family, my employer spends almost $400 a month apiece for my wife and me to have individual policies. I pay an additional $400 to cover my kids. That means that just my portion is more than a decent car payment, and the total (if I had to cover it all myself) is more than my mortgage. And in the event that we do have a claim, I still can shell out thousands in copays and deductibles. (This is an improvement, by the way--before Ann got a job with benefits, I had close to $700 a month going out in premiums--over $8000 a year if I was lucky enough to stay healthy) Moreover, every December we have a staff meeting to find out that our coverage is going down and our premiums are going up... a lot faster than our salaries. No wonder many healthy single people choose to keep the money and take their chances.

Therefore, I would welcome any change that holds down prices, and I don't even mind a mandate that everybody is required to enroll. Were it up to me, I'd have a payroll tax like we do for Social Security, so nobody gets off entirely free of charge. We could even work it in a similar way to the Social Security tax, with employers paying half of the tax. Middle-class folks like me would likely see our premiums stay similar. Employers may even see their costs drop somewhat (which should free them up to pay me more in actual salary, which I can use to pay premiums). The poor would pay little or nothing, and the rich would pay more--but nobody would have the option of sticking me with their bill and buying a new car while I drive a '95 minivan with no heat.

If that would do the trick, I'd be fine. However, I do have some worries. The old line is true--whoever pays the piper gets to call the tune. Right now the big insurers pay the piper. And they stink. They will try almost anything to avoid paying the bills. When and if the federal government becomes the payer, it will become some cubicle-dweller in DC's jobs to hold down costs. And the way you hold down costs is by saying "no." If you look at the bureaucratic nightmare that Medicare is for doctors and hospitals now, just imagine how it will be when those jokers run everything. My biggest worry is what single-payer systems look like in England and Canada, where care is rationed. There are plenty of Canadians who avoid the long waits of their national system by coming to the USA and paying cash. Once we are single-payer, where are Americans supposed to go if the system is unresponsive? New Zealand? I also worry about the quality of care going down. There are already doctors who are getting out of the medical field because the money and prestige are going down and the hassle is going up. I don't see more government involvement doing anything to slow down that trend.

My biggest worry, though, is about the American people. I support a national health insurance program. And I am willing to pay a fair price for it, even if that price is the same as what I pay now (I'm assuming that I'm not quite "rich" enough to be subsidizing those who pay less at any rate greater than I'm paying to carry freeloaders now). But way too many of my fellow citizens have been thinking for a long time that somebody is going to give them "free health care." We already live in a country where almost half of workers pay no income tax. Once we open the door to goverment-provided insurance, it's easy for people to demand more and more service for less and less (or at least steady) payments. This ignores the very real economic fact of costs. Somebody has to pay for all of this, and politicians don't like math problems like that. As Maggie Thatcher famously said, "the problem with socialism is that you eventually run out of somebody else's money." You could tax every dime of every millionaire's salary in the country at a 100% rate and couldn't raise enough revenue to support the rest of us. So make it fair. But bring it on.


MichaelPolutta said...

I agree with many of your comments, but not your conclusion.

Yes, things are "broken." I have ZERO confidence that more government involvement will improve anything, and 100% confidence that it will make nearly (if not) everything it touches worse - likely MUCH worse.

This administration is living in a make-believe world (even more than the last one, fiscally speaking) and working hard to shove it down my throat. (see 60-vote majority) America is moving away from a "representative republic" and toward a "social democracy." How badly misnamed is that? It's almost as badly misnamed as "common sense."

Yes, God is in control. But we must not forget that God let Hitler rise to power and exterminate Jews for years. God will allow things FAR beyond our expectation to draw us to him - as individuals, and I suspect as a country as well. We as a country are, IMHO, quite far from Him at this moment in time.

Pete said...

I agree w/ mike. I do not want national health care. what urinates me off is the idea that there are those who make a decent wage ($70k/yr +) and they're so loaded with debt that they "cannot afford" (or choose not to afford) health insurance.

sure, health care costs could be cheaper. But much like it says in Boomernomics, as the pig passes through the python, a different area of our economy inflates. Today, it happens to be health care... one day it'll be grave plots... then what?

bekster said...

It seems that we're going to get national health care whether we like it or not (most likely "not"), so we might as well make the best of it. I agree that cheaper insurance would be nice. As it is now, we're in an upward spiral of health-related prices. I would like to see a downward spiral. Maybe "they" can give us that, although there will certainly be other undesirable side effects.

If God is punishing the nation for our lack of faith and obedience, let's just try individually NOT to be the ones causing the problem.

Greg said...

As in most areas, I think the solution needs to be somewhere in the middle - and in this area, I really don't understand why there can't be some blending of ideas. There are certainly things the government can and should be doing to drive down costs of health care - negotiating prices for prescription drugs with the pharmaceutical companies for one. Surely there's a way to give adequate care to even the poorest of our poor (rather than sending them to the ER for the sniffles) and still let the rich get their designer medications and procedures if they're willing to shell out the money for them. Somebody just has to figure out how to do it.

I'm encouraged that the health care providers are at least willing to say they'll cut costs for Obama. Maybe all this talk of nationalization will spook the private sector to actually quit ripping people off at every turn.

Coach Sal said...

Guys, I hear what you're saying. And I tried to give the disclaimer that I'd prefer a free-market improvement in the current system. I'm pretty sure that when various proposals are out there, I'll personally prefer (and argue for) the most conservative, least-statist one. But I'm afraid the reality has nothing to do with what we want. There's not going to be any compromise, or exchange of good ideas. The Democrats have the votes, andd have already indicated they are willing to use the procedural trick of calling this a "budget reconciliation" to make sure they can pass their plan on a party-line vote. The only "give" you might see is an attempt to get a few of the RINO's like Snowe or Collins to get on board so they can claim a fig leaf of bipartisanship when the bill comes due down the road. So "change" will come. My only two feeble hopes are that (1) it doesn't make things significantly worse than they are now, and (2) that the math works--both for the country and for me, personally.