Universal Health Care
Just the words, “universal health care” strike fear into the hearts of many people. Here we go again, big government, huge intractable bureaucracies, poor service, people “lost in the system”. And the ever present question, “Why should healthy people who don’t need medical insurance be forced to pay for it?”
Well, even healthy people have accidents. Everyone gets sick at some time. Eventually, everyone dies.
Lets review the concept of insurance. The purpose of insurance is to spread the financial risk of an event over a larger population and, in case of health care insurance, a longer time. People pay in when they do not have medical expenses and collect when they do. In the long run, premiums have to match expenses. This is a slight simplification but I am trying to write a blog not a book.
If we set a goal of minimizing short term financial risk for everybody, we must include everybody in the coverage pool.
Why not just let people opt in or opt out as they choose? This is supposed to be a free country, right? There are two reasons that won’t work: Some people will not perceive the risk and opt out but need medical care they were not expecting; and, others will opt out because they cannot afford the premiums.
Some will say, “If they weren’t smart enough (or wealthy enough) to buy insurance, let’em die.” But they are a small minority and probably have never actually faced a situation in which someone was condemned to death for purely economic reasons.
Is there a way to make universal coverage workable? I think so. True, the government does a poor job at most things they attempt, therefore, lets keep their role at a minimum. The one thing they are fairly good at is collecting money. Let the federal government collect the premiums for health insurance but create one or more not-for-profit companies to administer the plans. Not everything has to be covered. Preventive health care should be covered because it is cost efficient and catastrophic care should be included. The rest can be left to private insurance companies and paid for by individuals or employers.
Why is this a good idea? Currently, most health care insurance is provided through employers. This means that those not employed by corporations do not fall in a “pool” and have difficulty purchasing insurance even if they have the money. It also means employers that need to attract any but the most minimally skilled workers must deal with the health insurance costs and the accompanying administration. This is one reason employers in the US are hellbent on reducing headcount. Our current lack of universal coverage is hurting the competitiveness of US workers and, I believe, costing us jobs.
Universal coverage will never be perfect – it doesn’t need to be. How effective it is depends on the details. It is time to accept the concept and start working on those details. American needs to become more competitive and this is part of the solution.