Health Care We Can Believe In
Contrary to the way it has been couched in the media and elsewhere, the debate going on in Congress tonight is not between ‘pro-health care’ and ‘anti-health care.’ There are a number of accurate and semi-accurate ways of presenting the argument, but that isn’t one of them. People like me who vehemently oppose the plan that will likely pass the House tonight don’t do so because we are ghouls who want children to die, or any of the other things that we are accused of. We do so because we think this plan is horrible and goes about reform in entirely the wrong way.
I concede without significant disagreement that access to health care is a human right. For many years, health care has been one of the few issues where I agree more with the ‘liberals’ than I do with the ‘conservatives.’ But the bill that will probably be heading to the President’s desk tonight is so fundamentally flawed that it will likely do more harm than good, and should be wholly rejected.
There are many reasons for this. First and foremost, I believe in the United States Constitution. Without a Constitutional amendment, health care is not and cannot be a federal issue. If we truly want to make health care available to everybody, it must be done through fifty state-based systems—the same way we have provided public schools to our nation through fifty state-based systems in the absence of an amendment to federalize it. There are a few elements of health care that rightfully fall in the federal purview, but they are things this bill doesn’t even cover! For example, the federal government (under the Interstate Commerce clause) may permit the sale of insurance plans across state lines, which would increase competition and decrease costs.
What else might a real reform plan include?
Well, let’s start with what it can’t include. One major sticking point on the health plan in Congress tonight is that it would provide federal funding for elective abortion, in an extreme deviation from established federal policy. Most of my readers are aware that I consider abortion to be no different than murder, morally speaking, and oppose it vehemently. But let us put aside the moral argument for a moment—we can debate that another day. Let us pretend, for the sake of argument, that an unborn human child—despite its unique human DNA—is just a collection of cells within a woman’s body, and that a woman has a right to do whatever she wishes with those cells. Fine.
Even accepting these arguments, abortion is—in almost all cases—a purely elective procedure. I exclude, of course, cases where the woman’s life is at risk (abortion in this case is, arguably, even a morally acceptable choice). I will even, again for the sake of argument, concede that abortion in cases of rape and incest can be considered a non-elective procedure, though I do personally reject this argument. What is crystal clear and goes without debate is that, excluding these rare cases (a minute percentage), abortion is an elective procedure.
Can anybody explain why an elective procedure, even if it were morally acceptable, should be covered by a national health care plan? Should the plan cover botox, liposuctions, nose jobs, or breast enhancement? Of course not. So why should it cover elective abortion?
It also cannot include a ‘mandate.’ If you and I are all required to obtain health insurance, then it is no longer a right but an obligation. I believe everybody has a right to obtain affordable health insurance; I do not believe anybody has a right to order anybody to purchase it. I have a right to free speech, but the government may not compel me to speak. I have a right to keep and bear arms, but the government may not compel me to buy a gun. I have a right to health care, but the government may not compel me to take advantage of that right.
Finally, it cannot include a so-called ‘public option.’ This is an absolute no-no at the federal level (remember, that whole Constitution thing), but is still a bad idea at the state level too. Look how well the ‘public option’ with our schools has gone: worst schools in the western world. Making health care available to all is great, just like making education available to all was great, but there is dubious value in making crappy health care and crappy education available to all. In fact, a well-architected, private health insurance system with some of the ideas below might end up being a model for fixing our public schools, because the public schools are certainly not a viable model for our health care!
So what would a proper health care plan look like? Here are a few key points that would be included if I were writing a health care reform bill (for Virginia, of course, since it is not a federal issue). In fairness, I’ve stolen many of these ideas from others ;-):
- An End to Employer-Based Insurance: Part of what leads to all these problems is that people’s health insurance is tied to their employment and, as such, is often lost along with a job. Various regulations have made this less of an issue (like, for example, you can now continue your employer insurance at-cost after losing a job), but the reality is that insurance companies aren’t competing for your business; they are competing for your employer’s business! Their plans are targeted at making your employer happy, not you. Instead, health insurance companies should be required to sell directly to their individual/family customers. This would force them to set their prices at a level that individuals/families can afford. Employers may, of course, continue to provide a health insurance voucher as an employment benefit, but could no longer choose your insurance for you.
