Health Care, Part V: Who's Looking Out for Your Health?

I have been arguing in this series, and have argued in a previous blog series, that while market forces are in general beneficial, it makes no sense to subject health care to market forces. I want to add yet another reason to the ‘pile.’

One obvious problem with health-care in America is that we have a ‘sick care’ system rather than a health care system. That is, we take care of people who are already sick, rather than taking steps to make sure that people don’t get sick in the first place (this is not a partisan point – it was one of the talking points of Mike Huckabee’s campaign). Classic example: its costs a lot of money to treat advanced colon cancer, but relatively speaking almost nothing to pay for annual colon cancer screenings.

Now, why do we have a ‘sick care’ system instead of a health care system? The answer is simple: we have a system in America that does not reward insurance companies for preventing illness. Currently, most people have health insurance through their work or some other temporary arrangement. In our current system, why would an insurance company create incentives for you to get a colon cancer screening if you are going to be someone else’s problem in 5 years? Answer: they wouldn’t. The point of their business is to make money, not to keep you healthy. This does not make them immoral, but amoral: they are just good capitalists.

But if the government were paying for health care, they would indeed have an interest in paying for that extra colon cancer screening for two reasons. First, they would be on the hook financially if you did have to have expensive cancer treatments. And second, the government needs a healthy citizenry to keep its economy working. Now I don’t care if the government is federal or at the state level. But it should be the government, because the government has the dual motivation I just described, which will lead them to take common sense measures to keep its citizens healthy. A health insurance company has no motivation whatsoever – you will likely be some other company’s problem by the time you get sick.

Health Care, Part IV: Private Compassion?

In Obama’s speech to the joint session of Congress, he saved his ‘preaching’ for the end. He described the practical advantages in the first part of his talk, and then the moral imperative: making sure that everyone has access to health care is our moral obligation. I certainly agree that there is a moral dimension to health care. It is absolutely shameful that we have the richest nation on earth, and yet are the only first-world nation where money (and/or insurance adjustors) comes between people and their lives.

Conservatives have always been sensitive about the morality issue, because in advocating small(er) government, their position ends up looking something like social Darwinism: the rich, talented, and well-connected survive and prosper, while the poor stay poor for generations. So conservative Christians, ever since they joined Republicans in the 70’s, have always had an answer ready: “of course we are concerned about the welfare of other human beings, but we think that it should be the concern of the private sector, not the government.”

I have heard several Christians stick to this same traditional line in response to Obama’s plea for health care. Now, if you oppose government-run health care because it gives the government too large a role in citizen’s lives, fine. I disagree, but at least I can respect that argument. But the moral argument that I just briefly described is quite different. The claim is that the private sector should be compassionate instead of the government.

This argument is as senseless as it is old. Are conservatives afraid that the government will ‘take their business’? That if health care is free they will run out of sick people to visit? I just don’t understand. Why is it an ‘either/or’? Why is it either the government’s responsibility or the obligation of churches? This would be a stupid position, were it actually the position of Christians who are politically liberal. Why can’t it be both the job of the church to provide services and then the government, when necessary. If churches provided free health care for everyone, then I would say, ‘Yes, keep the government out – the private sector is taking care of things.’ But they are not – people are sick and dying and filing for bankruptcy in numbers that should make any true Christian sad. If churches can't be bothered to stop persecuting gay people and instead provide health services for those who can't afford it, perhaps it is the government's turn.

Health Care, Part III: Healthcare and Capitalism

I am a fan of capitalism. A big fan. It is an economic system that can actually create wealth by harnessing talent, intelligence, and hard work, and in the end, everyone experiences the benefits. I like the fact that Wall Street executives get huge, ridiculous bonuses for doing a good job (although what happened recently was an outrage because many executives got enormous bonuses for doing a bad job). If you are good at your job, and your job is important, I have no problem with you getting rich. I like, for instance, that Steve Jobs and Bill Gates have more money than they know what to do with.

However, just because capitalism is appropriate for some situations, we cannot assume that capitalism is appropriate for all situations. Take for instance the health insurance industry. Conservatives are angry because a public health insurance option may put private insurers out of business eventually, and honestly, I think they are right. But so what? What’s so great about health insurance being subjected to capitalism?

Consider this difference: Steve Jobs had to be really smart to start a company that eventually gave us the iPhone. His intelligence, skill and hard work were rewarded by market, and he got rich. Good for him. But why in the world are there rich insurance executives? America is the ONLY country on this earth that has multi-millionaire insurance executives. The average pay for upper-level management is 12 million per year this year. But don’t they deserve their wealth, the way (some) Wall Street executive do?

In a word - NO! Health insurance isn’t chess; it's checkers. You get a certain amount of money coming in each month from premiums – let’s call that x, and you pay out a certain amount each month in claims – let’s call that y. In order to make money, your x has to be higher than your y. So what do you do to make that happen? Well, sometimes it happens naturally, and sometimes you have to deny a certain number of claims. That’s it. Someone please tell me why people deserve 12 million bucks a year for making that happen. Sure, you need a few competent people running your company and you have to have some good accountants, but their intelligence is just not irreplaceable enough to warrant giving them all that money. Capitalism just doesn’t make sense here, the way it does for financial markets, computer design, etc. We should take a cue from the rest of the world: no one needs to become a multi-millionare for figuring out how many claims to pay out.