I'm more than a little conflicted on the issue of health care reform. Seldom has an issue presented such a contradiction between my philosophical principles and my actual practical needs.
Philosophically, I'm a free-market kind of guy. I view most government intervention with a fair amount of skepticism. On my purely libertarian principles, I'm rooting for the failure of the health care bills now winding their way through congress. I can't help but think that the bills are going to increase costs for everyone by slapping on new layers of regulations, beaurocracy, and taxes, and actually decrease the amount of health care that gets delivered by creating new paperwork. I don't even need to know that actual details of the bills (since, right now, no one knows the actual details of the bills) to have a gut level instinct that this is going to be a disaster.
Practically, however, I'm keenly aware of how badly the status quo sucks. I would love to quit my job and make a go at living off writing alone. That might seem insane to some; after all, right now, I don't have any future books under contract. But, I have confidence that, when I write books, I can sell them. And, I also think I'd write a LOT more books if I didn't have my current job. And, I've lived my life with at least a modest amount of financial responsibility. When I add up my assets of savings and property, they exceed my debts by a respectable margin. If I add in all future moneys contractually owed from writing (at least seven more checks still owed from foreign sales, plus an open-ended amount from earning out on Bitterwood) I think I could manage most normal expenses, keeping a roof over my head, food in my belly, and clothes on my back.
And then there's health insurance. This is where the dream smacks into a brick wall of reality. I was very, very happy two weeks ago to discover I don't have diabetes. I hadn't had blood work done in a couple of years, and I was worried; both grandfathers were diabetic, my father is diabetic, a younger sister is diabetic, and it just felt certain that the blood work was going to come back with bad news, even though I don't have any symptoms.
Now, as bad as actually having the disease might be, I'm pretty sure I'd have the discipline to manage it. My real fear comes not from the disease, but from the financial consequences: I have friends with diabetes, and those who can get health insurance privately pay dearly for it: $2000 on month for one guy I know. $2000 a month is more than I currently pay for all my bills combined, including my mortgage. If this amount were tax deductible, it would still probably wreck my dream of leaving my job, but at least I'd have a shot. But, of course, private insurance isn't tax deductible--but if your employer provides insurance, they do get a tax deduction, and you pay no taxes on the benefit itself. The system is weighted to provide a strong incentive for people to remain employed by corporations, and a disincentive to work for yourself.
Of course, I do have the choice of not buying health insurance. In an ordinary year, I doubt my health expenses total $1000. My lifetime total medical expenses probably don't exceed $20,000. But, I'm 45. Every year that passes brings the looming promise that one day I will develop something that blows this figure out of the water. Cancer, heart disease, or some severe traumatic accident could wipe out everything I own and then some in a matter of weeks.
It feels fundamentally unfair that an essentially random event like cancer or getting t-boned in my car would would incur a debt greater than the value of my house. It feels equally unfair that the system is rigged so that, if I stay at a job I don't enjoy, I'm protected from this danger for only a few hundred dollars a month, tax free, but if I go it alone, the cost is suddenly ten times greater.
One could argue, accurately, that government regulation has helped create this unfairness. They've designed the tax incentives for employers to provide health care, and have imposed regulations that prevent insurance companies from charging different rates for employer based health care based on risk. If you're a 25 year old vegetarian marathon runner who works for Fedex, you pay the same rates as a 55 year old chain smoking couch potato in the same job. Since they can't legally charge the chain smoking couch potato more under current law regulating employer health care, they wind up charging their customers who aren't protected by regulations; i.e., me, should I choose to live off writing alone.
The reality is, as much as I dread government meddling in the free market, they've already meddled, and the current existing system is a Kafkaesque nightmare. It works for some people; for others its nothing but a drain of finances and energy. It's bad enough to get cancer. But to expect someone on chemo to try to understand the labyrinthine hospital bills that arrive side by side with insurance statements is just cruel.
How do we fix this? Those who tell you there is no problem with our current system are living in a different reality than I am. Those who tell you that the phone book sized bills floating around in various government committees right now are the fix are dreaming.
I think I could reform health care with a series of laws that could be written on 3x5 cards. Vote on each individually, rather than lumping everything together to pass or fall in unison. Target specific problems rather than trying to grab 1/7th of the US economy and attempt to rework it from the ground up.
1. Make private insurance tax deductable. If my employer gets a tax break for providing me coverage, I can't figure out what the argument is that justifies that I shouldn't get the same tax break if I'm self employed.
2. End the practice of rescission of health insurance for unrelated conditions. If you saw the Micheal Moore film "Sicko," you'll know what I'm talking about. It's probably the single most loathesome practice of the insurance industry. You go along for years, believing you have insurance, paying your premiums, and then one day you get cancer. The bills roll in. And, suddenly, your insurance company drops you. It seems they recently reviewed your application and discovered that you didn't report acne treatments you recieved when you were 19 in your medical history, so, sorry, but we're revoking your policy. The insurance company recently pointed out that only about 1% of their customers experience rescission. This is still tens of thousands of people each year, I'm betting that there are no healthy customers among this 1%. Now, I don't think that insurance companies should be open to fraud; there are people who will hide actual expensive conditions, and they should have the right to somehow penalize people who fraudulently apply for care. But, the simple solution here would be that all rescission decisions would have to be made within 90 days of applying for a policy. Let them check you out when you first apply. What's unfair is to keep you as a customer for years, even decades, then drop you the first time you get sick.
3. End the billing disparities between the insured and the uninsured for medical care. I once had a blood test for allergies. I got the bill afterward and discover the test cost SIX THOUSAND DOLLARS! It seems like something a doctor might mention when he orders the test. "We might be able to figure out the source of your sniffles with this simple test," says the doctor. "Great!" says the patient. "Oh, and the test cost six thousand dollars." "You know, my sniffles aren't all that bad," says the patient. However, the test didn't really cost $6000. Since I had insurance, there was a "negotiate rate," and the test actually only cost $1200. Insurance would pay 900, I'd pay 300. I did so, but couldn't help but wonder why a poor guy without insurance was going to be charged 5 times as much. But, this isn't some wierd anomoly: Look at your own bills. There's one rate for the uninsured, and a different one for the insured, and the insured rate is less. The logic baffles me. Why should the same service cost different people different prices? If the test can be provided for $1200 to the insured, it should be provided for $1200 to the uninsured. Am I crazy in thinking this? What am I missing?
Okay, I could probably go on to list at least ten more things that are unfair in our current system, but it's time for me to do some work on an actual novel now. But I know that at least some of my readers consider themselves libertarians, while others are conservatives. Can anyone tell me why the government should do absolutely nothing to reform our current system? Can you explain why these things I'm griping about aren't unfair?