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The Democrats Eliminated Health Insurance
What “health insurance” means–or used to mean, or at any rate should mean–is something like this: a financial product insuring against future medical problems, and having enough money to cover them at fair prices because it does not insure against past and current medical problems for the same price.
Democrats banned health insurance in America. (To be fair, some Republicans helped move things in that direction; see comment # 19 below.)
We can talk about how wonderful it is to have pre-existing conditions covered, but that doesn’t change the fact that requiring their coverage means banning health insurance.
Look at it this way:
Imagine a financial product people use to help with the expense of medical care. It’s called “health insurance” because it is a financial product insuring against possible future problems, not paying for existing problems. That’s why it is an efficient product: The money going out of the pool is less than the money going in, since people buy into the pool as insurance against merely possible future problems, and not all possible problems become actual.
America has a long history of using financial products to pay for healthcare which are not health insurance but which we keep calling by that name. (See comment # 33 below.)
But, once upon a time, real health insurance was at least tolerated by law.
Back then, healthcare was getting more expensive in America. America liked the idea of health insurance–or at least the idea of what we called “health insurance”–so much that we fell in love with the idea of a financial product that finances healthcare. We wanted to make sure that everyone had such a financial product–a worthy thing to want. Sadly, there was no easy way to make that happen, because some people already had actual problems. So health insurance, probably the best reason we ever had to like these financial products in the first place, was restricted and, ultimately, banned.
In its place we set up a different product which did not insure against future problems. This new product bore the name “insurance” by a misnomer, or perhaps by a change in the English language.
This new product, alas, was doomed to inefficiency; the money going out of the pool could easily exceed the money going in because it was not an insurance against possible future problems. Hence the need for the unConstitutional mandate to purchase the product, the solution to which is not just to kill the mandate, but to legalize health insurance all the way. Repealing Obamacare in whole would be a good start. (See # 19 for a hint at another good idea.)
But what about those pre-existing conditions? Don’t those people deserve help? Yes, they do. And that fact does not make a good argument for banning health insurance.
It’s not fair that some people have trouble getting a nice cup of tea whenever they want it. But that is a terrible reason to ban all tea and require everyone instead to drink something “almost, but not quite, entirely unlike tea.”
That does not make a better world.
Neither does banning health insurance for everyone so that some people can have a very different financial product.
Maybe this problem has, as Thomas Sowell says, no solutions, only trade-offs. But banning health insurance, I’d say, was the wrong trade-off.
Still, there are other ways to help people with pre-existing conditions, up to and perhaps including government assistance. And down to and including fixing all the problems that were making healthcare so expensive in the fist place. E.g., allow purchasing across state lines, do some more lawsuit reforms, and end federal action forcing big employers to shove thousands of very different people into the same one-size-doesn’t-fit-all policies.
Note:
This post has been edited in light of insights from commentators better informed than I! See, particularly, comment # 19, comment # 16, and comment # 33.
Published in Healthcare
I don’t know that I would object to wage controls on organizations that are operated as subsidiaries of the government.
Funny how they don’t have to compete on salary with foreign executives, while insisting that American workers be kept under foreign worker wage pressure. Which is another reason we got President Trump.
In a free market, you can switch insurers.
The USA does not have a free-market healthcare system.
It’s still more bother than switching health insurance companies.
I agree with you. I never ever said we did have a free market health care system. Since late summer 2009, we have had a bit of legislation that until Trump stepped in, fully mandated through a “tax” that all people would pay monthly for an insurance premium.
The ACA was one of the most shining examples of the true Elites’ inner circle managing the government for the “benefit of the average person.” A true case where a reform of a system was actually fashioned by those elements who had caused the need for a reform.
But that reform was not without some benefits, especially if your name was Rahm Emanuel or Liz Fowler. (Those two oversaw the writing of most of the 2,000 plus pages of the ACA.) I doubt that Rahm had to pressure too many Big Insurance insiders too hard when he needed monies for his first Chicago mayorial campaign. And once the ACA was passed, Ms Fowler received a cushy job at one of the big insurers. (I think United HC if IRC.)
And in a free market, you can also run out of money and not be able to purchase any of the available options at all. But we’ve already established in this thread that we don’t want to allow that to happen, at least not to people whose expenses aren’t “their fault”.
So we’ve actually already agreed that we don’t want to have a genuine free market healthcare system in the US. Yet everyone still constantly runs back to singing the praises of the free market in threads like these.
