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August 16, 2009

What Will Be the Next "Health Care Reform" We Can Beat?

There's a lot left.

Individual mandates, for one.

To be perfectly honest with you, I personally am not completely opposed to this one, in principle, assuming it would take a tolerable form.

But I don't assume that. It will take an intolerable form. I assume it will take the form of the stupidest, vote-buyingest, most socialistic scheme possible, so I oppose it in fact.


So long as it's not greatly socialist -- e.g., young people, with barely any need for insurance at all (which is why they skip it) are overcharged ludicrously so they are forced to subsidize the elderly, who use a lot of insurance dollars. Or rich people are forced to pay money for the poor. In that case, I could kinda get behind it, or at least not bother myself to oppose it strenuously.

Or it covers anything except unpredictable, rare, catastrophic health crises.

This idea that taxpayers ought to pay for someone's eyeglasses or routine visits to the doctor or utterly-predictable need of antibiotics or flu immunizations is, well, two words; In. Sane.

That's not "insurance." Insurance is a contract by which someone agrees to pay if you suffer a rare expense. That's how real insurance manages to be fairly inexpensive -- the risk insured against may be costly as hell (e.g., your house burns down) doesn't happen very often.

In the US, "insurance" moved away from real insurance to disguised payments in lieu of wages during the Depression and WWII, where the socialist Roosevelt Administration controlled wages. So firms began offering more and more generous "insurance" to evade/break/semi-legally flout these restrictions, which stopped being insurance against a rare risk, and began becoming simply disguised wages as they paid for things which weren't "risks" at all but inevitabilities, such as your needing to pay for eyeglasses and flu shots and routine check-ups and everything else.

The normal maintenance of your body, in other words, the same as buying food.

No one could "insure" your need to eat food, as it is not a risk at all but an inevitability. Or, in theory, I could "insure" you against the "risk" you will need to eat at least $100 of food per week, but as it is guaranteed that you will eat that much, the "insurance policy" would have to cost... $100 per week plus administrative and other expenses, meaning you'd pay a company $125 or $135 a week in order to get a $100 check from the company every week.

This is exactly what "insurance" has become in the minds of most -- "someone else pays for stuff that in a sane world I'd pay for myself."

The reason that employees at companies that pay for insurance get most of this paid for is that their employer is merely paying them wages in a different form; i.e., rather than pay you an extra $10 a week or $500 per year, they'll pay $500 of medical expenses you would otherwise have to pay yourself.

They're not "insuring" you. You cannot be "insured" against a "risk" 100% guaranteed to occur.

They're just delivering wages in a roundabout fashion.

The reason I'm not really against individual mandates, properly fashioned, is that it is a fact that any one of us might get deathly sick or take one wrong step and wind up in traction for a year, and yet of course, even if we don't have insurance, expect the hospital to treat us, even if we can't pay. And of course that means that some of us are free-riding on the insurance other people have/purchase, so we are unfairly extracting money from them.

This particular point is not one I think of "socialism" and "state control" versus "freedom." There is not a hardcore libertarian in the world lacking insurance who, if he gets cancer and needs treatments costing $150,000 or more, is really going to say "Do not treat me; I have not paid for this and cannot pay for this; and I refuse, on my libertarian principles, to extract money from another citizen to benefit myself."

Doesn't happen. Won't happen.

What is really going on is that some people are, of course, willing to game the system so that they don't pay into it but when they need the care, they expect to get it (and mostly will... mostly), but on someone else's dime.

Someone else is forced to subsidize them. That may or not technically be "socialism," but it sure ain't capitalism, either.

Some people are wealthy enough to self-insure and so should be excluded, but then, they almost all have insurance anyway so the point is practically moot.

I suppose that some socialization is expected in America, as regards the most poor and destitute. I suppose that some catastrophic coverage could be provided for the most destitute... but then, if someone's making $35,000 a year, I don't really want to hear he doesn't have $500 $400 a month to cover his family against catastrophic health crises. See correction below. Actually, with a high deductible of $10,000, a commenter says it costs as little as $42 a month.

However, while I am not against individual mandates in principle, I am against them in fact, because I know damn well that the mandates will break every single one of my rules for acquiescence.

It will be heavily socialized, with young subsidizing the old and the rich subsidizing the poor, and even worse, it will not be restricted to less-costly catastrophic coverage (less costly because, even though it's the costliest of all when needed, it is a thankfully rare situation... unlike the very routine fact you need to get flu shots every year).

In other words, the idea that some have that they should just sort of "get free shit" on someone else's dime. This is, was, and always will be the central, critical notion of "health care reform" as conceived by the left.

Individual mandates for catastrophic coverage don't give politicians any benefit, because most people won't need it and even those who do need it aren't particularly benefited, because, in America, they'd probably get 70-80% of the treatment they needed anyway... just subsidized by those with insurance. So people would tend not to notice they were getting a benefit at all.

And of course most of those getting the benefit would have paid for it, so... no free stuff. And no free stuff = no bought votes. If you have to pay for something with your own money, people tend to think they haven't gotten anything from the government.

In fact, they've gotten a lot. Self-reliance and the reinforcement of the capitalist model, the greatest wealth-generating system in human history.

But they don't notice that. They want free stuff, they want someone else paying their costs, they want someone else picking up the check. If the government isn't putting its hand into someone else's pocket to give them a fraction of someone else's wealth, they don't consider the government to be "working" for them at all.

So my whole idea is of course a non-starter. Would never happen, because it doesn't benefit the most important class that must be considered with regard to any legislation -- the legislators themselves.


Correction: A commenter tells me I waaayyyy overguessed on the the cost of catastrophic care coverage:

@2 No way in hell should "catastrophic" insurance cost that much.

And it doesn't (last time I shopped), in states where it was legal. I found plans for $42 a month, with extras I could add like oncology for $120 a year. The deductible was $10000, and I had Visa for that. But it was in Texas, and I was working in New York. There high deductible was not an option, and it was $400+ a month. But my heroin detoxes would be covered.

$10,000 is a lot, but it's now less than an entry-level sedan. Yes, a poor family would have to scrimp to pay this off over several years, but they could in fact pay it.

And they'd be covered for the truly exceptional, life-altering crises that insurance really should be covering in the first place.

And for $400 a month apparently you can have a much lower deductible.

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posted by Ace at 02:20 PM

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