- Insurance Cannot Be Dropped, Nor Prices Jacked-Up: No health insurance company can drop any customer just because they get sick. Period! If a person/family has made their payments, they are insured and remain insured as long as they continue making their payments. Period. The end. Full stop. Even if they stop making payments, there should be a 60-day grace period before coverage ends. Furthermore, health insurance can’t work like car insurance where your rates skyrocket after a claim. I would require that insurance companies set their rates based not on individual claims but on amalgamated averages computed across their full customer base. Your rate would be the same as others with your age and gender, regardless of how sick or healthy you are in comparison to them.
- Preexisting Conditions (for the previously insured): Preexisting conditions can’t be held against people when they move between insurance companies. Period. The end. Full stop. Nor can they be held against a new-born (or pre-born) child. Period. The end. Full stop. However, a blanket prohibition on considering preexisting conditions altogether would bankrupt the insurance companies and set us back to square one (i.e., no good). If they couldn’t be considered at all, many people would go without insurance until they got sick and then buy a plan. Because they would have gone months, years, or decades without paying into the system, they would reap the benefits without any investment. If everybody did this, the system would collapse overnight.
- Preexisting Conditions (for the previously uninsured): Preexisting conditions would have to be considered in the case of customers who had voluntarily opted-out of health insurance previously (obviously this would not apply for a period of time after the reform plan is passed, to allow the uninsured to become insured at the start). However, this consideration would have a time limit (1 or 2 years), and could not be used to deny coverage of other (non-preexisting) conditions in the mean time. Companies would be required to offer a plan that would cover all conditions, even preexisting, though these could be offered at a [possibly significantly] higher cost. After the time limit expires, their rates would go back down to the standard rates.
- Interstate Insurance Sales: As mentioned earlier, interstate insurance sales would go a long way toward improving the state of health insurance competition. In many states, there are only a small handful of health insurance companies available. Even in the absence of a federal law, I would permit any health insurance companies that met certain minimal quality standards to sell their services in my state. The more companies competing for your business, the more choice you have, and the lower the prices will be.
- Tort Reform: This is another tough one, but it cannot be denied that a large part of the cost of health care in this country is the indirect cost of medical malpractice insurance. Doctors pay their malpractice insurance, then they pass that cost onto the health insurance companies, then the insurance companies pass the cost on to you (or your employer). Malpractice insurance is so costly because physicians are faced with a constant barrage of frivolous lawsuits. This is a difficult problem to fix because, in legitimate cases of medical malpractice, people have to be able to sue. If a doctor cuts off the wrong leg or leaves a piece of medical equipment in your gut, he must be held accountable. However, medicine is an imperfect science—sometimes a doctor makes an honest misjudgment, or, simply, tries his best and fails. Exactly what ‘tort reform’ should do is up for debate, but it’s clear that we need it one way or another.
- Vouchers for the Poor: The poor (the exact definition of ‘the poor’ would have to be worked out) would be eligible for a government voucher that would provide them a certain base level of medical insurance for free, or provide a significant discount for more ‘full featured’ plans. Nobody should ever be put in a position where they seriously can’t afford health insurance; however, people should be mature enough to choose paying for health insurance over paying for, say, cable TV. If they willingly opt-out of health insurance to save money, that’s on them and nobody else bears responsibility for the consequences.
- A ‘Mandate’ For Children: While government has no authority to mandate that any adult purchase insurance, government can and must mandate that parents obtain medical insurance for their children until the age of eighteen. Period. The end. Full stop.
This would be health care we can believe in. The monstrosity that the House of Representatives will likely pass tonight and send on to President Barack Obama (D), however, is something else entirely.