"Slarrow" refers to the "slings and arrows of outrageous fortune" from Hamlet's soliloquy. Here are the chronicles of such darts and whatever attempt there may be to take arms against such a sea of troubles.

Location: Ozarks, United States

Friday, August 28, 2009

Couple of Medical Insurance Thoughts

I posted the following as a comment in response to Ron Rosenbaum's piece on PJMedia.

Two factors to keep in mind during all of this, though.

First, whether it’s an insurance company or a government panel, you’re asking other people to pay for either (a) your extended life (or, strictly speaking, your postponed death) or (b) your improved life. If your benefit is coming out of someone else’s hide, they have a legitimate right to have a say in that. I don’t see any way of getting around that. What I think is important, though, is that if that body says no, you have somewhere else to go. Ideally that’s a competing insurance company with whom you can make an independent deal, and if there are legal problems in the way, then let’s address those with medical insurance reform. The concern about government death panels in particular is the prospect of no appeal (the combination of cost-cutting authority with single-payer/public option monopoly that folks fear.) That’s ultimately the impetus behind conservative distrust of liberal universal health care options: that in order to serve everyone, the government must become strong enough to have the power of life and death over all. There’s still no escape from well-intentioned totalitarianism.

Second, contrary to repeated claims, the cost of medical care will not bankrupt the country. We the people always have the option our forebears did: we can do without if we can’t afford it. That will probably mean more suffering and earlier death, but we all owe the world a death anyway. Perhaps we would benefit morally and spiritually from such knowledge, perhaps we would suffer, but it would be in the hands of each of us. What can happen, though, is that the cost of medical care could bankrupt the government, and that can turn our current lives into a misery which we cannot control. Death and taxes are supposed to be the two universals, but I am not eager to see a day in which death is embraced to escape taxes.

A couple more thoughts: there is a tremendous imprecision of terminology that's complicating these issues even more. "Health care" is personal and vast and must be done by the individual who takes care of his own health. That's brushing your teeth and eating right and exercising and all the rest, and some of it may not matter a bit because of genetics. (Incidentally, the only way to really get everyone the "proper" health care, it seems to me, must involve totalitarianism. That's my problem with the competing worldview on "health care".)

"Medical care" is what doctors and nurses and dentists provide. That's where the market forces are ideally working to provide people the services they desire. Each player in that market has costs they have to cover, services they want to consume, and profits they want to make. These folks are typically part of people's lives in three types of situations: (1) as part of individually determined "health care" (like dentist visits every six months), (2) when professional expertise is needed (condition must be diagnosed or treated with resources/skill beyond the layman's level), and (3) in accident/emergency situations that aren't foreseen and require immediate treatment (broken arm, car accident, unexpected heart attack, etc.)

"Medical insurance" is the major tool people use to pay for medical care. First and foremost, I think it needs to be clear that when I use my medical insurance to pay for a procedure, I'm buying a benefit with other people's money. That's what insurance is. (More info about this situation in the next post.) Part of the problem is that medical insurance makes the most sense when applied to categories 2 and 3 of medical care. However, most insurance these days is also used for category 1 types of medical care, and that's where all the structures and rules fall apart. But that's the next post.