(DISCLAIMER: I have neither read nor fully analyzed this proposal yet. I have no plans to discuss details here, because doing so would require more time, diligence, and research. What this IS about is the state of health care in this country, and why fixing it is going to mean breaking a LOT of eggs (apologies to the late Nikita Khrushcev).
In listening to Sen. Hillary Clinton discuss her new proposal for universal health care coverage, I find myself with more questions than answers. She talks about about leaving what works in place, and fixing only what’s broken. In the end, though, I find it difficult to envision that we’re somehow going to avoid ending up with the equivalent of a dog’s head grafted onto the body of a horse: it promises to be ugly, inefficient, and poorly designed- in short, unworkable. The ultimate question, though, is: CAN IT WORK? Can a system that combines the “best” of private health care insurance with a mandate that all Americans have health care coverage actually function effectively without degrading the quality of coverage and care currently available to Americans? Currently, I find optimism to be in short supply.
In her argument, Clinton falls back on the “insurance companies need to change the way the do business” argument. A nice and reliably populist sentiment, to be sure, but why would this be true? The business of insurance companies is not to provide coverage to Americans- it’s to maximize profit for their shareholders. Sure, we’d all like to think that an insurance company would do the “right” thing for the “right” reasons, but the reality is that covering Americans is merely what these companies do in order to complete their mission- maximizing profit for their investors. Until insurance companies are incentivized to do the “right” thing, exactly NOTHING will change…and why should it? They’ve got a good thing going, and they know it.
In the world of auto insurance, there’s something called SR-22. The short version is that states pool “uninsurable” drivers and then essentially dole them out to insurers. Because a drivers must have liability insurance, companies who want to do business in a particular state agree to accept the risk of taking on drivers who they might otherwise refuse to insure. This is merely the reality of doing business in the world of auto insurance. Health care insurance, however, knows no similar phenomenon, and while instituting this sort of requirement might make sense, there’s the question of who’s going to bear the costs involved? Hint: it’s not going to be shareholders. This means that the people ultimately bearing the cost of insuring the otherwise “uninsurable” will be everyday Americans like you and I, whether through higher taxes or higher premiums. Yeah, I know; like health care insurance isn’t already expensive enough.
Of course, the government could become involved in incentivizing and subsidizing carriers who would be required to take on the “uninsurable”, but that raises a whole other raftload of issues:
1) Brace yourself for accusations of creeping socialism from the Right, most of whom neither recognize nor acknowledge the existence of anything resembling the social contract. Yeah, I know…Rousseau was probably a (&^^%$# socialist, anyway….
2) Will this sort of system create a two-tiered system of care, in which the “haves” enjoy good health care while the “have nots” are shunted off to low-cost, low-quality health care providers? Uh…if memory serves, that’s pretty much what we have now, isn’t it?? Can a society really call itself “fair” and “just” when economic status determines the quality of health care? Oh, wait…that IS exactly what we have now.
3) If the federal government is to be involved in subsidizing and/or incentivizing companies to do the “right thing”, does this mean that yet another level of bureaucracy will be created? Well, yes…because a system large enough to do this requires some level of administration and accountability. Greed and avarice, after all, are universal human values. Otherwise, we’ll end up with a system like our never-ending war in Iraq, in which billions upon billions of dollars simply disappear, never to be heard from again.
4) Right-wingers and devotees of Ayn Rand will resist any system that requires Americans to put out anything to assist those in need. To this way of thinking, those who contribute little should also reap little…which is all fine and good unless you’re the one in poor health and uninsured because you’re unable to work. These folks never see the need for “haves” to assist “have nots”…until they’re the ones who find themselves dependent on the assistance and largess of others. Hypocrisy…the gift that just keeps on giving, eh??
5) Sen. Clinton talks about “insurance reform”, but what incentive does the industry have to “reform”? Why, the industry will argue, should they bear the brunt of a change in the way health care is provided and paid for in this country? Why are they being made the scapegoat for adapting to the system currently in place and doing what they can to maximize value for their shareholders? Isn’t that what business does…and since when does “compassion” and “doing the right thing” contribute ANYTHING to a company’s stock price?
6) You can bet that the health care industry- both providers and insurers- will spare no expense when it comes to propgandizing the American sheeple against ANYTHING that smacks of “reform”. Should you doubt me on this one, simply go back to 1994, when Sen. (then First Lady) Clinton was portrayed as Evil Incarnate. If it will force them to change the way they currently do business, it’s bad and it must be killed off before
Satan Sen. Clinton and her evil minions are allowed to dip into their corporate coffers. After all, if the free market isn’t allowed to be free, how could government possibly improve the situation?
7) Stay tuned for Sen. Clinton’s proposal to be painted as a precursor to a “socialisitic” single-payer system a la Canada, France, or Great Britain. Count on Sen. Clinton’s detractors throwing her 1994 effort to reform health care in her face early and often. You can also count on the fact that none of Sen. Clinton’s detractors will discuss the things that make a single-payer system into an attractive alternative to what we currently have.
8) MICHAEL MOORE!! SiCKO!!! LIBERAL WACKOS!! SOCIALISTS!!! NANNY STATE!!! NEXT, THEY’LL BE AFTER OUR GUNS!!!
I applaud Sen. Clinton for being willing to jump-start this conversation, but I’m not certain that she’s the one in the best position to be moderating this debate. Perhaps if she wasn’t so beholden to insurers and health-care providers, she might enjoy a greater degree of credibility. As things stand now, though, it looks as if she’s trying to straddle both sides of the fence- reforming a system desperately in need of it while not rocking the boat for those who write large checks to her campaign.
Stay tuned; this ought to be an interesting conversation/debate, even though it’s highly unlikely that anything will change substantively. If nothing else, it should be fun to check out the creative ways in which various special interests can demonize Sen. Clinton, eh??