The Supreme Court is hearing arguments for and against the Affordable Healthcare Act, specifically the individual mandate. At issue is whether or not the Constitution allows Congress to require people to pay for something they do not want. Commercially, that is.
At least, that’s the stated issue. Depending on the group you listen to, the real issues range across the board, from “death panels” to socialism to Big Brother government intrusion to contraception.
There are some paradoxes. Without getting into precise numbers—because, really, which ones are correct?—I’d like to review some of the inherent curiosities in this debate.
Health care costs are going up. This fact is not disputed, I think, by anyone. (Just taking this from a purely personal viewpoint, I’m one, maybe two rate increases away from having to give up my own insurance.) There are a number of reasons for this—aging population, more and better technology available, slicker, more sophisticated pharmaceuticals, malpractice insurance, etc. One factor, of course, is fewer people in the health insurance pool. Common sense tells us that the more people you have participating in something, sharing the cost, the price per person goes down even while the overall pool of available money increases. This is simple logic, basic math, economics 101. Health insurance has gone up in large part because a great many people have dropped out of the load sharing.
Yet any attempt to make all those people participate is characterized as a bad thing.
Freedom of choice, you say. Fair enough.
It would be fair if those people did not receive any health care they could not pay for out of pocket.
But they do. We won’t let hospitals turn them away when they show up at emergency rooms. Fair would be to tell them “you don’t have coverage, go home and die.” Then live with it. But we won’t do that. Which means the load sharing increases on all the rest of us who do participate.
Hm.
Paradox number two. Everyone—well, everyone who seems opposed to the AHCA—is terrified of rationing. Of not being able to see a doctor when they want and then being refused treatment.
But that happens now. Except it happens within the private health care system. Insurance companies deny coverage, hospitals in turn do not deliver certain levels of care, and if you’re really poor you don’t get to see a doctor when you want for checkups. The only time you usually see a doctor is when you absolutely have to and then it’s an emergency room doctor you may never see again for follow-up.
So…what’s the complaint? That the rationing that happens now is acceptable and the rationing that might come from the AHCA is not?
Why?
Back to costs. The worry is (stated worry) that we will have to pay for something we don’t want. I, being a healthy twenty-something who has never had more than a bad cold (aside from the usual list of childhood diseases, many of which I didn’t suffer because I received vaccinations, which I got because health care was both available and paid for by someone else), can’t justify laying out a hundred bucks a month for an insurance policy I think I don’t need, and resent the idea that the government is going to make me pay for it. Besides, this cool job I just got offers health care as part of the package.
But next year I’m going to be required to pay a higher percentage of my employer health care because costs are rising. Hell, I don’t need it, so just cut me from it. But that means everyone else in the company will end up paying more because I’m not chipping in. At some point, the raise I expect will be delayed because the company has to meet rising expenses, which is a rip because I’m healthy and I’m being penalized now because other people aren’t.
So…what was that about being forced to pay for something I don’t want? Just because there’s no check written that I send to someone for it does not mean I don’t pay for it. There are many other ways in which the costs get levied.
Of course, I always intended to buy a policy when I reached my forties or fifties and maybe start having a few more problems…
By then, it’s not a hundred a month, it’s more like four hundred a month. Why is it so high? Because the costs are spread over a smaller and smaller pool of buyers. (And, to be strictly fair, we have more and more care available to pay for—technology has handed us a veritable cornucopia of options these days.) How come they don’t do something to make all those self-centered smart asses pay their fair share so my up front costs aren’t so high?
Paradox the fourth. No one, I’m reasonably sure, thinks pre-existing conditions are fair excuses to be denied the right to buy something you do want—namely, health insurance.
But somehow the government forcing insurance companies to provide such coverage—to people who want to buy it—is an infringement of personal choice? That the rights of the insurance company are being violated?
Okay, so let’s have a public option. Oh, wait, that opens the door to government control and rationing and private companies won’t be able to compete…
So if that’s not an option, what are people with these conditions supposed to do? Wait till a crisis and go to the emergency room.
Either way, you’re telling them that whether they’re willing to pay or not, they can’t have what they want because…?
Other problems. “Everyone knows” that preventive care saves a lot of money. Catching problems before they get big means a healthier life, lower risks, lower costs, and so on. “Everyone” knows this but no one thinks the government should mandate it. We should rely on private insurers to offer the policies.
“Everyone” forgets that there was a hell of a fight back in the Nineties when the government did finally require insurers to offer things like Well Baby Care. Insurers didn’t want to do it. Mainly because a lot of doctors didn’t want to do it—it’s a low profit practice.
But maybe I’m misunderstanding things here. Maybe I’m missing the whole point. I can’t seem to wrap my head around the fact that a lot of people seem to believe that private enterprise will do something it has been consistently reluctant to do unless the government makes it, that in order to preserve some construction of liberty we should be willing to just suffer from a range of treatable ailments and force fewer and fewer people to pay more and more, privately, for less and less available care.
Don’t get me wrong. American medical care is probably the best in the world—if you can afford it.
If you can’t, well, it’s still not bad, but it’s lurching along, bleeding from open wounds, and one of these days the rationing everyone thinks will occur with government involvement will become very real without government involvement. Maybe one of these days we’ll get over our objections to just turning people with no money away and sending them home to suffer and die.
I don’t really think people have thought this through. But I could be wrong.
But I do know that, human nature being what it is, people will generally try to avoid doing anything, even if it will benefit them, if they don’t have to. The problem is that “don’t have to” part. It’s like that old auto repair commercial—“You can pay me now…or pay me later.”
