Health Care

I'm glad that the recently passed Senate version of the health care bill doesn't include a federal option! I might be missing something, but a couple of reasons come to mind. First, it's just hard for an organization to specialize in a lot of things. I remember when I started working full-time and hearing about companies (Sears, perhaps?) that had been titans of the merchandising industry and then tried their hand in mostly unrelated businesses with unfortunate results, and ultimately a drain on their primary product. As far as I can tell, the government for many years has had trouble breaking even with the operations it already has, a questionable position from which to take on a new venture. And not just any venture, but one with some of the most mystifying expense growth and financial issues known to America.

That national deficit's another reason I'm glad that the government's out of the market for now. In small towns across the country, big deep pockets of national chains have put local, profitable, successful stores out of business. If a federal plan happened to be badly mispriced on the low side, the apparent ability to shrug off losses in the short run would leave private insurers in an impossibly competitive situation against what amounts to a discount store with unlimited resources. How could citizens logically go any other route, with other bills to pay? If the trend swept far enough, there'd essentially be a monopoly in place - the industrial equivalent of a monarchy, with the government unrestricted in its ability to raise premiums at that point. I take the absence of the federal option as a sign that Congress reminisces well enough about the good job it's done throughout history to keep monopolies from infecting the economy.

There are some things to note as this bill gets closer to passage.

At least two groups of people will start paying for other people's medical care.

The first group is people without pre-existing conditions. For example, Dena and I are in the process of applying for individual health insurance, and fortunately since it's been over ten years from her overcoming a bout with melanoma we were able to answer "no" to the question about recent disease. A person who'd experienced cancer in the near past is a higher risk, and more likely to have related expenses beyond what Dena would incur. Logic (and indeed, insurance companies) would charge a higher premium to this class of people, or put another way, would not charge a higher premium to everyone else as a way of subsidizing those more at risk. The bill, however, would disallow companies from raising premiums for a pre-existing condition. It actually goes further still, disallowing companies from denying people at all. So consider a theoretical company which insures exactly one person, and had him perfectly priced such that the company's premiums would cover expenses to the penny every year. Now an otherwise identical guy shows up at the door but with six months to live and a stack of medical bills ahead. If the company must insure him and charge the same premium as the healthy man, it bankrupts. That is, unless it raises premiums overall based on the average expenses of the two, which naturally causes the healthy person to overpay.

The second group is the elderly. The $1 trillion package (which amounts to more than $3,000 per man, woman and child in America) is partially funded by reductions in Medicare coverage. If you are living on a fixed income, which many Social Security recipients are (noting as an aside that in 2010 for example there will be no inflation increase in their checks), and your medical costs increase... then something else has to be cut.

As with most social issues, there is the question as to whether the "right" group of people are being served by these actions. 50 million Americans are uninsured, and most will be required to become insured under the law. The fine for failing to buy insurance, by some accounts that I've read, is far less than the cost of annual premiums. Would this mean that reasonably healthy uninsured people will remain so... choosing the less expensive route of the minor fine over the more expensive route of health insurance? And that the previously described individuals in poorer health individuals would jump on board? This concept of "anti-selection" is one of the premises which insurers have been successfully able to charge for in the past. And as noted, in the future this cost could be spread to healthier or older people.

I'm glad for the veteran of our military who's developed a crippling disease in the course of her labors and has yet to be able to find enough work to afford health insurance, or is too ill to find any today. And sad at the thought of the one whose long history of self-abuse, self-pity, and malaise might get the same deal under a new law. Broad-stroke laws may not be able to distinguish the two. And on the whole, I'm glad for the inherent optimism that most of these Americans are doing their best.

The other day someone gave me the idea of a system where the first step is to prescribe combinations of diet and exercise, if a legitimate possibility, before medication. If only there were some way to monitor accountability to these, prior to approving medication or subsidy or handout, so as to distinguish a group who've earned it. Life isn't that straight, of course, it's curly... and on the whole, I think it's more interesting and alive that way for the many other places where this creates the hope of an unseen future.

I wish that this new law would go away. But like most things, I believe that we're part of a great plan which is better enjoyed than resisted or suffered as much as we can. Which in this case means vetting a few thoughts to e-paper, and then moving on to a fabulous Christmas Eve with the family!