I’ve been reading a lot about healthcare in the U.S. recently and have come up with a few thoughts. First of all, let me tell you that I tend to be fiscally conservative but socially liberal. This makes the U.S. healthcare debate interesting for me because I like the idea of near-universal healthcare but I don’t like the idea of government-run healthcare both for costs and bureaucracy (I majored in Economics, after all…) On top of that, I am in a position where I have a pre-existing condition (almost 5 years in remission!) that makes health insurance either prohibitavely expensive or not available at all to me. On top of that I am a self-employed, small business owner so there’s really no hope of me getting insurance through my business. Let me first talk about what I like about a government health insurance provider:
Size
A government-run program would benefit by having a large pool of people to help offset the costs of caring for the sick. How the system is set up now with private insurers is the pool of insurance-holders is becoming smaller and sicker. See, every time premiums go up a certain amount of *healthy* people leave because their insurance is no longer worth the amount they are paying. This leaves a smaller pool of people left within the system that are either wealthy or so dependent on medical care that they can’t afford NOT to have insurance. This feedback will happen pretty indefinitely until health insurance can only be attained by the very affluent.
Accountability
Private insurance companies have only one goal: to maximize profits to please shareholders. This is crummy for the people being insured because their insurance has an incentive to get out of any health care costs you incur. A government program could be set up to provide care for people regardless of pre-existing conditions, family history, or any number of unavoidable health issues. Again, so long as the pool of people involved is large enough, the system should be sustainable.
What am I concerned about?…
Bureaucracy
I’ve worked for city government so let me tell you something you already know: red-tape in government is extremely stifling. So much money goes towards bureaucracy that costs are typically much higher than in private enterprise. Also, there are so many rigid rules that I imagine a lot of people will fall through the cracks of the system. Long lines and mediocre care are a concern (though I think an avoidable one.)
Politics
Populism and special interests run ramped in Washington and are rarely in the nation’s best interest. On top of that, many politicians get cold feet when having to make tough decisions, even if it’s the right one. That is certainly not the mentality we want in the health care industry (which is ~1/7th of our economy, btw.)
So what do I think will work? I like the idea of health coops because they are accountable to the right people: you, the person paying for health insurance. NOT shareholders who are more concerned with returns on investment. I think if we set up the system correctly, we could shift incentives and have the best of free-market efficiency and government accountability.
Imagine a government health insurance “company” that contracts out the service side of the industry to countless coops throughout the country. You could have coops as small (local church coop) or as large (state of California coop) as you’d like and still take advantage of a nationwide pool. The government could set the minimum insurance rate and each coop could add onto it as they see fit. Maybe you join the “Typists Coop” that has especially good treatment for carpal tunnel syndrome or maybe you join the “Organic, New-Age Coop” that specializes in alternative treatments or maybe you join the “National Gym Coop” that specializes in preventative care and gives discounted gym memberships. Whatever niche you’re apart of, there would be a coop for you (in theory). Had a bad experience with coop A? Sign up for coop B tomorrow without any hassle since they are all under the government umbrella. The only thing the government would be in charge of would be to provide start-up money and ensure that all coops are following whatever guidelines the government sets forth.
Those are my thoughts, any how.
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