This contradiction is precisely why “conservative health care reform” has never and will never get anywhere.
I want to eat a few hundred M&Ms tonight. I may choose more wisely.
When I said “we don’t want that to happen”, I was not referring to us as a groups of individuals. The reasons that Western Chauvinist’s children have expensive health conditions has nothing to do with any choices that she, they, or anybody else made.
I was referring to the collective “we”, as in the people on this thread, the Ricochet brain trust, the conservative movement writ large, and American society as a whole: we all agree that people who have expensive conditions that couldn’t have been prevented by their own actions should not have to forgo treatment if they can’t afford it.
That desire is contrary to the free market.
Right on, right on.
I’ve often wandered–and this is one reason for posts like this–whether we might make more progress if we adopted more rhetoric like “The Democrats banned health insurance.”
To be fair to the Ricochet brain trust, freedom in markets comes in degrees. Other than a few very enthusiastic libertarians, most us would be delighted to move the US economy a few notches closer to Hong Kong in this policy and that policy, and a few extra notches in healthcare where America is extra un-free.
If we took all the free-market suggestions recommended in this thread with the one exception of a welfare program for people with pre-existing conditions, that would be a big improvement, wouldn’t it?
(If it’s not good enough, you might be just the right sensible Puddleglum / Bard of Laketown voice to object!)
As I said in a previous comment in this thread, I think one of the biggest weaknesses in your argument was your assertion that “Americans fell in love with real health insurance”. I disagree completely.
What Americans liked were the subsidized, pre-paid health care plans that we erroneously term “health insurance”. The few people exposed to actual, acturial-driven health insurance in the pre-Obamacare age generally hated it and desperately wanted employer-provided coverage.
So if we had actually had widespread, genuine health insurance in the US (which rendered people uninsurable as soon as they developed an expensive condition), Democrats would probably be hailed as heroes for banning health insurance.
Probably not.
The problem is that with healthcare (as with many other fields), there’s a massive divergence between the theoretical simplicity of a system and the actual technical implementation.
In a forum such as this, the concept of designing a system in which “most reasonably healthy working adults consume health care in a free market while the few with expensive/uninsurable conditions get taken care of by the government” sounds like a straightforward idea.
Once you start to try to implement this plan in practice, things start getting very messy very fast. I’ve tried to give a few examples here (like the requirement for government panels to choose who gets healthcare and who doesn’t) but the list is almost endless. Another thorny point to consider is that while the number of people with pre-existing conditions is relatively small, the percentage of our total healthcare spending that they consume is huge.
Long story short, like cold fusion, the concept of “free market for everyone except high-risk patients” sounds like the perfect plan in theory but will always have some deep Achilles heel in reality.
I think pointing to countries like Singapore or Hong Kong (I know, not a country) as models is just as misleading as when the left constantly points to Scandanavian countries as models for their fantasy social democracy.
Both the Scandanavian countries and the small eastern Asian enclaves are exceptional situations which almost certainly wouldn’t scale to a country as large, diverse, and culturally unique as the US.
Furthermore, while I’m not intimately familiar with the healthcare system in Singapore, I’d bet dollars to low-carb donuts that it’s actually pretty messy and interventionist if we could look under the hood. Since I work in several European healthcare payments systems, one argument from the left that constantly frustrates me is “look how simple and easy these European healthcare systems are!”. What they don’t see is the unbelievable amount of kludge that takes place behind the scenes to keep that public facade of simplicity working. My strong suspicion is that it’s no different in Singapore.
I thought all I said was that Americans fell in love with healthcare-financing products because of real health insurance.
At any rate, there was this, including the failed tag!
Sorry, my bad!
A good answer.
I highly recommend that approach. It has been mine, and it will continue to be mine.
Yup. Unlike with communism or libertarianism, there can be incremental changes for the better. Communists and Democrats don’t want incremental changes for the better, because any improvements are threats to the future implementation of totalitarian health care (aka single payer). And libertarians want all or nothing. So if somebody proposes a health care system that is a mix of government welfare and voucher mechanisms to increase the use of free-market price mechanisms, your local local libertarians are likely to squeak up and say, “Nope. Can’t have that. Government shouldn’t be involved.” So we end up with nationalized health care that maximizes governmental coercion and cuts individual choice out as completely as possible.
I think most of @mendel‘s arguments and points are valid. What I fail to understand so far is, given we have some government system in which everyone and every medical condition is covered, what is the rational for banning opting out of that by individuals and medical practitioners?
