Tuesday, October 13, 2009

Who Would Jesus Insure?

I'm not a religious man, but I do believe in doing the right thing.
Any way you look at it, I cannot see how anyone could argue that offering health care to every man, woman, and child in the U.S. is morally wrong. So why would someone be opposed to such a proposal?

Two of the more common arguments are:
1) The government would run a public health care option incompetently, squandering money and providing sub-par health care coverage.
2) The government would run a public health care program so well that it would put commercial health care companies out of business.

Proponents suggest a third option:
3) The government program would compliment and co-exist with existing commercial offerings.

I'll contend that argument #1 is obviously false. The "public option" being proposed is intended to provide a baseline level of coverage. In other words, it is intended to cap the lower-bound of coverage options. It does not preclude anyone choosing a private health care option. It does not restrict the maximum level of coverage. As such, it can only raise the level of coverage for those currently most poorly served. One would be a fool to choose the public option if a better private option were available; if no better option is available, the public option cannot be inferior to something that does not exist.

Which only leaves the cost component of argument #1. I would like to see the government run the public option in an efficient way, but if it takes an inefficient organization to provide a baseline level of health care to people who have no better option, than that is simply the cost of doing the right thing. There is no moral high ground in putting money before the health of another human being.

As for argument #2, I cannot see the future so I have no way of guessing whether this is true or false. My gut instinct is that it is false. But, if the government were to be capable of running a program so efficiently that we all received better service at lower cost for all possible treatments, I fail to see the problem. Opposing a public option for fear that it will do a better job that corporate options is analogous to corporate welfare for the less-efficient companies. I do not see the moral high ground is putting the health of companies before the health of citizens.

So our possible outcomes are:
#2 is true - we all get better coverage, albeit from a government-run program.
#3 is true - the public option provides a baseline level of coverage but people/companies can still buy health insurance from private providers for a superior level of coverage.

A number of people seem afraid of a single-payer system, as would result if argument #2 were true. However, I emphasize that the only way for #2 to yield a single-payer system is if that single-payer were superior in the marketplace than all other options. If the government were outlawing the competition, that might be a legitimate concern, but there is currently no proposal to do any such thing. As such, gloomy talk of a single-payer system forcing us to endure inferior service to our current corporate plans is nonsense. The only single-payer system on the table is one so superior (and unlikely to happen) that complaining about it seems neurotic.

In summary, there is small but unlikely possibility that everyone in America gets such superior health care that corporate insurers cannot compete. The expected outcome is that every American is guaranteed a minimum level of health care and those of us fortunate enough to be able to afford better health care can still purchase it just as we do today.

Personally, I do not care what happens to my individual health care package. But I firmly believe that ensuring every man, woman, and child in America has access to at least basic health care is the right thing to do. And I am deeply ashamed that a small but vocal contingent of my fellow Americans so despises their fellow man that they want no part in it.


metapundit.net said...

I haven't heard anybody express your point #2 in exactly that way. Let me suggest an emendation that might clarify opposition for you:

2. The government would run a public health care program so unfairly that it would put commercial health care companies out of business.

Which basically makes argument #2 an enhanced version of #1 - not only will money be wasted but no one will end up having a choice. Since government sets the rules for the healthcare industry it's will be in the simultaneous position of player and umpire - a conflict of interest at least. It isn't out of concern for the survival of corporate entities (is there really anybody who "likes" insurance companies?) that some people are worried that government run healthcare will end up eliminating their health insurance choices.

And that's the last bit I think that's important. This whole debate is not about health care reform - it's about health insurance reform. As someone who grew up poor and without any health insurance I'm well aware that not having insurance is not the same thing as not having health care. People do feel a moral duty to aid the suffering - and clinics and emergency rooms do not turn people away because they can't pay.

My own political suspicions cause me to suspect that #2 is the inevitable end of increased governmental expansion into healthcare - less choice and more cost to me. This may be offset by increased health care access - but I'm not sure that will be the outcome. And I suspect that there are catastrophic side effects such as diminished pace of innovation in medical research - see http://www.city-journal.org/2009/eon0922bp.html for example - that in the long run mean lower standards of medical care than could otherwise have been available.

Grant said...

I have a friend who lives in the Dominican Republic, and their system seems okay. She has government provided healthcare for her basic needs and private insurance for extended coverage.

From my own personal experience, I'm a veteran and have dealt with some VA hospitals over the years. None have been the best, but all were far from the worst I've seen in private hospitals. The only real problem I encountered was that under the Bush administration they decided to stop treating veterans who grossed over $30k/year and didn't tell me until I went to the hospital with a life-threatening illness and got turned away. I doubt that would happen with regular government healthcare, however. They'll cheat certain elements of the population like that, but if they created a universal system and then suddenly decided not everyone would be covered then it would be certain to make the news.

Kelly Yancey said...


I disagree without point about no one being denied health care. It does no one any good to receive care in an emergency room (possibly delaying care for people who have real emergencies) and then go bankrupt because you cannot afford the bill. Technically, you received care, and then your life was destroyed financially. Yay.

Next time you visit the hospital, trying looking at what the bill would be if you had to pay it out-of-pocket. My wife was in the hospital for 3 days once and the bill was over $25,000. I think my lucky stars I had insurance through my employer. It doesn't take much empathy, though, to imagine what that could do to someone without insurance.

You do raise an interesting point, though: technically, no one is completely denied access to medical care under our current system. So, if the uninsured can't pay for that care, who is? The hospitals are just rolling the cost of caring for the uninsured into the bills of the insured. In other words, people currently insured are already subsidizing the care of the uninsured.

As an aside, I take heart in knowing that, if a proposal were ever made to use the power of the federal government to put corporate health insurance companies out of business, people like yourself would step up to stop it. I'll be right there with you. However, as I mentioned in my original post, there is currently no such proposal on the table so opposing health care reform on that grounds seems a little premature.