This is an article which is a long time coming. Unless you've had your head in the ground, you can't have missed the discussion on health care going on lately. I've had plenty of chance to muse over the issues myself, both on my own, with my wife and with a number of my friends. I've heard a lot of good ideas, but also some misunderstandings and I'd like a chance to lay things out as I see them.
In my time as a working adult I've had the opportunity to experience pretty much the whole range of health care options. I started at the top, working for a large company who had quite a few options. We picked the one that matched our coverage needs the best, based on the fact that we were planning to start a family. When that momentous occasion came, we ended up payed very little out of pocket. It was quite nice, in fact. And for all that, the cost was very reasonable, my share of the cost, anyway.
Many Americans are in this boat and I think for them, their perspective is clouded. They see a decent system, payed for by the economy of scale of a large company, which gives them good options at decent rates. But such is not the case for everyone.
Jump forward just a few months. The tech bubble burst and I ended up out of a job. For over a year we squeaked by without any insurance. It was rather scary actually. Our new son needed shots, of course, but they were $70 a pop at the doctor. He recommended we go to the county health department instead where the shots where subsidized down to about $10. We had a few things come up. Our son had some breathing trouble early on, something that delightfully has disappeared, and every time he'd have trouble we'd be stuck with a hefty doctor's bill. We would panic if he started having trouble on a weekend and generally we'd (well, he would) suffer through until Monday morning when a doctor's office visit was much cheaper.
I would not wish that experience on anyone, but it's something 40 million Americans experience every day.
After suffering for a while I finally landed a decent job at a small company. The drawback was they didn't offer any benefits, but compared to slogging extended warranties or worse, it was a huge step up. Once we'd saved up a small amount, managed to move out of the in-laws' house, we looked to our options for health care. We came away somewhat depressed. In the end we found a plan on the open market which gave us basically what we needed for basically what we could afford.
Since we were coming in without a current health plan they were very emphatic about not covering preexisting conditions, especially pregnancy. In fact, to cover pregnancy at all required a separate rider, a separate waiting period, and a separate deductible. That was the time of our lives so we shelled out the extra cash and put our family on hold for a bit. Things worked out OK, but I would rate that experience somewhat lower than our first insurance scenario.
Eventually we moved on to a new company, where I'm still working in fact, and they had some pretty good plans. The deductible was higher than we would have liked, and it didn't quite cover as much as we wanted, but it worked and it wasn't outrageously expensive either. But nothing stays the same, and this was no different. Every year our premium went up by $40 a month. Every month some small aspect of the plan was reduced or dropped. Vision care, gone. Dental care, optional. Coverage amounts were lowered but somehow we kept paying more.
The current situation is that we're now on a high deductible health plan coupled with a health savings account. There are some benefits and some drawbacks, the primary one being that every expense is now out-of-pocket making for a strong disincentive to seek necessary care. I'm not yet certain how I feel about this plan but so far (it's been just 3 months) I'm not convinced.
So hypothetically speaking, if I'm dissatisfied with my situation, what can I do? Well, I do have a few options.
- Drop my health care. Obviously that's not a reasonable solution, not with the costs of health care in this country. Just about anything is preferable to that.
- Seek out a health care on the open market. For all the people working for small companies, or who own their own business, that's their only choice. The costs are high, the benefits not all that great, and the selection is limited. Consider the amount of leverage a single customer has and you can see it's not really in the company's interests to be competitive.
- Get a new job. In this economy that's often easier said than done, and the simple fact is I like my job. I like where I work and what I do. And even more importantly, why should that have anything to do with my health insurance? Does my employer choose my car insurance? My home insurance? My grocery store? The simple fact is that it's rather ludicrous for a health care plan to be tied to employment at all. It's merely a historical happenstance that it occurred that way at all and now we're stuck with it. Life would be much simpler, for both me and my employer, if the two were separated completely.
- Or just stick with the one plan that's offered me.
Let me switch topics just a bit and address a point which I think is entirely overblown by far too many people: the term "socialism". In some circles even mentioning the word is like preaching vi usage to an emacs mailing list. Too geeky for you? How about wearing a Yankees jersey to Fenway Park? You get the idea I hope. Many people have made "socialism" a religious issue when it needn't be so.
I put the word in quotes above because it's a very mis-understood word and used completely out of context. Consider for a moment a few very socialist institutions: your local police force, the school system and the Forest Service. If we were to take a strictly capitalist approach to those organizations we would have private armies, private schools and private forests. Well, we do. We have both, so don't let anybody convince you that one cannot exist in the presence of the other.
But just looking at the police for a minute, I think we can see that a capitalist police force would be much less efficient. Those with money to hire guards would be able to protect themselves. Those without, well they'd have to fend for themselves. That in turn would encourage more crime by those more destitute which would lead to a pretty miserable feedback loop I fear. So it's in everybody's self-interest to provide for a common police force. And in this country I would argue we've done a good job of it. There's the occasional account of corruption or pandering, but far and away most cops are good folks doing a good job.
We've established that some scenarios just play out better with a socialist scheme, and I would also argue that many scenarios work better with capitalist setups. And many more are a mix because dogmas rarely work perfectly in the real world. The task we face is to select the one that is the best fit. We shouldn't let ourselves be driven by blind ideology or clever witticisms about liberty or freedom. Never let yourself be so vain to think that your ideals are without fault.
Well then, where does that leave us? First and foremost, before you make any choices you need to go watch Frontline: Sick Around The World from PBS. It's the most honest, unbiased collection of the facts of health care around the world that I've ever seen. I reserve the right not to debate anyone who has not watched it. Yes, it's that good.
Now that you've done that (I'm very patient, aren't I?) I can suggest to you what I would prefer. I would like health care to be divorced from employment. I would like minimum health insurance standards to be enforced on insurance providers and required of citizens, with subsidies for low income levels. I would like the option to buy up to better insurance if I felt it would benefit me.
Speaking to a few specific points, I would like to have the public option merely for the fact that it fills a needed gap and provides a certain incentive for private companies to stay competitive. I'm not convinced yet that co-ops would fill that role, but I'm not opposed to those either.
I'm also not against a single payer system (aka the Canada system) in principle. The devil is always in the details but I don't believe we should exclude it just because it's "socialist" or because the moose people do it.
The biggest stumbling block I see to coming to consensus on health care, to bringing affordable insurance to all Americans, to reducing the nightmare that is our heath system, is that people aren't willing to listen to each other any more. I see too much hate. Too many ideologues. Far too much 24 hours cable news. We have to forget our biases and start acting civilly again. If we do, I think we all stand to benefit from the results.