The harder an industry tries to make you believe it cares deeply about you, the less it does. Health insurers don’t love you. They love your premiums. They want you to pay them, but they don’t want to return the favor. That they suck, however, doesn’t mean the alternative of Medicare for All is necessarily better.
There are three things you need to know about Medicare for all, which in the current debate has come to mean a pure single-payer health insurance system, in which the government provides all coverage, with no role for private insurers.
There are millions of things we need to know, because each of us has different needs and expectations of health insurance, but that would make for an unwieldy discussion. So Paul Krugman simplifies it for us groundlings.
First, single-payer has a lot to recommend it as a way to achieve universal health care. It’s not the only route — every major advanced country besides the United States achieves universal coverage, but many of them get there via regulations and subsidies rather than by relying solely on public insurance. Still, single-payer is clean and simple, and many health economists would support it if we were starting from scratch.
But we aren’t starting from scratch, which is the second thing you need to know. More than half of Americans are covered by private health insurance, mainly through employers.
It’s not that people love their current insurance, but that they know what they’re getting now and have no clue what the theoretical future brings. And not to belabor the obvious, but if employer-paid insurance is eliminated in favor of Medicare for All, will employees get a big raise from the monies that used to be paid for insurance, and which will be taxed from them personally later to pay for the grand new scheme?
Which brings me to the third point: In reality, single-payer won’t happen any time soon. Even if Democrats win in a landslide in 2020, taking control of the Senate as well as the White House, it’s very unlikely that they will have the votes to eliminate private insurance.
This may be true. It may not. It may mean we’ll get some fixes by committee.** While Krugman’s contention that if we were to invent a health care system from scratch today, a single-payer system certainly makes the most theoretical sense. It eliminates the middleman, the health insurers, who take a huge chunk out of our premiums for themselves, such that what we spend and what our health care providers receive don’t match. And needless to say, health insurers (not to mention hospitals and drug companies) don’t feel particularly bad about it.
But the great many personal and economic issues aside, there is a question that is too impolite to ask: What do most of us get for our health insurance dollar? For most of us, the answer is “peace of mind” in case of catastrophic need. Other than that, we don’t get much. If you have health insurance, chances are that you can’t make the deductible and copay, so as to enjoy the niggardly return.
If you have a chronic illness, then it’s not really insurance at all, but a straight out transfer payment. This may well be a worthwhile use of public monies, as no one in this country should suffer for the financial inability to pay for health care, but to what extent?
The problem that’s rarely discussed is whether people are willing to “take a bullet” to pay the cost for health care that never inures to their benefit but covers the cost of other people’s needs? Does this give rise to government telling people not to drink sugary drinks so as not to be obese? After all, it’s got medical ramifications, which we’ll all pay for. And the implications for sex can be enormous, since we’ll be paying for births, or not for births, as the case may be.
The discussion of health insurance is replete with sad stories, and they are, undeniably, sad. But what of your “sadness” working hard to provide your family with food and shoes? Do you believe that taxing the super-wealthy will pay for it, not to mention all the other goodies to be delivered free? Do you trust the government to run a system that could spell life or death?
Some believe. Some don’t. Does it matter, since our private health insurers are so awful and suck so much money out of the system now that government couldn’t be any worse? Or could it? And even if Medicare for All could be run well enough to accept, cost less than what it costs now (at least for most) and come close to fulfilling its promise, would we serve the next ten years riding government designed camels to the hospital?
*Tuesday Talk rules apply.
** As in, “a camel is a horse designed by committee.”