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Back in the late 1600s, people noticed that houses sometimes caught on fire and burned down. This sometimes even spread to nearby houses and destroyed a great deal of property and killed or injured a number of people. At the time, the best defense was forming a little community bucket brigade to pass water from one person to the next and throw it on the fire. But then someone had a great idea: form a permanent organization whose job it would be to put out fires. How do you pay for such a thing? Private fire insurance. How well did that work? Well, like an HMO, it was better than nothing.
If your house was on fire, you or your neighbors made an effort to contact the fire company that was displayed on the front of your house. That company—not the nearest company—came to put out the fire. Of course, if you couldn’t afford a fire company, your house burned down—sometimes with the firemen standing around, waiting for you to come up with some cash. And maybe your house’s fire would spread to your neighbor’s house, in which case, the fire brigade would put out his house but not yours, if his insurance was paid up.
By about the time of the Civil War, people pretty much agreed that privately funding various fire brigades was foolish. So local governments began to fund a municipal fire department. Suddenly, no matter who you were, no matter how much money you had, if your house was on fire, the nearest local fire department came to put it out, no questions asked. We all agree that this is the most sensible option for the same reason that we all agree that we don’t want to pay a private “police company” to investigate any crimes against us.
“I’m sorry, Mrs. Lunchbucket. Your policy covers you for a burglary investigation, but not for a murder investigation, and that’s really what you’ve got here. Now, if you had hidden your husband’s corpse before calling us, then we’d at least be able to try to find your TV.”
It turns out that, the more people who are covered by a risk-based social program, the more efficient it is. The most people of all is “everybody.” If everybody is covered automatically, risk is spread evenly across the whole population of the country. Better still, precious time and money aren’t wasted figuring out if policies are up to date or if the right company has been called. If there is a fire, the nearest firefighters arrive and put out the fire, no charge. And they can do it cheaply overall, because they don’t need to make a profit on the venture and everyone’s taxes are used to pay them—not just the subset of people who have decided they can afford it. And people with “pre-existing conditions” don’t get locked out because they’ll hurt the profit margin.
Today, we have private health insurance that is very similar to antiquated private fire insurance. It’s only a little over 100 years old, for one thing (compared to over 300 years for fire insurance). For another, we all need it but not all of us can afford it. And sometimes one person’s health problem can spread to their neighbors and coworkers when it isn’t treated.
“It will be more expensive!”
Conservatives try to argue that a national health care system would be inefficient. But a national health care system would ensure health care for everyone thru a social network just like private insurance does. Instead of a huge insurance company having 30 million policy-holders, a national system would have 300 million policy holders. As with fire department costs, that spreads the risk even more broadly and makes the system more efficient and predictable. And, like fire departments, instead of needing to make a quarterly profit, it would operate at cost, keeping costs as low as possible.
Keep in mind, too, that conservatives like to argue that the poorest of poor people already get free health care by going to an emergency room for treatment and simply being unable to pay for it. But this raises costs for the hospital, which passes it along to paying patients, which means it just gets folded into your insurance premiums. So, in that respect, insured people are already funding health care for the poorest of uninsured people—they’re merely doing it in the least efficient way possible. If those people were covered in the first place, they could get low-cost preventative health care, which would mean they wouldn’t end up in an emergency room with a high-cost problem later.
So, yes, covering “pre-existing conditions” and destitute and low-income people who can’t pay into the system would raise costs. But the absence of profit motive, increase in the coverage pool size, and the advantages of preventative health care offset that.
“Social programs are socialism!”
No sane person wants to get rid of Social Security or Medicaid. But these are social programs that are antithetical to the lunatic free-market utopia of conservatives. These are people who seem to wish they could live in a world where dumb people—and people of ethnic varieties they don’t like—starve to death because they can’t get work, and orphan children work in factories because, hey, there’s no free lunch.
Our government is there to benefit the people of the nation in whatever way is practical. We elect people to lead us to safety and prosperity.
But can it really be that what works for fire and police services could work for medical services? It does—in numerous developed countries around the world. Australia, Canada, Great Britain, France, Germany, Japan, Denmark, Norway, Sweden, and many others all have national health care systems that their people would never part with. Better still, these government-run systems are responsive to their constituents, so when wait times for hip replacements start to get long, the right people gets thousands of demands to fix it. And each of those systems only serves a few tens of millions of people—about the size of one big insurance company in the US. America has the benefit of having an insurance pool of 300 million.
Canadian doctors boast that their lives are far easier under their universal health care system. They have a small staff, and they don’t have to argue with an insurance company over what care is appropriate and covered. Everybody knows the rules, there’s only one set of them, and doctors lobby the government as an organization to get the rules changed when necessary.
We don’t have to use Canada’s model, of course. We have several excellent models to choose from, ranging from government-mandated private insurance with a small percentage of government benefits to 100% government-funded medical services, where doctors are actually employed by the federal government. President Obama’s plan would be on the conservative side, probably more conservative and free-market than any other developed country.
But it would ensure that, if you or anyone you love gets sick or injured, adequate health care is guaranteed.
This will work. And it very likely will get passed now. And, five years from now, when the kinks are worked out, we’ll all wonder what the big deal was.