At any given time, only a subset of the population will be needing active medical care. Most people get along great for many years on end without requiring any sort of medical intervention short of checkups to verify that that is the case. Obviously, if the entire population funds the healthcare system on a continous basis through taxation, there is money enough to run it and provide everybody with quality care without having to say “Ok, you can get care, but you over there can just go home and quietly die, sorry.”

The problem, however, is that the current system is a profit-making one. As soon as you introduce a profit motive, that will become the end goal of the system – not providing quality health care, but ensuring maximum gain for the maximum number of middlemen. Currently, that is the health care insurers, but also the health care providers and drug companies that have jacked prices up to ridiculous levels across the board. US citizens are paying several times more for the same drugs alone as other nations – and the reason they do is because of the current system being milked for everything its worth.

I fail to see how anyone thinks it is fair or even sane to have a system where citizen A pays in money into the system, then insurance company B siphons off a large part of that and calls it profit and medical care provider C gets a fraction of that money to provide health care to citizen A and others like him. What in the name of heaven is party B doing in that equation in the first place? It seems self-evident that a party with no profit-making motive, merely a cost-management one – which most likely means civil servants of some kind – handle the money management. Keeping costs down is an entirely different beast than callously sucking money out of the system to fund record-breaking profits, the way the insurance companies do today.

Essentially this too is a sign that the current American system of rampant capitalism is broken. It is failing just as badly as communism did, and for the same reason – it doesn’t adequately allow for the fact that people are scum, and always look out for number one. It is the natural thing for humans to do, and they will do it – and that needs to be recognized and be tempered by laws and regulations made by legislators who understand that fact.

I don’t personally think it is a bad thing if someone makes an obscene profit on selling luxury goods (by which I mean anything above and beyond basic clothing, basic shelter, basic food and healthcare) but some things – things the entire population will need without exeption throughout their lifetimes – should be funded by taxation. Healthcare is one of those things, as are roads, public utilities, law enforcement and fire safety, among other things.

Those of us already fortunate enough to live in nations run by those principles can only look at American health care and goggle in amazement that people will accept that. I mean, something is severely wrong when what is purportedly the wealthiest nation on earth is now the biggest beneficiary of help organisations that were set up to provide emergency health care to people in third world nations…

All plans, including private insurers, nationalized management (UK, Canada), Medicare and VA Benefits basically rely on “reactionary treatment” of disease and injury. This is the most costly portion of medical treatment. Very few ever offer weighting to “disease prevention and lifestyle management” which is cheaper, but a chronic expense. The current insurance systems target early deaths because it is the most cost effective way to manage high expense treatments. However, what business fails to realize is that the longer more people live and remain productive the more tax we can pay into the system. For any program like the Oregon Plan, Medicare or private independent insurance to work the public needs to accept the fact that we are ultimately responsible for our own health. If we expect to be careless and live poorly, we should expect to pay severely to get relief.

Thanks again for sharing your thoughts. Like you, I am highly skeptical of any promises made during a campaign season, and for that reason I have not bothered to study the specifics of either of the candidates proposals in much detail. Until one of them is actually elected and puts forth a real proposal, we won’t have any details worth studying. If any legislation ever actually passes, it will likely bear no resemblance to their campaign promises.

My original purpose in writing this article was not to take sides in a political campaign, but to point out the economic realities that any nationalized health care system must address. The people who believe that universal coverage will provide botox and boob jobs for everyone are going to be in for a very big disappointment.

I’m curious to know whether you have any reliable data on how many people like you fall into the category of uninsurable? If my wife were to ever change jobs, she would certainly be included in that group. She actually had two heart attacks at the age of 40. She is fully recovered now and is otherwise in perfect health, but we are exceedingly fortunate that she is one of the few Americans who has worked for the same employer for her entire career. Otherwise our entire family would be without coverage.

Chris

Back to finish up my other thought… I agree with your point that the Obama Plan’s proposal to fund itself through increased tax revenue drawn from the top 5% tax bracket seems incomplete at best. The plan (pdf version here) refers to additional self-funding by driving down the cost of treatment and slashing the current system’s administrative overhead. Sounds reasonable, but how doable these kinds of things are is a question I lack the expertise to answer. Plus, since we are smack in the middle of presidential-campaign-promise-making season, I keep grains of salt handy as a key critical thinking tool.

As you’ve probably surmised, I am an Obama supporter. That said, I aim to always at least find out what both candidates’ relative proposals are on key issues, even if I suspect that I already know which way I’ll vote. Upon looking at the McCain health care proposal, I must say I can’t find anything that seems like more than brief lip service to addressing a predicament like mine.

The centerpiece of the McCain Plan is a tax credit of $5000/family – or in my case, $2,500 per individual – for me to use to go out and buy myself a health insurance plan. Thud. This wouldn’t help me at all, since insurers won’t sell me a policy at any price. Digging further into his plan I did find more specific stuff, but unfortunately nothing that inspires much confidence:

John McCain’s Plan Cares For The Traditionally Uninsurable. John McCain understands that those without prior group coverage and those with pre-existing conditions have the most difficulty on the individual market, and we need to make sure they get the high-quality coverage they need.

OK, it’s nice that he cares. So how, specifically, is he going to help me get insured?

…John McCain will work with governors to develop a best practice model that states can follow – a Guaranteed Access Plan or GAP – that would reflect the best experience of the states to ensure these patients have access to health coverage.

