One subset of the greater healthcare debate

Healthcare has been a topic of discussion — and in many cases strong disagreement — in American political debate for more than eighty years now.  FDR, who profoundly altered the direction of the US economy during his tenure as president, was unable to make headway on healthcare.  LBJ got the first meaningful changes in healthcare thirty years later with Medicare and Medicaid.  Then no meaningful changes until the Patient Protection and Affordable Care Act of 2010 (also known as Obamacare).  

I want to believe that the best analogy to Obamacare, whatever becomes of it, is that of a stepping stone.  A step forward from what we had but not the end solution.   Not unlike, for example, the Don’t Ask Don’t Tell policy towards gays in the military.   While preferable to completely disallowing gays from military service, it still was too small a gesture and was destined to be discontinued.   

It seems to me that, given the current state of debate on health care, the democrats and republicans are trying to appeal to two very different constituencies.   I haven’t seen statistics that demonstrate which constituency is larger but my gut tells me that the group targeted by the blue team is larger.  And I am actually sympathetic to both groups of people.  

At the heart of this divide is the individual mandate provision in the ACA.  Insurance companies recognize that covering pre-existing conditions would be something that will yield more outlays (pretty much by definition) so their choices would be to deny coverage or find something that will increase the money they’re bringing in.   And there are basically two sure  ways of doing that: increase individual premiums or get people who might not need insurance onto their rolls of the insured.  

So the democrats are, generally speaking, in favor of the individual mandate.  People don’t want to lose their healthcare simply because of a pre-existing condition.  This also has the added benefit of driving down premiums for everyone since the health insurers are bringing in more money from everyone required to have it.  

The republicans are against the individual mandate, seeing it as unnecessary government intrusion into people’s day to day affairs.   Outside of the libertarians who would get rid of every piece of government regulation, this is appealing to the young and healthy individuals who, given the choice, wouldn’t have any health insurance at all because they’d perceive it as a drain on their already limited financial resources.  

There may be some room for criticism of the people who don’t want health insurance because of its cost, in that they’re clearly not thinking of a future when they won’t be so young and healthy, but that criticism can definitely wither against the argument that thinking of the long-term future is meaningless if they can’t afford dinner today.  And I’m not unsympathetic to this problem.  

Neither is the ACA, which has provisions to help those who can’t afford health insurance, to buy it.  But these provisions are also problematic because the bar might be too low for qualifying, or other regulations could limit the amount people might be entitled to, in the form of assistance.  And the current White House has shown little interest in making it easier for those people to have quality health insurance.  

So we have two very clearly delineated sides in this debate and the two parties have chosen their sides.  Whichever side emerges on top in this debate, they will rightly continue to have grievances against the other side.  The solution to this problem is both straightforward but fraught with other problems: take the mechanism for paying for health care out of the hands of the individuals and insurance companies by incorporating it into the tax structure (not unlike the disposal of garbage in many municipalities).   That’s what they do in Canada, France, England, and many other countries…

Before we do that, though, how many jobs would be lost in such a massive disruption of an industry as large as health care?   Most hospitals employ more administrators than nurses, after all, because they’re needed for dealing with the insurance companies.  


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