So I have this habit (or it could be a talent, or some might say it’s a problem) of simplifying things and/or breaking complex ideas & systems down into manageable chunks. Often, this has allowed me to work with (design, fine tune, fix) some rather complex systems (computer programs, manufacturing processes, warehousing flow, and others).
With that in mind, I’ve been asked to (and would like to) apply this methodology to the question, or issue, of health insurance…
Health insurance… Health care… Medicare… Medicaid… Oh my! The very words raise questions, eyebrows, blood pressures, and even hackles. These are complicated issues and generally very emotional ones, which serves to complicate them even more. But, although I may agree that they are highly emotional, I don’t think they’re actually that complicated. Take health insurance, for instance.
In order to deal with health insurance properly, we must first separate it from other issues such as health care. Relax, it’s OK, the break is legitimate & logical, as we’ll see next.
Health care, simply stated, is the act of caring for one’s health.
Health insurance is, simply stated, the guaranteeing of payment for health care.
Less complicated already, isn’t it?
Now, when we look at “health insurance”, we can remove most of the highly charged and emotional issues surrounding “health care”. What we’re left with (or what we’ll be looking at) is the issue of how people will pay for their health care – not what that care comprises, how good it is, or even how expensive it is. (Perhaps I’ll look at those & other “health care” issues in a future post.) OK? So let’s begin…
I think everyone will agree that whatever form it takes, health care should/must be paid for (a reasonable assumption) and that it will probably be expensive (today, a fact).
So how do we pay for heath care? Seems there are a few options:
1) we barter,
2) each one of us pays as best we can,
3) we purchase insurance (a ‘collective’ payment), or
4) we ‘nationalize’ it.
Item ‘1’, bartering, (though it has many advantages) in this society, is inefficient, old-fashioned, and so impractical considering the expense that we might as well we leave it as non-viable.
Item ‘2’, individual payment, could certainly work but first we’d need to realign our thinking about what constitutes “just compensation”, procedures “needed”, etc. – i.e. we’d have to figure out a way to make health care truly “integrated”, “realistic”, and “affordable”. So, for the sake of relevance in today’s reality, we’ll leave #2 as non-viable too. (For the record though, I’m in favor of doing what we need to do to be able to implement this option – back to basics.)
[A side note: Although options ‘1’ & ‘2’ may be impractical today, if other aspects of our society/civilization and their attendant costs – such as manufacturing, transportation, education, jobs, technology, pharmaceuticals, etc. – continue on their present course, either option may soon be the only option. And that is not to mention other influences such as the quality of the food we eat, air we breathe, and water we drink – all of which directly affect our health, the need for health care, and the level (& cost) of that care. But that’s for another post.]
This leaves us with options ‘3’ and ‘4’ – insurance and nationalization – both of which are essentially the same in that we all pay a little into a ‘pool’ from which compensation is made. But there is, I think, one important difference…
The insurance industry, by its very nature and definition, is a ‘for profit’ enterprise. This inevitably means that the people working in the industry become more concerned with what goes into their own pockets (wages), or into their investors’ pockets (dividends), than how affordable the insurance is. I say inevitably, because no matter how altruistic the people in the industry may be at first, in the end they have to feed, clothe, and house themselves and their families – or report to their bosses/investors. Thus it follows that the goal becomes not so much affordability (the initial reason for insurance) but profitability (which evolves too easily into the antithesis of affordability).
Sooner or later, as we can see today, the insurance industry has to charge higher premiums and/or worse yet, encourage behaviors that lead to increased reliance on it (insurance), while discouraging behaviors that increase payouts. This is why we read (in those expensive high gloss, ‘marketing’ booklets) things like “ask for generic” or “get regular tests and checkups…” or “…make an appointment instead of going to urgent care”. Or, sadly, we hear “…no insurance? Sorry… no health care” (what ever happened to social conscience & charity?).
So it follows that, inevitably, the industry mantra becomes (or more accurately, has become), “The more people we sign up, the more they pay, and the less we spend, the more profit we generate.” All of which leads to the final and ultimately arrogant step of ‘mandatory health insurance’.
At this juncture, I think an important point needs to be made about health care and subsequently health insurance. That is: once any ‘service’ becomes (or comes to be considered by society as) necessary or vital (or even, God forbid, mandatory) to the well-being of its citizens, that service should no longer be based on profitability. It should be taken out of the hands of corporate, private, and/or elected profiteers, and become non-profit only. Which brings us to item #4 – nationalization….
If we, as a society or nation, decide (as we already have for all practical purposes) that health care is a basic right or fundamental privilege, and we don’t want to address the issue of nationalized health care (an acceptable, but most likely temporary, avoidance), then we should at least nationalize health insurance. See what the true costs are, decide what a fair wage is, and figure out how to spread the cost out among the population in an, this is very important, equitable and just manner.
All other issues such as who pays how much (do the wealthy pay a lot more?), efficiency (treatments, billing, etc.), limits (who gets what care, when, and for how long), managing fraud (both in payments and/or services & procedures), malpractice, etc. are just that – other issues.
There it is, my more-or-less simple analysis and conclusion on the issue of health insurance – nationalize it. Once that is decided, we can move on to the next issue.
Wait! Before y’all start criticizing my thinking, to reiterate: I’m for option ‘2’, remember?