The profit motive

Profit is the centerpiece of capitalism, and competition. Profit motivates innovation. Make a better product, sell more products, make more money.

Health insurers, however, don’t make anything. They just provide a place to pool the money they’re paid in the form of premiums so when those insured need money to cover health-care expenses they can draw off enough to cover those expenses. Problem is, insurers don’t want to do this for nothing. Besides covering their overhead, they want to make some money in the process — the more the better. And, in order to increase their profits, they often find excuses not to pay some of those claims. Just as bad, they tend to be selective about who they cover in the first place. People with health problems — IE. those likely to need some of that pooled money — need not apply.

You can’t compare health care to a car. People who can’t afford a Cadillac will make do with something of lower value. They can live without a Cadillac. They can’t live without health care. You can aspire to owning a Cadillac if you want to, but you shouldn’t have to aspire to having health care. I will not argue that everyone has the right to own a luxury car, but I will argue that everyone has a right to health care. Car buyers have choices: if you can’t afford a new Caddy, you almost surely can afford a used Chevy.

Pooling money is the whole idea behind insurance. It’s a community’s way to spread the pain, and spread some comfort. Insofar as health insurance is concerned, people should have the means and the right to pool their money to cover the predictable and unforeseen expenses associated with health care — without having some of that money cleaved off as profit for someone who really doesn’t do much.

This describes the public option. It’s a way for people to pool their money and have it used most efficiently, with all except what’s needed to cover administrative costs going to cover what it’s designed for. Is it socialism? Maybe… but it has nothing to do with Cadillac. For those worried about the collapse of capitalism, let’s separate providing health care from building cars. There will still be plenty of capitalism in this country, and creating a public health insurance system will do nothing to endanger that economic system.

Dumb arguments against health care reform

You hear them all the time. You just have to be able to recognize dumb when you hear it. I plan on updating this post every time I hear new dumb.

Some are suggesting a surtax on soft drinks as one way to help cover the costs of universal care. It’s a good idea, but there’s an ad that says new taxes are the last thing we need at a time like this. BS. Think of the surtax as part of your health-insurance premium. It’s not a tax — it’s an insurance payment without an invoice or a payroll deduction.

My own Democratic senator is running ads that say she supports health-care reform that DOESN’T restrict your right to choose your own doctor. That’s Republican-speak for opposition to a public option — which, in the long run, could spell the end of private insurers. That’s BS too. Medicare and Medicaid patients can see any doctor they want (providing of course the doctor accepts such patients). That still leaves a lot of damn fine doctors from which to choose from — the kind of doctors who care about patients. Many private plans give you a list of “approved” doctors, and if you pick a doctor off the list, you pay more. I’m disappointed in Senator Hagan, who leaves me with the impression that she’s been bought off by the private health-care and drug industries. I think she owes more to Obama than these companies for winning her seat, considering he carried North Carolina.

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.