The Trickiest Part of Universal Health Care

Health insurance is not like other insurance. Take fire insurance. Chances are, your house will never burn down. But you pay a little bit each month so that if you should be the unlucky one, you will have the cash to move on with your life.

Health insurance is different. Sure, you are protecting against disaster, but it’s not if you will have a health disaster, it’s when. We will all of us get sick. So sick we might die. It’s just a matter of time. Health insurance is about all of us putting our resources together so the sick people can get better without bankrupting themselves.

For this plan to work, healthy people need to pay into the system. The Affordable Care Act, lovingly known as Obamacare, tries to force healthy people into the system by taxing them if they don’t have insurance. This is not popular, and I’m not surprised. The new plan proposed by the Republicans does away with that, replacing it with an even more ill-advised penalty for coming back.

The core of the problem is this: Your insurance is only as good as the group of people in your pool. If you’re in a pool with lots of young, healthy people, your costs are low. The insurance companies have been slicing us into literally thousands of pools, and have made rules to keep people who are already sick out of any pool at all.

Both ACA and the new Republican plan miss the point. The problem is not how to force healthy people into the pool that has the sick people. The problem is that there are too many pools. Insurance companies make a shit-ton of money slicing and dividing us, and it’s time to come to a simple realization: we’re all in this together.

One pool.

I’m still pretty healthy, but the insurance companies don’t come a-courtin’ the way they used to. I’m sliding into the riskier part of the actuarial table. Still, I work for a company that takes care of its people, to a level I’m not allowed to talk about. I’ve got good health care, though, and my company doesn’t spend as much as it might because overall its employees are a pretty good pool.

Chances are, I’d be on the losing end if all the pools were united, but I’m OK with that. More than OK. Excited at the idea. Excited that the emergency rooms across the nation won’t be clogged with people who needn’t have been there if they had access to basic care. Excited that maybe some of the homeless I pass each day on my bicycle may be able to get the care they need and, yes, get a fucking job.

Side note: the phrases “Get a fucking job, you bum!” and “They took our jobs!” often come out of the same mouth.

So let’s get back to the basics and realize that the offerings of both parties fail to understand the core of the problem. It’s not about pushing people into a pool that’s disadvantageous to them, it’s about getting rid of all the goddam pools.

One pool.

One nation, indivisible, with liberty and justice for all.


2 thoughts on “The Trickiest Part of Universal Health Care

  1. Under a sane system, you would get your wish: the federal government would not try to impose a one-size-fits-all system on the rest of the country, and California could implement the one-pool system it would like to, without interference from DC. Then, you could show the rest of the United States how amazing this system would be.

    Meanwhile, Texas would be free to let me buy insurance again.

    What you describe is not insurance. It’s a health plan. By trying to pretend that it’s insurance, you are driving costs far higher than they should be, and also forbidding anyone from buying actual insurance. Because while it’s true that we will all, at some point or another, have at least one life-threatening illness, most of those life-threatening illnesses are not something that should require insurance to fix. It is utterly crazy that pneumonia, a life-threatening sickness we’ve known how to treat well for decades, should cost $14,000 on average—and up to $38,000—to cure. It should be less than a hundred dollars. (That is, less than a quarter of what my monthly payment for “insurance” would be under the ACA.) The reason that so many should-be-cheap treatments are so expensive is a direct result of the crazy incentives that rule under our heavily-regulated and government-run system today.

    Put those same incentives into any other industry, and prices would skyrocket while quality plummeted.

    I fear that your one-pool system would just ramp up those incentives, but if the federal government let the states do what they want, you’d be able to try it and see without screwing up everyone else.

    I strongly recommend reading David Goldhill’s Catastrophic Care, to see how these incentives work to increase costs and decrease quality of care.

    • Thanks, I’ll look for that book. I agree that it’s not really insurance; that’s why the title says Universal Health Care. I don’t think your “actual insurance” is really insurance either — not in the sense that any of your other insurance is.

      The act of “pretending it’s insurance” is not what makes health care expensive. One of the three great leeches on our care costs is in fact insurance companies. I suspect that even California doesn’t have what it takes to buck the Insurance lobbies and the massive marketing campaign that they would mobilize to kill any single-payer system, so honestly I don’t expect any dramatic change. In the end, anything that got through the process would be so watered-down and distorted that it would hardly be recognizable. Not unlike what we have now.

      If we did get it working, it would be a very interesting experiment. Either California would have to build a wall to keep everyone else out, or everyone else would have to build a wall to keep Californians in.

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