So, he’s essentially saying that he’s going to hand off the problem to the States. He describes the Guaranteed Access Plan as “a best practice model that states can follow” – that doesn’t sound like a guarantee to me, that sounds like an optional guideline.

Also, having access to coverage is one thing, but being able to pay for care is another. On that point, his plan continues:

One approach would establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.

*Sigh*. These kinds of risk-pooling organizations already exist. They’re called Discount Programs. I know this because I’m in one, in lieu of actual insurance coverage (my membership card even says, in all caps and on both sides, “This is not insurance”). The best that can be said of such programs is that they are better than nothing. Think bare-bones, rock-bottom HMO plan, except with higher monthly premiums, fewer included office visits to FAR fewer kinds of doctors, and a much smaller pool of providers. I have to pay for my weekly therapy sessions entirely out of my own pocket. The real killer is the meager discount of only 5-10% on prescriptions, and not all drugs are covered. My meds end up costing me about $500 a month.

Another thing about this smells funny, too. Like his proposals on most other issues, McCain’s overall health care plan emphasizes the free market and individual choice (tax credits for health care consumers, etc). So when Mr. Free Market talks about setting up a nonprofit organization to liaise with insurance carriers and states, the effect is like a dog says “moo” (I better be careful here in the perilous land of animal metaphors, ha ha). It’s like, “Whose tune are you trying to sing here?” Makes me look sideways, anyhow.

Anyway, I’ve written quite a bit here. I could go on to talk about how the Obama plan is much more concrete and commits specifically to measures that would enable me to have actual insurance. Or about how McCain’s Nonprofit States-and-Carriers-Discount-Program-Redux thing flies in the face of the established model by which insurers pool risk in order to set premium prices. But I’m tired, and you and your readers are probably tired of reading my words by now. I can’t even cross-post all this on my own blog… because my name isn’t really Bill. Going public with the details of my health insurability might not come back to haunt me, but with things as they are there’s no way I’m going to chance making it even harder to get myself insured.

So to wrap it up, I wrote partly because your post mentioned an aspect of Obama’s plan but didn’t include anything about the McCain alternative. Preference for one candidate or the other aside, I think you and I agree that both campaigns recognize Americans’ desire to be assured of medical coverage that they can afford. They tempt voters with the appealing but illusory promise of universal coverage. Cynic that I am, I have to come to fully expect presidential candidates to promise more than they can deliver. All we can do is sort through the details critically and decide for ourselves. Speaking of cynicism, part of your conclusion jumped out at me:

When we finally move beyond political posturing

I hope you’re right about “when,” as opposed to “if.”

Thanks for taking the time to share your thoughts. It sounds like you really are one of the people who falls through the cracks. I’ve worked for several very small companies that were not able to provide health insurance benefits for their employees. I think one of the most important things we need to do in this country is re-examine the link between employment and health insurance. Our lifelong need for medical care should not be dependent on our fleeting relationships with a series of employers. It made sense when workers routinely spent their entire careers working for the same company, but those days are long gone.

Chris

First of all, this is a very well-considered and skillfully written piece – good job. :)

I agree with the general thrust of your post, i.e., that “universal health care” is a mirage and that in practice, what will have to be implemented is something along the lines of the Oregon Plan, with its attendant limitations. You’re absolutely right that we Americans are pathologically averse to facing the truth that the resources available to us are finite. Not to stray too far off-topic, but we have conditioned ourselves to be consumers with a taste for – nay, an expectation of instant gratification. This tendency is exploited by shrewd advertisers and marketers every day, and right now it is being played to with abandon by both of the major parties’ presidential nominees.

However, I would like to interject something into your statistical analysis of the 47 million uninsured number. By your reckoning, I’m not sure if I would fall into the group that you call “the voluntarily uninsured” or not. I bear some of the statistical symptoms you ascribe to that segment: I’m relatively young (37), I’m in generally good overall health (more on that in a minute), I reside in a household with a total annual income of $50-75K, and I have the financial means to purchase at least your average individual health insurance plan.

The problem is that health insurers won’t sell me a policy at any price – not even the skimpiest number of benefits, and not even at their highest deductibles. I am too great an insurance risk – or, in actuarial parlance, “uninsurable.” As I said, I am in generally good health: I’m an off-and-on marathon runner, don’t smoke, and have no family history of cancer or heart disease. However, I was diagnosed more than a decade ago with clinical depression and Adult ADD. In order to function without impairment, I am on a maintenance program of 4 medications which I take daily.

I had health insurance through a job with a large company. I was laid off in early 2007, but kept up my coverage through COBRA. Then I got a new job with a small office, and a misunderstanding occurred. The new job “provided medical benefits,” which I took to mean group health insurance; as it turned out, it meant “go buy yourself an individual plan, and the company will pay your premiums.” That’s when I found out that I can’t buy myself an individual plan – and believe me, I tried every health carrier and insurance agency under the sun.

Bottom line: there’s nothing voluntary about my uninsured-ness.

One of the common elements of virtually every healthcare reform proposal is a requirement for universal participation.

That’s a little bit of a blanket statement, especially considering that the Obama health care plan does not mandate participation. It requires that children be covered, but it does not require that they but covered by the national plan – parents/guardians may choose to have kids covered under an existing family/group policy.

I have another point that I want to address, but I have to be somewhere pretty soon, so I’ll have to get back to this. So till then, my compliments again on your substantive, astute treatment of this subject.