The only time I’ve ever been in the same room with Senator Lindsay Graham was in 2017. It was a town hall event at the Columbia Convention Center. I wrote about it in a blog called “‘Healthcare is a right’ and other stupid shit people say at town hall meetings.”
Senator Graham asked how many people in the room wanted Medicare for all and when a number of hands went up, he responded that Medicare doesn’t include prenatal care, so it wouldn’t work for all. As if that put a pin in the universal healthcare conversation.
::facepalm::
We do have a healthcare problem in the United States. No one should say we don’t. So what is the nature of the problem? Can we take it down to first principles and really understand why it costs so much, is inaccessible for so many, and seems skewed in favor of big pharma and insurance companies?
First, let’s talk decoupling. Let’s decouple “healthcare” from “health insurance” because they’re not the same thing.
Healthcare is the services provided by trained individuals from pharmacists to surgeons, nurses, technicians, physicians, therapists, and medical assistants of every skill level. These services are provided by SKILLED workers, people trained in their profession. People certified, licensed, in their profession.
And you are not entitled to their labor. So, no, healthcare is not a right.
Health insurance is the payment mechanism that pools financial resources from willing individuals and redistributes it depending upon the needs of the insured. In a free health insurance market, individuals would have the liberty to select which payment mechanism works best for their family and companies that provide coverage would have the liberty to reject risky participants so they pay out less than they collect.
Insurance companies are businesses providing a service and meeting their stakeholders’ needs. Stakeholders are employees, stockholders, suppliers, and customers. How the company prioritizes those stakeholders is in response to the power each group has. If customers had more choices for health insurance, they might have more say in how the insurance company behaves.
Insurance is tied to employment. This is problematic for two reasons: 1) the insurance company doesn’t have to satisfy individual customers, just the corporate partners they contract with, and 2) employers do what’s best for the whole of the company, not what’s best for each family. During the covid pandemic, we saw how problematic health-insurance-tied-to-employment actually is. What have we done about it since then? Nothing. We just went back to “normal” acting like we hadn’t been confronted with the problem.
So: decouple. Decouple health insurance from health care. Decouple health insurance from employment.
Health care professionals own their own labor and should be allowed to set the rate for it. A free market for healthcare would create competition for all manner of services. It’s commonly called ‘consumer-driven’ or ‘patient-driven’ care in that patients can choose providers based on all the regular market factors, including price. And providers can decide what services to render and what to charge based on their own business model.
Health insurance should be a catastrophic response agent. Big diagnoses like cancer, sudden major injuries, or chronic and terminal illnesses, those need health insurance to offset catastrophic costs. Like car insurance, homeowner’s insurance, boat, renter’s, and liability insurance, we should pay a monthly premium on the gamble that we may need big coverage someday. The insurance company will collect those premiums all while betting we won’t need that coverage.
Not having health insurance should not keep you from receiving care. You don’t expect your car insurance to pay for oil changes and car washes. Health insurance shouldn’t be for regular care payment. Individuals should still pursue preventative care and regular maintenance like physicals. They should still see a general practitioner for colds and flu and other ailments. Pay cash for them. Let the market deliver reasonable care for reasonable rates.
Employers should not be obligated to offer health insurance. If a company policy reduces rates and seems like a good benefit, offer it. If not, let your employees find coverage elsewhere. Retirement, disability coverage, stock purchase, vacation days or paid time off, even annual passes to local theme parks are perks employers use to lure talent. Let each company decide what benefits make the most sense.
Government should not be in the health insurance business. It’s there because when citizens retire (Medicare), or if they are under-employed (Medicaid), there is no insurance for them. Decoupling insurance from employment would fix that. Government insurance distorts the market by setting prices for reimbursement that other insurance companies and providers follow. That distortion is the reason for outrageous and nonsensical pricing.
Healthcare and health insurance markets will provide competitive rates and services and benefits people actually want. But only if we get the government distortion out of them. Decouple. Undo. Remove government from the free exchange of money for services.
Less government is a strange concept for politicians. They’ve been growing government since they got elected and they’ll continue to do so unless we check them. As voters, it’s our job to make them justify the growth.
At that town hall meeting so many years ago, Senator Graham also asked how many people in the room were Democrats. Should it matter? No, it shouldn’t. But we know politics is a team sport. The parties want what they want, and not for themselves but for their stakeholders: donors, corporations, interest groups, and yes, same-team-constituents.
When policies don’t work for everyone, then they don’t work at all.
Let’s do a better job designing healthcare policy, then we won’t have to justify or enforce it, because it will fit and work and people will like it. Then we can move on to the other tough problems and solve them, too.
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Whereas healthcare IS NOT a right, the ability to practice healthcare should be. The ONLY involvement government should have in healthcare (or any industry) would be for issues of contract and fraud.
Agreed, Martin. Government’s primary role should be to protect our rights. That means intervention that goes beyond protecting rights (i.e. subsidies, central planning) is intrusion.
Your argument falls apart the moment you open the Constitution.
You say healthcare cannot be a right because people aren’t entitled to someone else’s labor. The Sixth Amendment guarantees the right to counsel. An indigent person charged with a felony is entitled to an appointed attorney. That attorney provides skilled labor. Recognizing the right means ensuring access to that work… not demanding that lawyers work for free.
The same principle applies to healthcare. Doctors and nurses deserve to be paid AND people deserve access to necessary care.
And they should, because cancer isn’t a consumer preference. A child born with a heart defect hasn’t failed to take personal responsibility. Someone having a stroke cannot comparison-shop from the ambulance. Illness can strike anyone, and access to lifesaving treatment should not depend on their bank balance.
Healthcare ought to be a right because every person has inherent dignity. A society capable of treating someone should not leave them to suffer or die because they cannot afford the bill.
Hi, Don, thanks for the thoughtful response. I’ll disagree about the sixth amendment, as it guarantees the right to obtain counsel – that doesn’t mean for free. It was the Supreme Court in Gideon v. Wainwright that extended it to publicly provided counsel for the indigent. If poor health were a citizen being prosecuted by their government, I might be inclined to agree with your logic. But as poor health is the result of genetics, poor choices, and/or bad luck, I don’t see the government (and thereby taxpayers) as being on the hook to pay for health providers’ skills and expertise.
All that said, I definitely want the sick to be cured and the ill to be cared for. I think business models can solve that problem. Free medical clinics that are supported by communities who voluntarily give their resources to pay providers (we have one in Columbia) and direct primary care where physicians work on a subscription model to provide preventative and basic care are just two examples of better healthcare. I think government restricts markets, protects influential businesses from competition, and that we’re all worse off for its intervention. And that government intervention is paid for through coercion, which to me is a violation of rights.
As for the inherent dignity and society’s responsibility, I won’t disagree. I would never advocate for a system that enables individuals to suffer and die if they cannot afford care. A free market health system would not let that happen. I’m confident providers want to heal people and I want to see a system that makes that as easy and affordable as possible, for everyone. As evidenced by the generous philanthropy we see in our nation, when organizations create value – like healing sick people – they receive support. We don’t need government to facilitate that.