Sometimes it's a good idea, when debating policy, to go back and try to define, as best you can, the exact nature of the problem you are attempting to alleviate. In health care, it seems to me the problem is that most people, most of the time, have a substantial risk, too high to be ignored, of requiring medical care that is so expensive that paying for it out of pocket would ruin their financial life permanently. I should say, my research is old, and may be inaccurate; it's possible that the problem really is that most people regularly<\/i> require more medical care than they can afford, but I hope not. I think if there was no insurance, most people, most years, would be able to pay for what they needed. But some people every year would need far more, and there is no real way to tell who.\n\n
Digression, already:<\/i> This state of affairs is, of course, the inevitable and happy result of medical advances and our national ideals. People who used to die quickly and cheaply are given years or decades of unimaginably expensive life, and not just the people with wealth and power, either. We don't assume that the newest, most beneficial treatments will be kept for the sole benefit of an autocracy, but expect that poor people, too, will get the care they need to stay alive, and will pay for it, too. I don't mean to suggest that there is a real and observable equality of resources in this country, but there is a laudable belief<\/i> in equality of resources, which tends to break down some of the walls around the upper classes. At any rate, the one solution that nobody seems to be seriously arguing for is the one that would be the easiest to implement; letting the middle-classes bleed to death from car crashes and cough their lungs out from pneumonia, so they won't cost so much to keep alive when they come down with something really expensive. End digression.\n\n
Anyway, the way we have managed to distribute health care to the people who require it is a hotchpotch system of private insurance, public assistance and charity. It's kind of a fun system, where nobody really knows what care is available, and what it costs. Still, as I see it, there are three current problems. First, there are a lot of people who, for whatever reason, are uninsured. Some number of these will be bankrupted by their medical needs every year; some number of health care providers will not be paid for their services to these impoverished people. And, of course, because some of these people, logically enough, will take substantial risks with their health (rather than with their financial future), there will be public health hazards involved. I don't want to overestimate this; most of the uninsured are healthy and won't need much, if any, medical care while they are uninsured. But it's a matter of statistics; the larger this group is, the more people within that group that need medical care will be, and the greater the public health risk is. It's likely there is some acceptable size for that group, but however big it is, it remains a problem.\n\n
The second problem is that a lot of people are insured, but can't really afford the insurance they have. They manage to keep paying the premiums (through their employer, usually) at the expense of, oh, fixing the roof, saving for their children's education, buying healthy and fresh food, starting a new business, air-conditioning the house, buying books. I saw in a recent AP article that the \"average\" family policy costs $11,500 a year. At the moment, that money is, for most people, money that their employer is not paying them, rather than money they are paying from their checking account. I'm not sure that makes a difference. And y'all know, Gentle Readers, how much I hate averages. Still, when I think of what ten thousand dollars a year would mean to our household budget, our relatively affluent household's budget, I find it hard to believe that people aren't being squeezed out of some pretty major purchases by that cost.\n\n
The third problem is that there is a group of people who are insured, but who are not getting their money's worth from it, because the care they need is denied or delayed. It's hard for me to tell how big this problem is, because of course their insurance companies are unlikely to keep statistics on this sort of thing. I suspect that it's a big problem, but not quite as big a problem in actuality as it is in the culture. Every case of this (and there certainly are many of them) gets talked about a lot, so everybody knows somebody who was screwed by their insurer somehow. Just by virtue of that, however, the problem of this group is likely to be larger than their actual numbers, because people will perceive their insurance to be less valuable than it is, and be more likely to risk a time without insurance. And, of course, the people in this group, however many of them there are, are either doing without health care or being ruined by the cost, so they might as well be counted as uninsured, as far as public health policy goes.\n\n
So. Having done all of that, if you will kindly wake up and pay attention to this next bit. Everyone? Yes? OK. I'm coming to my point, now. Yes? Do you need some more time? No? OK, here we go:\n\n
Politically and rhetorically, it's very important for our Party and its representatives to face any new proposal with the explicit question of how it will help with the basic problem and (even more important politically) how it will help the three groups I meantion above. I think the paramount issue, from the point of view of persuasion, is the second group, the people who have insurance they can't quite afford. So, when Our Only President suggests his nonsense proposition which he claims would save a typical family a few hundred dollars a year, the Democrats have to go on television (and the floor of the Senate) and say Will this really help the working family who is sweating their health care now? Will this mean more money in your paycheck every other week? Will this keep your employer from increasing your premium? Are you getting off the treadmill, or are we just increasing the speed?<\/i>\n\n
In terms of actual policy, I'd be suspicious of any attempt to make health care cheaper<\/i>, in the aggregate. We could, I suppose, institute some sort of price freeze, but other than that, I think the reason health care is expensive is because health care is expensive<\/i>, and while it doesn't have to be quite as expensive as it is now, it does have to be expensive enough that the main problem, that most people are at risk for incurring more medical expenses than they can ever pay off, will remain. The simplest solution to protecting against that risk is (it seems to me) a inclusive single-payer system, relying on the fact that most people at risk in any given year do not, fortunately, really incur those costs. I'd like to see that argued forcefully, in the national conversation. But it isn't the only way to deal with the risk.\n\n
My point, though, is that any policy proposal that doesn't address the current problems does not actually address the current problems, and it's a good idea to point that out, clearly and in detail. Make it clear that you understand that people are going bankrupt, and that Our Only President's proposal would do nothing at all to help them. Make it clear that people are being squeezed by premium increases that have the same effect as cutting their wages, and that Our Only President's proposal will do very little to help them. And make it clear that people are getting screwed by unscrupulous insurers who went into the business of health care to make a profit out of people's need, and that Our Only President's proposal is a proposal to help those insurers.\n\n\n
Tolerabimus quod tolerare debemus<\/i>,
-Vardibidian.<\/p>\n\n","protected":false},"excerpt":{"rendered":"
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