My thoughts about health care

Health care seems to be the big topic in the news nowadays. I will admit, I have not diligently followed the debate, and I don't know the specific contents of any of the proposals, counter-proposals, etc. that are floating around Washington. But I think I've gotten at least some of the broad brushstrokes of the debate, and inasmuch as the topic is inescapable, I have given the matter thought.

I think it's misleading to try to describe health care as a "right", since somebody else has to provide it, but I do think that ensuring that decent health care is generally available to people is a legitimate, even laudable, function for government. I perceive, however, that there is tension between those who want the government to actually provide the health care, and those who want a free health care market. It's often described as a battle between socialism and capitalism.

But I think that sort of misses the point. Years ago, when nobody was looking, that decision was already made.

Let's think about insurance a bit, since that seems to be how health care is delivered now and how one side of the debate thinks it should continue to be delivered. Insurance---health, fire, liability, etc.---is, at heart, gambling. An insurance company bets, based on its research and the work of its actuarial staff, on the likelihood of an event occurring. The potential downside times the likelihood of occurrence generates a number which, with a margin tacked on for profit, is used to determine the cost of the insurance policy. Over the long run and multiple policies, the insurance company hopes that it figures right, and it ends up taking in more than it pays out. The insured for his or her part pays part of the cost of an eventuality which may never occur, in exchange for the peace of mind that comes from knowing that if it does occur, they will not have to pay the full cost. Everybody, theoretically, is happy.

However, there arise situations in which the likelihood of the insured-against event occurring approaches 100%. A classic example is the need for medical treatment when the patient has a pre-existing chronic condition. In that case, the logical course for the insurer is to deny coverage: not to play the game; not to take the sucker bet. Or, alternatively, the premium would be equal to the cost of treatment (plus profit). That's not evil, or greed, or any other malicious trait---it's logic.

But, when it comes to health care, We (as in, society) are not willing to accept that. It's too gut-wrenching to see some poor old lady with cancer who loses her job being denied the treatment she needs to stay alive. Given the premises that (a) everybody should have health care, and (b) health care is paid for by insurance, the conclusion is that everybody should have insurance. But in that case, what you're talking about is no longer insurance. Insurance is the gamble described above. In this new situation, what ends up happening is, everybody pays in, and then out of what everybody pays in, everybody gets their health care paid.

Know what another name for that system is? Socialized medicine. I mean, what's the difference? The mechanism is ridiculously simple: everybody pays in; everybody gets treatment if they need it. The cost of treatment is spread out over the entire society. If that's not socialized medicine, what is it?

So, ever since the first law was passed regulating when and whether insurance companies could deny coverage, we have been operating under a system of socialized medicine. The situation reminds me of an old off-color joke:

A knavish man meets an attractive woman at a party. He asks her, "Will you have sex with me?"

"Not bloody likely," she replies with disdain.

"How about for a million dollars?"

She thinks about it, and finally says, "Yes, I suppose for a million dollars, I'd have sex even with you."

"I don't have a million. How about for ten bucks?"

"Of course not!" she huffs indignantly. "What sort of girl do you take me for?"

"We've already established what kind of girl you are," he replies. "Now we're just arguing over price."

That, I think, is analogous to the current debate about health care. There seems to be a lot of huffing and puffing from people who are afraid that American health care, and perhaps society on the whole, will head off to hell in a handbasket if we adopt any form of socialized medicine, but the funny/ironic/pathetic thing is, we've already decided we want socialized medicine. We've had it, in an impure and inefficient form, for years! That horse is out of the barn; that water has passed under the bridge. That question has been decided; now we're just arguing about the details.

The switch to socialized medicine, which took place years ago, was not immediately apparent, however, because the insurance companies remained in place, and often in the current debate it seems that insurance companies represent the opposite of socialized medicine.

But I think the REAL role insurance companies play is, they interject a middleman with a profit motive into the mechanism of providing the socialized health care, which the public demands, to the public. So you end up with high costs and fights over coverage, and parades of horribles due to people being denied coverage or dropped for pretextual reasons. Everybody feels that things like that shouldn't be happening, but the reason they do is because the square pegs of insurance companies have been shoved into the round holes of socialized health care, and obviously the fit is not good.

One cannot really blame the insurance companies, who have been paid billions of dollars to play the role they currently play, for wanting to preserve the status quo. It is in the nature of corporations, especially big corporations, to mercilessly protect their profits and maximize their income and value. But I think that if people looked at the situation clearly, it's obvious that the insurance companies need to be taken out of the loop. In fact, I am sure that if the whole system was being conceived from ground zero without decades of history and having arrived at the current situation by little steps, I think anybody who tried to do what we have now---arrange things so that huge amounts of money were funneled to private actors to perform a public function, and not even very well---I have to think that guy would go to prison for it, and there would be riots in the streets if Congress tried to enforce a system like we have on people, if they weren't already used to it.

One likes to feel good about one's country, and it is disillusioning to see the extent to which big business, both in the health care field and the financial arena, has taken over our government, to the extent that so many public servants are willing and even eager to work against the best interests of the public for the benefit of private entities. But I don't know what can be done about it, if even in the wake of last fall's financial meltdown, which could have destroyed our economy, there is not the will and/or ability to reform that industry, and even though I get the feeling that most Americans feel that there is something wrong with the health care system, Congress can't/won't do anything about it, despite the best opportunity that may come for a generation to actually make a "change we can believe in".

People have surprised me in the past; I live in hope. But I don't hold my breath.