The Alabama Moderate

In response to Five questions that linger for me about Health Care reform:

My apologies to BrokeSnake for not simply leaving a comment, but there is a character limit, and so I’m taking this opportunity to answer him on my own blog.

1.  Do people want good, low price health care or more government control?

Well, here’s the rub.  You can’t have good, low price health care without more government control.  We know that doing nothing certainly won’t give us good, low price health care.  That’s obvious.  And while I’ve seen folks argue that less government control might work, consider that we already allow them to be exempt from anti-trust laws (a government control).  Look at the good that’s done us.  It’s eliminated competition for them, and we’ve got health care that is more expensive than in any other country and isn’t guaranteed– even if we’re paying for it.  That scenario alone should tell us that these companies at the very least need to be subjected to anti-trust laws so that they are forced to compete with each other, but that’s a type “government control.”  Even without a public option, you’ll still at least need some government regulation to improve the situation.

2.  Is the guarantee to all Americans a service that will provide all of us with free health care?

No, and it never has been.  The idea that there was somewhere a guarantee for “free” health care actually comes from opposition talking points.  Even proponents of a single-payer system will tell you that it isn’t free.  Of course, you might have some gullible loony somewhere that believes there’s some public services fairy that waves her wand and gives us police protection and public schools, but most people with an iota of common sense realize that nothing is ever free.

The actual goal is not free health care.  The goal has been better quality health care with a cheaper price tag.  That’s a realistic goal that’s been implemented in too many other countries for us to say it’s impossible here.  Americans deserve it.

3.  If affordability is the issue, what the hell is wrong with Medicaid?

Affordability is one issue, but it’s not the issue.  While the cost of health insurance is too high to be acceptable, many people are still able to afford it and will actually buy it.  The problem is that many of those people cannot get insurance because the insurance companies refuse to sell it to them.  Or some buy it but get dropped after they get sick.  Let me repeat that for you.  People who are able and willing to pay for health insurance and some who actually have insurance are the ones who most need reform because there are too many cases where the insurers will only cover a certain amount and then drop you or they will refuse to cover a treatment that you thought was covered.

Back to the affordability thing.  Let’s say that you are dropped.  Let’s say that you can’t afford insurance.  In order to qualify for Medicaid, your income cannot exceed a certain amount.  Therefore, you are encouraging those people to be less productive so that they can get medical coverage.  Do we really want that?  Add to that, when you have government providing coverage for the sickest, oldest, and poorest Americans, it guarantees a profit to insurers.  It’s basically a government subsidy for a private corporation.  Why not instead do what other governments do and require private insurers to offer coverage to everyone and allow the pool of younger, healthier patients to offset the cost of the older, sicker ones?  Meanwhile, those who actually do have a lower income can receive a tax credit so that they can purchase a private plan and keep that money flowing through the private sector rather than the federal government.

But again, it’s not the poorest among us who are suffering the most.  As you pointed out, they’re covered by Medicaid.  The larger issue is in fact the middle class and the stability, quality, and affordability of the coverage that they pay for.

4.  How would a government option not be a monopoly?

Before I answer this question, let me say this.  I am not a health insurance executive.  The profits of a private corporation are not my concern.  For me, it is much more important that, should someone in my family become seriously ill, we would not have to sell our home or declare bankruptcy and could instead focus on that person getting better.  There are some things more important than corporate profits, and it does no less than infuriate me that someone who is not an executive of one of these companies would actually argue that corporate profit is the REAL important issue.

Now, let me direct you to the salary for the faculty of Harvard University.  Take a gander here as well.  That should at least in part answer your question.  Those are not crappy salaries, and yet this is a private institution in direct competition with a government option.  If you ship a package, you don’t have to do it through the USPS.  Companies still get sprinkler systems and hire security guards and get surveillance cameras in spite of public fire departments and police departments.If your objection is that a corporate exec should not have competition so that he can make a $12 million bonus instead of a $3 million bonus, then I’m sorry that I can’t see eye to eye with you.  Now, there’s no doubt that these companies would make a lot more money if government equivalents did not exist; however, they do in fact exist and do quite well.

But if you are seriously arguing that we should not inject government competition into the mix that would encourage lower costs and better care simply because a health insurance executive would earn $2 million a year instead of $12 million, then I can’t sympathize with your argument.  They can compete.  They just won’t be able to compete and make obscene profits at the same time.

5.  If we were not happy with the service, how do we change it?

The same way you change it now.  Seriously.  Have you even looked at the contents of what’s being proposed?

There would be a large variety of plans offered– all by private insurers.  And if you add the public option, it would be as simple as adding one more insurance company to the list.  You can get coverage through your employer or on your own.  One cool change is that if you have a good plan through your employer that you like, you can keep that plan should you go elsewhere or start your own small business.  The same variety will still exist.  Selecting those offered through the proposed Health Insurance Exchange will look like this.  (That link, by the way, is the system used by members of Congress and federal employees.)  Of course, packages will still be offered outside the exchange, and you are free to purchase one of those if you like, but plans offered within the exchange have a minimum set of benefits that must be covered and must have a cap on the amount that you will pay out-of-pocket.  Those plans must also be fully portable and cannot be dropped due to health or age.  Insurers can offer as many benefits as they like and as many different kinds of plans as they like as long as they cover those minimum benefits.

Additionally, if your income is within a certain range (most of us), then you’ll receive a tax credit to help you purchase insurance through the exchange.  Basically, the only real change is that your insurance companies will be required to offer more plans that meet certain standards, and you’ll be offered the opportunity and assistance in purchasing them.  In essence, you’ll have even more variety to choose from than you do now.