What a public option needs

It occurs to me that a public option for health insurance might attract primarily low-income individuals and families. This might not necessarily be a good thing. While most people may not be entitled to entirely free health insurance — some will have to pay something, according to what they can afford — odds are that the collective premiums won’t be enough to entirely fund the program. As I’ve said before, in the interest of fairness, the premiums for any public health plan should be paid on a sliding scale.

But with mostly those of very modest means signing up, the pool of money will probably be smaller than what’s required to cover the health-care expenses this “group” is likely to incur. And that’s what insurance is all about — pooling money to cover expenses.

For a public plan to even approach cost neutrality, it’s going to have to attract people from across the income spectrum, with people at the higher end willing to pay fair premiums in order to ensure that their less fortunate plan members have equitable coverage.

Ultimately the most sensible approach to health insurance is universal, single-payer. Private insurance companies simply don’t need to be in the equation — not as long as their products leave out so many people. Today private health insurance is the equivalent of a Cadillac, when too many people can only afford a used Chevy.

I don’t think it would hurt us to thoroughly examine the system in France at some point, which seems to be a model for universal health insurance. I’ve heard only good things about it. In the meanwhile, a public option seems to be the best way to bring the uninsured into the system. It will just need broad participation.

Money is no object, except when it is

My personal view about health care for everyone is “Damn the expense — full speed ahead.” What could be more just? But cost does seem to be a problem for some of the less compassionate policy makers in Congress. So let’s revisit the issue.

There are figures being bandied about — two trillion, one trillion, something in between. This makes it sound as if we’d have to spend this much new money to cover everyone fairly. It’s not so. For this to be true, you would have to assume that no money is currently being spent on health insurance.

I don’t know how much, but I’m not going to bother doing the research. There are plenty of congressional aides with decent salaries who could do that. But we have a general idea of where the money comes from.

Most probably comes from employers, in the form of premiums paid to private insurers as benefits for their employees.

Some comes from individuals who pay premiums for their own insurance.

Much comes from the government, which means you and me — either from Medicare deductions or from general tax revenues.

My feeling is that it’s an awful lot of money — enough, probably, to cover everyone if it were spent more efficiently.

What is insurance but a pool of money into which people contribute to cover potential expenses or losses they might incur? Doesn’t group insurance spread the risk? Isn’t a large group more cost-effective than a small one? Doesn’t it make sense to ensure that all the money in the pool is dedicated to its purpose? Does it make sense that some of the money is removed from the pool to provide profit for those who create the pool?

Don’t get me wrong. I have nothing against profit. I want GM to make a lot of money again someday. I don’t mind if some of my money goes to GM shareholders when I buy a car. But health care is not a Chevrolet. My life, health, and well being doesn’t hinge on owning a new car.

We spend a lot more money per person on health insurance in the US than any other industrialized nation, yet we leave about 50 million uninsured. And those who are insured often have their claims denied, or treatment prohibited, because the insurance simply doesn’t cover it. How wrong is that?

I don’t want to get into too many details about how to go about using all the money we spend on health care more efficiently, but I’ll say one thing: I’m willing to bet that most employers wouldn’t mind not having to worry about providing insurance to their employees. They could give said employees decent raises instead, which would help cover whatever tax increase they’d face for a single-payer, government-administered system. Meanwhile, people would pay their premiums in the form of taxes on a sliding scale, which would be calculated to ensure that everyone was covered. Everyone. Your insurance card would be your social-security card. The poorest of the poor would be entitled to the same coverage as the richest of the rich.

I understand political reality. I also understand that too many policy makers just don’t give a damn about people. I doubt if I’ll live to see a fair and equitable health-care system in the US. But I hope my son does.