Or for allowing plans that operate as insurance to be offered alongside the government-mandate plans?
If memory serves, that was in one of the failed GOP bills.
And I don’t even see why patients shouldn’t be able to use both, although there may be reasons I can’t fathom. Maybe there are reasons why practitioners could only be in one or the other. Can someone who knows something here, say something?
Not me!
But I think it’s safe to say that this would still involve some interference with free exchange–which means lots of inefficiency, which means the healhcare-funding mechanisms would be less able to help people, which means more people suffer, which is the reason this stuff matters.
But less interference, less inefficicency, more helping, less suffering–if it means those things then it’s a step in the right direction.
First, don’t give me the “Pete’s sake”. I’ve worked in a hospitals budgeting and finance office. Have you? The hospital I worked in didn’t charge self-pay patients double what insured pay – and keep in mind, what’s charged vs. what’s covered by insurance are two different things. There were discounts in place for self-pay. Why? Because of the savings involved in not having to pay hospital accounting teams to manage the insurance payments, and payment was immediate, not drawn out over time.
Also, don’t give me the victim statement “If you’ve never been uninsured you wouldn’t understand that”. That’s just crap. That’s like saying I can’t give an opinion on NASA because I’m not an astronaut.
I’ve been uninsured before – which really means, I was off private insurance, not that there wasn’t insurance available. I suffered a brain injury in 2002, months after becoming unemployed. I had no private insurance. The hospital put me on the Vermont version of Medicaid, then called VHAP (Vermont Health Access Plan), which is really just the Medicaid block grant. I paid zero. What the hospital charged VHAP, and what VHAP reimbursed, is back in the same place as it’s always been – the cost shift.
Finally, from the article: The multiplier you and he cite uses the Medicare-allowable costs – the “charging more” just means the hospitals are charging what it costs, not what Medicare
Anderson’s analysis determined the ratio between the prices hospitals charged self-pay patients and Medicare-allowable costs, which are the costs that Medicare has determined to be what it costs to provide care to all patients. In 2004, the ratio was 3.07, which means that for every $100 in Medicare-allowable costs, the average hospital charged a self-pay patient $307.
Of course they charge more – than what Medicare will reimburse. Why? Because Medicare has its own payment schedule, which is always less than what it costs the hospital to provide the care. Hospitals are not charging self-pay 2-3X what it costs the hospital to provide the care.
This is part of an e-mail I recently wrote. It shows how steeped we all are in socialism and it’s lifestyle that we don’t see it clearly. We don’t even realize how much we accept other people stepping in and controlling our lives.
Dear Nelly,
I woke up wondering what in the world a “private pay apartment” was, what you meant by the term in your last e-mail. There are two kinds of “apartments” in this world. In English. Really, Nelly, there are two. There is the kind that you rent, and there is the kind you buy: one is like renting a car or a house, and it’s not really yours, but you are in possession of it and can use it as your own, but you have to pay for the privilege month after month. And the other is like when you buy a house and it’s yours forever (so long as you pay the tax); this is not a condo where there are shared areas, and condo fees and lawn care fees; it’s an apartment in a building and you own a certain portion of the building; it no longer is owned and rented out to you by the landlord of the apartment building; it is owned by you. This is often how it is in other countries: you buy and own an apartment, or you can rent one.
We don’t usually use the word, “private pay apartment” for any apartment in the United States, so I wondered if buying an apartment that you privately own has come to Springfield or something. It took two days to figure out that, yes, Nelly probably means what we in the United States call “an apartment”, a normal apartment, one that you rent from a landlord and pay rent on forever. Is this what “private pay apartment” means to you when you use it?
If so, then I understand something else. You have been so steeped in the government-programs, paid housing, paid food and everything else, you now live in a completely different world than me, with completely new terms and lingo. Now, I gather, you live in a world where so many people live in housing paid by other people, people other than yourself, that this has become the norm or the standard for you and your associates, and to rent an apartment like the rest of us has become in your world a new and separate thing; it has become “a private pay” apartment. It has become a novelty to you, something other than the standard, such as going to a doctor and not having an insurance company pay for the office visit: you are “a private pay” patient, like the rich man who is so rich he doesn’t have to go to a “participating provider” but can go to a private clinic, and get a doctor’s help privately, and pays privately, for private medical care.
I love it. This reminds me of scene descriptions in police procedural and detective mysteries when they are set in the United Kingdom. Based on the frequency, I have to say a quarter to a half of the people’s occupation is on the ‘dole’.