Yesterday I had a conversation with a friend whom I respect very much. He is generally a political moderate, and very objective. He and I disagree about national health insurance. As we both value our friendship, we have (I think quite wisely) simply agreed to disagree on that particular subject.
I understand the core of his conviction: that people should not be left unable to obtain health care because they can’t afford it. On that point, I happen to agree with him. But I see the possible solution as being a very different one than his.
There is, currently, a very popular saying: “It is what it is.” In order to grasp what a thing is, we must also know what it isn’t.
Insurance is a pooling of the risk. In the early days of the industry, those who gathered their funds to provide for a rainy day tended to be very similar to one another. Therefore the experiment worked so well that the popularity of insurance grew.
Merchant seaman might, for example, form a mutual company to provide for their widows and orphans should some be lost at sea. They all pretty much faced the same risk, and each had an equal chance of falling victim to it. This made it both equitable and relatively easy to share that burden.
A huge pool, which includes everybody, cannot hold over the long term. Some people end up subsidizing others, and the resentment that grows out of this inequity eventually leads some to quit the pool for some alternative, or to destroy it by gaining from it in unfair ways. This ends up helping neither them nor those who need the pool the most.
I believe everyone can still be covered under a system in which many smaller pools exist, instead of just one great big one. Like those early merchant seaman, or firefighters, or police, or whomever else originally pooled their funds for insurance, people can band together with those who share risks similar to theirs and insure themselves. The only way the pool can survive being totally drained (in which case there will be nothing left for anybody, no matter how needy) is if the risk is shared in such a manner.
Providers (such as doctors and hospitals) have also become greedy, thereby corrupting the system. The very fact that insurance now covers virtually everything MAKES EVERYTHING MORE EXPENSIVE. My father, who spent over fifty years in the insurance business, used to call it “the deep-pockets syndrome.” If the pockets are deep enough, some people are going to raise their rates in order to dig more deeply into them.
Many of the things now covered under health insurance should not be covered at all. Think viagra. If they were not, the cost of them would actually go down. This may be difficult for some to imagine, but without such deep pockets to dig into, providers would have an incentive to lower their price.
Insurance is not welfare. If some remain uninsurable, of course some system must be devised to enable them to get the care they need. But a national health care system actually hinders our ability to do this. All we’re doing is draining away the reserves we might otherwise use to help these people.
This is why I believe what I do. It is not because I do not care what happens to people who can’t afford healthcare. My friend knows me well enough to understand that I’m not a bad person. Good people may disagree on the best course to take, but by all means we must discuss it without always having to argue. Someday he and I will have that discussion, though yesterday was not the time. I can be sure he will listen thoughtfully.
I only wish more other people were like him.