Midseason Replacement

Earnest Pettie, comedy writer

The Argument For– And Yet Against– Universal Healthcare

It is increasingly clear to me that with regard to universal healthcare in America, there are two camps: people who support universal healthcare and people who are so blinded by their political prejudices that they can’t fathom why we should have it. The problem is that the people who argue against universal healthcare believe that a market-based approach will keep our health insurers honest and competitive. Someone who believes that is someone who doesn’t understand the most basic truth about capitalism and  markets. That is, in a truly free market, profit will always move toward zero as more competitors enter the marketplace and drive prices downward. As we don’t see more competitors or cheaper insurance, we must accept that health insurance isn’t a “free market” and is, in fact, a broken market.

Allow us to take a step back for a moment and assume, for the sake of argument, that the market for health insurance is healthy and vigorous. If that is the case, then every person in America should have access to some form of medical insurance at some price point, correct? The how does one account for the group of people excluded from medical insurance because of the nefarious “preexisting condition?” Preexisting conditions are ailments suffered by patients prior to their application for health insurance that the insurers then use to disqualify the patient from coverage (or if you’re in California, you probably were disqualified AFTER you were already approved!). Should a person who has been sick have to waive his or her access to our medical system? Some states have what are called “High Risk Insurance Pools,” that are open to people who have been disqualified due to preexisting conditions, but those pools are prohibitively expensive. At, a thousand dollars a month, those premiums are just slightly less than the entire yearly salary of our country’s minimum wage employees. Now, given this information, you can either believe that everyone should have access to healthcare, or you can believe that the markets should determine who has access to healthcare, that the companies have a right to determine which people, for whatever reason, deserve to be covered by medical insurance.

So let’s take another step back. We’ll assume that the market for health insurance is competitive and vigorous and is doing a good job, sorting out deserving customers from the undeserving. What happens to those, the miserable, who can’t get health insurance? What should their medical experience in America be? Clearly, most can’t afford just to go see a doctor. If doctors were affordable, we wouldn’t need health insurance to cover the costs of doctors’ visits and healthcare in the first place. Many, however, will see a doctor eventually… in the emergency room, where medical care is probably at its most expensive. Unlike health insurers, emergency rooms are not allowed to turn customers away because we, as a nation, have decided that everyone deserves lifesaving medicine. Someone must bear the cost for the visits of the uninsured to the emergency room. Most likely, it will be you, the insured, thanks to the markets you so cherish. As the costs increase for the hospitals treating the uninsured, they will pass their increased costs on to their patients in higher fees. That cost goes to the insurer who then passes their increased costs on their customers in the form of higher premiums. The profit margin is secured and the patient pays. This isn’t the only way the average person pays for the healthcare of the uninsured, but it’s all we need address now.

So here’s where we are: We have assumed that health care should be governed by a market-based approach, that health care companies should be free to decide who is and isn’t covered under their system, and that those the discarded by the system will have access to medicine in the Emergency Room, at a higher cost, shared by everyone involved in the healthcare system. By accepting all the arguments of the market-based approach to medicine, we have arrived back at universal healthcare– everyone sharing in the cost of medical care for all– albeit a much more expensive and inefficient  approach to healthcare that doesn’t seek prevention of illness– just the treatment of symptoms, after illness.

The fact is that universal healthcare already exists but it is the most expensive implementation of such a system possible. Health insurance premiums are exorbitant and only move up, not down. Everyone pays for the care of the uninsured and uninsurable through tax dollars and health insurance premiums, and they pay for the most expensive care possible since an ER visit is so much more expensive than a regular doctor’s office visit. I think a single-payer approach where the government pays for healthcare through our tax dollars would be the ideal implementation. Given that everyone in America would be covered, the risk presented by the very sick would be offset by the hordes of the healthy, which is how insurance should work and would work if the markets were truly competitive. That is anathema to too many, raised on cold war fears of Communism, to be implemented in America. So, as a compromise, I suggest what is being called “The Public Option.” That is where the health insurance markets remain largely intact, but the government is allowed to offer a health insurance plan that would cover enough people to allow for truly competitive premiums. Ideally, the health insurers would react to the presence of The Public Option by lowering their premiums and insuring more people. That is, after all, how a market-based approach to health insurance should work. Right?


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This entry was posted on March 5, 2009 by in Big Ideas.

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