Sunday, March 21, 2010

Here's the thing about mandating health insurance...

The health insurance system only works right if everyone buys in. If you just have old, sick people buying insurance, every account pays out. Insurers can't earn any money.

You could theoretically solve this by just socializing the entire health care industry, and making it a not-for-profit wing of the US Government. But Americans don't really care for that idea. To be honest, though this is probably the version of health care reform I'd prefer, I share some of their concerns.

If, instead, you want to base the system on the continued existence of private, for-profit health insurance companies, the only way to make the system solvent and universally applied is to guarantee young, healthy people - who won't actually cost serious money to insure - pay in. I kept hoping that someone would propose a third option - a way to guarantee basic, affordable health coverage to every American through private insurers but without a legal mandate for all who were able to pay in to the system - but I've never heard one. If you have, please suggest it in the comments below.

These systems don't exist in a vacuum. Public policy has to work in the real world, not in the hypothetical world of ideological purity. I feel like that's where most Americans, at least the outspoken ones I've been speaking with and reading on Facebook, Twitter and blogs, lose the thread. They begin the discussion based on what's "right," the abstract way in which they would prefer America to function. They speak in moral terms and absolutes. They harken back to particular interpretations of Constitutional law. And, sure, they make compelling points now and again. But unless you're willing to sacrifice living, breathing human beings, suffering from a lack of health coverage or crippling medical debts, to ideology and argumentation, you have to think about how these things actually play out day-to-day.

Posted via email from Lon Harris


Nathan said...

What are the ideological arguments you're referring to? Yes, you're right given the private insurance solution the Democrats have passed, you absolutely have to have an individual mandate. I think all of the objections come from the fact that there are no real cost controls so people are being mandated to buy an overpriced product. As a viable middle ground, check out the Singapore system. Universal government covered catastrophic insurance, and then a tightly regulated private insurance market with price controls. Like every other rich nation's, it is far cheaper than ours and covers everybody, go figure.

Lons said...

I think, to a lot of people, the argument boils down to where you stand on progressive taxation. The "I don't wanna pay for freeloaders" mentality prevents us from having a real discussion about the costs and methodologies for implementing universal health care. How many discussions about this subject have you had with someone who simply insists that they shouldn't have to pay so fat people and smokers can see doctors?

Your thoughtful argument about cost control is WELL beyond the tenor of the health care discussion I've been watching unfold in my personal life and in the media. Criticisms of the plan boil down to a vilification of health care mandates as fundamentally (not practically) unjust and trite dismissals of the Obama plan as anti-competitive or socialist.

Nathan said...

Sorry, somehow I thought your original post was a response to Progressive criticisms of the bill, rather than an argument for why a mandate is ok, generally speaking. For the most part, semi-sophisticated wonky arguments have been entirely trashed b/c 80-90% of people are just ideologically loyal on this one. If you're a Republican/conservative, you know with certainty that this is the other side's cause, that they can't be trusted, and that a win for them will set your side back a hell of alot. In the last couple years, things have gotten so bad that the Republicans obviously looked at the polls and decided they couldn't say
"Move along, nothing to see here" anymore. But anybody who follows this stuff knows this has always been a Democratic issue and the Republicans never intended to do a goddam thing. For somebody who just wants us to adopt one of the myriad FAR BETTER systems out there and be done with it, though, watching this whole thing play out has been very disappointing. For the love of God, you don't have to be an expert, a wonk, or a nerd, just recognize who they are and DEFER to them.

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