A Modest Healthcare Proposal

Insurance

I have seen a number of posts over the last few days about Obamacare and the personal mandate, basically since the enrollment period opened.  People bitching that they are forced to buy insurance against their will.  Saying that being required to buy something is un-American.

Not only is this attitude wrong, but it screws over the hard-working people who want to do the right thing and not be a burden on society.

Here's the thing, unless you are independently wealthy and able to cover your medical bills out of pocket, the rest of America has to subsidize your refusal to pay for insurance.  OUR medical bills go up because you can't pay.  You declare bankruptcy, and then every single one of your creditors has to eat the bills that you have run up.  These bills don't just go away because you can't pay them.  Therefore, everyone needs to buy insurance so that they can get treated and the bills don't devolve on the rest of us.

This is how insurance works: the risk pool gets spread around.  Healthy people subsidize the sick, and the cost evens out.  This is actually how a free-market survives in any area, the risk gets spread around so that no single person or entity has to bear the full weight of risk.  This is the economics that underpin the stock market, by the way.  A large group of investors each buys a segment of a company, so that no single person holds all of the risk.  Also, the individual buys stock in many different companies, so that if one tanks, all of their eggs aren't in one basket.

But back to insurance.  A health care insurance system full of sick people will go bankrupt, quickly.  This is the motive behind raising the Medicare Eligibility, to completely bankrupt the system.  You see, Medicare depends on the relatively healthy 65 to 70 year olds, so that the older, sicker people can be treated.  If you raise the age for Medicare, you shrink the pool of healthy people subsidizing the sick, and the system fails because the outflow is less than the inflow.  It is simple economics.

But, I hear you say, it isn't fair that healthy people have to subsidize the sick.  I'm sorry, but that's how it works.  In that case, it isn't fair that people who don't have a house fire have to pay out for the people who do.  It also isn't fair that a person with a perfect driving record has to pay for someone who gets into accidents.  But, that is how the system works.  Further, in this country, in order to drive, you have to buy auto insurance.  If you don't, in most states, you face immense fines and probable jail time.  So even the argument that you can't be forced to buy insurance is already false. 

For decades, people have been forced to buy insurance.   If you want to drive, you must have auto insurance, at least liability.  If you don't, you can't buy a car, get a car licensed or anything else like that.  If you don't buy homeowners insurance, you can't get a mortgage.  The entire system is built on spreading risk through insurance.

And health insurance is no different.  The number of people who have no insurance is the major reason why health care in America is the most expensive in the world.  It isn't malpractice suits, it isn't even corporate profits, it is the fact that vast numbers of people who walk into a hospital can't pay.

For example. my childhood best friend John didn't have health insurance.  Even though he had a good job, it wasn't a great job.  He could pay his rent, and eat and even have a bit of fun, but health insurance was not possible.  He couldn't afford it.  One day, he got a back ache that wouldn't go away.  After suffering for a few weeks, the pain go so intense, he went to the ER.  It turns out he had very late stage cancer.  He died a week later. 

However, this isn't about how he could have been saved if he had insurance.   I have no idea on that.  This is about the fact that for one week in the hospital in intensive care, he racked up about $150,000.00 in debts.  The hospital's bill collectors then went after John's mother as his next of kin.  They filed lawsuits against her, tried to garnish her wages, and ultimately forced her into bankruptcy.  I understand that they should not be able to do this, and it was probably illegal.  But because she also couldn't afford a lawyer, she would up in that situation.

Regardless, someone had to eat the $150,000.00 bill John left behind.

And that was all of the people who went to that hospital after John died.  His unpaid bill was amortized across the rest of the hospital billings.  Each person who went there had to pay a small amount of John 's unpaid bill.  No one ever say it, because there isn't a line item for that, but they still saw cost increases in their bills, because the hospital wasn't going to eat that cost.

And that isn't because they were being cruel or mean or anything else, it is because there are hundreds and thousands of "John's" in American hospitals every day.  Now we could debate the appropriateness of a "for profit" health care system that must make money to satisfy the investors, but really this is the system we are stuck with.  (And if you think the screaming about Obamacare is bad, just imagine what would happen if the government nationalized the entire medical profession.)

So in the end, in order to make health care remotely affordable, and to be able to allow everyone who has pre-existing health problems to get health care, everyone has to buy it.  You see, health care is a utility.  We don't think of it that way, but it is.  Just like fresh water, it is a service everyone needs.  You can opt out of it, but if you do, then you are forced to figure out some other way to get it.  Water is the most apt utility to compare it to, because, while people can live without electricity, cable or phone, everyone has to have water.  You either get it from a well, a truck or a city line, but you have to get it somehow.  The same goes for health insurance.

If you are sick, you have a few options, you go to the doctor, you treat yourself or you die.  Not a lot of options here.  Therefore, in order for the entire medical system to work, everyone has to pay for it.  Back to the utility analogy, in some parts of the south, you have to pre-pay for the fire department.  If you don't, they will literally stand on the edge of your property and watch the building burn.

And in this idea, heath care should be treated the same.

If you cannot bear the thought of being forced to buy insurance, and you can't afford your treatment, I have a deal for you.  Don't get medical treatment.  No matter how bad your illness is, or how seriously you are hurt, don't go to the doctor, don't go to the hospital, just deal with it on your own.  If you die, then, I'm sorry, you have to die.

You want a completely free market in health care, then you can have it.  You are fee to not buy health insurance, but in return, you either pay at point of service, or you will be allowed to die. 

The choice is yours.