I’ll Be a Card Carrying Communist

By harvest time I’ll be eligible for Medicare. I should be glad because our health insurance premiums are going through the roof at the same rate as my increasing aches and pains. We let our insurance agent do the research and she says it is the best we can do. We pay higher deductibles and get less coverage. Politically, being self-employed doesn’t take advantage of the mob very well. We are hung out to dry when trying to compete with unions, corporations and various associations. There is strength in numbers.

Group health insurance plans had their beginning in the 40’s when Congress feared a post war hyper inflation similar to Germany after World War II. Using the short term thinking that is so prevalent today, they set wage and price controls. Employers couldn’t compete for good workers in any way but through offering benefits. Companies could use volume as a negotiating tool with insurance companies for the lowest rates while enjoying a 100% tax deduction.

This situation made individual insurance rare. Many self-employed people have a spouse who works outside the home merely for the health insurance; another blow to the traditional family with a parent raising children at home. This situation has evolved into the notion that a family cannot survive on one income, even though closer examination of the issue reveals a ratcheting effect of compensating for lack of a family life with unnecessary luxuries.

As I near sixty-five it reminds me of 1965, the year our blessed government instituted Medicare. In studying for this article I saw a picture of my future Medicare card. Right at the top it said “Insurance.” Medicare is not insurance any more than crop insurance is insurance. Yet, once people get comfortable with looking at a nation as family, taking your piece of the pie is no longer theft, it is your entitlement.

People under sixty-five spend a relative pittance on healthcare. The system we have now has been in place since 1965 for the vast majority of medical spending. It is socialized medicine, poorly executed. There is very little competition to control costs. So any blame for our present problems cannot be placed on free markets or “capitalism.”

Liberals who call for a single payer system as an alternative to our present system have a point. In much of the western world single payer systems are proving to be less expensive than the complicated mess we have here. (Although I found a case where amputations for diabetes complications were much higher in the U.S. than the U.K. That was presented as a negative by the simple minds at The Huffington Post. But jazz trumpeter, Clark Terry, had that procedure and it improved his life immensely for four years. Always consider the source and think long term.)

Does that mean we need to adopt those socialized systems in an effort to be more like those countries? Consider some of the good points of medicine in the United States before we do that. The whole world looks to us for breakthroughs in research. We have the shortest wait times for service. Those are products of the market oriented portion of healthcare in America.

Senator Joni Ernst promised to “repeal and replace Obamacare.” My dad said, “Conservatives worship big government the same as liberals; they just think they can do it better.” That is at the root of our poor performance in healthcare. If Mrs. Ernst had simply said to repeal Obamacare, she would be getting somewhere, but she’s only being another shill for government control in an industry that would do well without any government control at all.

It is time that we, out here in the cheap seats, see that what has been presented as two extremes on the same scale is really a modest difference in how we pass our responsibility on to others through government. The choice is not between socialized medicine and better socialized medicine. It is between socialized medicine and free market medicine.

We had something close to that before 1965. People bought insurance to control risk that would exceed normal expenses, and insurance companies would set premiums to assume that risk on an individual basis.

With group plans and The Affordable Care Act we end up ignoring individual risks (such as smoking) and insuring for unnecessary risks (such as pregnant men). One-size-fits-all only works if one size really fits all.

My youth was spent in Cold War times. We hid under our school desks to prepare for nuclear war, a good indicator of the wisdom of government. That war was claimed to be about freedom versus communism. Another thing my dad said was, “In the Soviet Union, everybody has to carry a card.”
I get my card in October.

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2 responses to “I’ll Be a Card Carrying Communist

  1. I think I could get behind purely market-based healthcare and insurance if I actually felt assured that several things would happen if we switched to it:
    – healthcare pricing would actually come down to sane levels
    – quality would be maintained or increased
    – healthcare and insurance companies would not simply try to maximize profits to the detriment of an, “acceptable loss”, of patients and patient care
    – somehow having been dealt a bad card of health by fate or chance wouldn’t leave myself and my family destitute, or anyone else’s family destitute.

    The fact is, I don’t have faith that any of the above would come to pass.

    Some pricing would definitely come down as people had more skin in the game (which I agree with) and better choices had to be made, but I’ve been in the pharmaceutical industry and seen the labor and materials that go into medicines, and there’s not as much wiggle room as people like to think there is in margins. No doubt there is corruption and expansion and greed going on in various sectors, but much of the money sloshing around is actually going into what is a very complex and intense science.

    And, on that note, you suddenly have the cutting of corners for the sake of price, not quality, and we get lower quality product because hey, it’s cheaper, and the margins are better, and there’s not enough volume to produce a quality product for the few that can afford it. Oops.

    Healthcare and insurance companies already try to factor in a percentage of the population that they are actively looking to discourage away from their business. Why? Because by being perpetually sick or needing perpetual care, they cost the system more than they contribute. In a free market, these folks would be refused care and coverage under the guise of simply being uneconomic to handle. Are we prepared to accept that some folks simply won’t get healthcare because they’ve been dealt a bad hand? (I’m not looking at smokers and other clear risk-takers here.)

    And on that note, sometimes we have a very active hand in our health. I know when I’m fatter, I have less health, and that’s my fault for not eating right or exercising. Or I know if I smoke, that’s under my control; same with drugs, etc., etc. But there are plenty of people who simply DO NOT have control over what happens and, despite all efforts, end up needing care, sometimes into the millions of dollars which, under a free market, may not be able to be compensated for, even with available insurance. Are these folks to be committed to a life of debt and poverty because of a random stroke of luck?

    There’s other nuances to this, but these are always the questions in my head as I consider these factors. I can choose to drive or not drive a car and accept the risks associated, and insure against them in the best way possible, and I know the limits and the stakes ahead of time. Car insurance works well with market dynamics. With health, it’s not easy to estimate and compensate properly for risk because it’s mostly hidden, so we do a crap job of it. Leaving all that hidden risk to the market means that we’d have to accept a lower standard of life, living, and health *in aggregate*, and I’m not willing to accept that that’s the best answer.

    • Yep. I think there could be a lot of problems in fine print. It seems like you gotta be a lawyer to live life these days.

      My whole idea on health insurance is that it should be purchased at an early age and premiums adjusted with occasional assessments of lifestyle ect. Like laws, health insurance should be purchased or sold in a stable environment and should not be allowed to be cancelled if the contract says so. Health insurance for families should cover the kids until they are out of the house (18?). If a condition exists at that time the policy should follow treatment until it isn’t needed as per the contract. At that young age the chances of an insurance company insuring a costly client are remote enough it could be figured into the cost and spread among the pool. That’s what insurance is all about.

      It is a shame some people are cancelled in, what they think is an unfair manner. It seems like they didn’t read that fine print, eh? Specialization and individual treatment of the clients’ relationship with the company should produce better economy. But it’s hard to crack through 12+ years of indoctrination that says nothing can work without some inferior bureaucrat stamping things as OK.

      On Tue, Mar 24, 2015 at 2:02 PM, alternativebyfritz wrote:

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