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Health Care Heresy

Terry Gray

14 August 2009

On the PBS Newshour, Dick Armey was a guest speaking about health care.  He decried the so-called "public option" and the fact that he couldn't opt-out of medicare, saying "even if you're a Christian Scientist" you can't opt out (without also opting out of social security, I think.)  He was upset that he couldn't choose…  I have several problems with this position.

Dick Armey does have a choice; he has money; he can buy as much health insurance as he wants, from pretty much any insurance company --what kind of coverage he can get, modulo existing conditions, etc, is another matter, but he has options.

Therefore, I infer the following:  he is not concerned about his lack of choice; rather, he does not like to pay taxes for things that may not benefit him.

Such discomfort assumes that medicare payments should be his own; go directly to a pool for his later benefit.  I don't believe that is the case.  Is not medicare just like social security in that it is a transfer payment system?  That is, welfare, if you like.  The current taxpayers pay benefits to the current beneficiaries.  It is not a personal insurance (or retirement) fund.

All of us have to pay taxes for things we either don't believe in or don't benefit from.  Is it fair that I have to pay high property taxes to help pay for K12 education, even though I have no kids?  Yes, because education is fundamental to democracy.  Similarly, basic (not gold-plated) health insurance *ought* to be fundamental to any civil and successful society, so we should be willing to pay taxes for some basic (and catastrophic) coverage.  I also pay gas taxes to build/repair roads I'll never drive on, and I think that is OK.  There is still such a thing as "public good" --we don't have to reduce everything to "what's in it for me?".

Buying insurance is not like buying a book, or food, or a house.  You are buying a promise; a promise that someday the insurance company will come thru for you.  This is a promise that has often been breached.  We saw it after Katrina, as well.   Moreover, we see more often that if you ask the insurance company to make good on their promise to you, they punish you, e.g. via higher rates in the future.  We also see that in auto insurance, where it is widely agreed that unless the damage is very significant, you are better off just paying for it yourself, and forgetting about your insurance company.

There is a fundamental problem with insurance companies.  Like all corporations in the US form of capitalism, they are "in it for the money" --or "shareholder value", to use the preferred term.  Nothing wrong with that if the interests of other constituencies besides the  executives and shareholders are balanced.  However, if you have just enough competition to put a ceiling on pricing, the way you increase shareholder value is to screw the customer.  In health insurance that means denying claims and jettisoning high-risk customers.  That's not right.  So in this case competition has an adverse impact.  Not to mention that health care itself (not insurance) is one of the fields where competition actually drives up prices, as when every hospital decides to buy the latest MRI machine to compete, even if demand doesn't warrant it.

Oh, and about those death panels we keep hearing the gov't would create.  Who do you think makes those life/death decisions now?  Santa Claus?  The insurance companies decide whether to pay for your treatment, and many have died when the answer was No.

Finally, about the claim that a public option would lead to rationing.  As if we don't have rationing now.  it's called: how much money do you have?