Health Insurance or Health Care?

The discussion is still about insurance, not health care. Is it the government’s purvey to provide health insurance or provide that government care for the infirm and ill? Traditionally, government did provide for the poor out of humanitarian reasons or out of the need to prevent revolution from the ground up. The funds came from the king and the wealthy. Religious institutions also provided assistance to the poor out of a necessity to prove they practiced what they preached but probably out of a natural human need to care for others.

I am heartened by the Republicans finally coming up with some ideas to reform health care delivery systems. I am disappointed in the Democrats for embracing mandatory insurance as the way to provide better health care for our citizens.

Requiring business to buy health insurance for employees keeps the price jacked up and the whole scheme going. The idea of mandatory insurance for all citizens will also jack the price up. Government price controls are resisted as the public option, which would limit what could be paid for a given medical service, forcing health care providers to rein in costs or services to patients or forcing them to take a pay cut. The debt overload is staggering uphill, so it is suggested commercial debt relief to medical care providers. Exorbitant commercial prices during the boom left medical businesses swamped in building debt in the form of high rents or payments.

These bills our fearless leaders are coming up with contain the idea of mandatory insurance. Our elected leaders deem it necessary to force the people to pay for insurance instead of health care. They also think that insurance companies are better at handling our money than we are.

If this mandatory insurance idea is foisted upon us, I suggest the following be implemented along with mandatory insurance payments:

All health care providers must accept all insurance. No hoity toity, no exclusive treatment salons that do not take Medicare, no ‘private’ clinics that take ‘exclusive’ insurance. If a rich person hires a private doctor for cash payments, that is private enterprise.

All health care providers must accept all insurance because all citizens are required by law to buy insurance. We lose our right to choose, health care providers lose the right to choose who they treat. This means all hospitals, doctors, clinics etc. who accept any insurance have to accept all insurance.

Price fixing between health care providers and insurance companies should be a thing of the past in that prices for procedures will be dictated by the government that requires us to buy insurance. We should not be charged more than what the insurance pays, since so many people with insurance are bankrupted by health care costs. When insurance is mandated, the health care people will earn less since price controls will be instituted.

For the health insurance people, you cannot demand we buy what you are selling without us having some ideas how we want our money managed. Insurance companies must accept controls on pay, number of employees, standards for judging claims, premium price controls and intense oversight. No more golf holidays, spa visits and celebrations of plenty while using premium money to party and gamble.

The domino effect is present here. The strongarm tactic of forcing people to buy insurance creates other hassles. Some of our legislators evidently believe it is easy to force people to buy insurance but in the interests of fairness, the insurance industry and the health care industry will also lose volition. Sure, the insurance companies will have millions more bank accounts to tap into but is it worth the change in our socio-economic structure?

Not one to criticize without offering a solution, here are a few ideas:

The mandatory insurance idea is not free market. Insurance should only be an option, not the only way to achieve affordable health care. Capitalism allows for a variety of approaches, never mandating that one way is the only way. Affordable health care is the real goal, not propping up exorbitant salaries in the insurance and health care arena. As I wrote before, why not use stimulus money to establish low cost clinics in the neighborhoods and to fund nurses in the public schools? Remember, providing health care is the goal.

Health Care Cost Containment

Institutions have lost flexibility, the ability to adapt to changing conditions. The loss of flexibility comes from rules, laws, policies, taxes and regulation. The purposes of these phenomena vary, but range from addressing public health issues to increasing revenue to policing moral failings expressed in destructive business tactics.

The issues of human fragility, a lack of moral attentiveness, or a combative competitive urge towards anarchy has been dealt with by the creation of governments. A government is created at a point in time from then forward must use the system to meet new situations. The familiar situation will be the most easily solvable and the new variant situations will demand creativity and flexibility in order to survive the new conditions. Maintaining moral values must be imperative as the system morphs enough to meet changing conditions.

As a moral imperative to be honest and trustworthy apparently will not define the current moral atmosphere that if it is not defined as illegal then it is all right to proceed, no matter what earlier moral codes would have prohibited such action on the basis of good or evil. This malfunction of the economic system is a demonstration of a lack of adaptation to changing conditions and a failure of moral predictability. An economic system that is posited on the rule of law, growth and cheap resources worked well in the conditions of Manifest Destiny but may not function so well under population and resource buildout conditions.

The basic tenets of free enterprise were developed under frontier expansionism but were soon diluted by regulations within communities. Free enterprise is exactly that: an individual will have freedom to open a business using their property for that business, barring some public health concerns. Commercial areas are now long distances from the clients, must maintain huge parking lots and must pay exorbitant rent, pay higher taxes and buy insurance for employees. The small entrepreneur working out of a home is priced out of the market due to the money siphon to government assisted by big business. The recent economic downturn has closed down businesses, the city and county are raising taxes and the unemployment level is climbing. The system is so tied up in revenue enhancement, gigantic loan payments, fees and high taxes, all flexibility is lost.

The subprime scandal is an example of maladaptive behavior that some would view as criminal, as that self serving cynicism appeared to rule human behavior, rather than a well considered morality aimed at the good of society. Some confuse free enterprise with a free for all attitude resulting in personal gain without consideration of the peripheral damage. Free enterprise must have rules like chess in order to function. Eliminating competition through buying politicians to install high government fees and taxes on small businesses is not free enterprise. Competing should be based on quality service and quality goods, not manipulating the environment so no others exist. The current economic environment is regulated into sluggishness and rising unemployment, amid the crisis of confidence created by the subprime scandal.

The fewer choices people have, the less free enterprise functions. Government ordered expenditures from the earnings of citizens in the form of mandatory insurance results in price fixing and high prices plus an unwelcome power grab on the part of those anointed to sell this mandatory insurance that can be cancelled with no refund for you. Forcing citizens to buy insurance will tie up more money into the hands of a few.

So what kind of system do we here have? Private profit and subsidized losses for the financials immersed in the subprime morass? That did not please many citizens, whose losses were ignored as the ‘investments’ went under with the money long gone. The bailouts were disliked and resented at the grassroots as the scandal continued in bonus payments promised through the implementation of a business model that was aimed at selling specific debt derivatives to unwary investors, a goal that had nothing to do with the public good, only a short term profit for a few. And now taxpayer money subsidizes these people as they collect high salaries and ‘bonuses’ earned by bankrupting the company. Of course more regulation became reality as a result of this lack of social responsibility. So we have a system that takes from the taxpayer to give to the financials and insurance companies while also forcing the citizenry to buy services from insurance companies, entrusting them to make payments to our health care providers. We subsidize private sector insurance middlemen as required by law.

Using private enterprise to enforce public policy is contrary to the system of free enterprise. The government should not mandate that the citizenry buy from private enterprise or government. If private enterprise needs more clients, the services they are selling should be competitive, not mandated by the government. Free enterprise begins with the consumer and discretionary income and free choice to buy or not to buy. Free enterprise depends on the consumer having freedom of choice to patronize any given business. If discretionary income is so allotted to mandatory programs, fees and taxes, free enterprise suffers.

So are we a free enterprise society or not? The current health insurance debate seems to leave personal choice out of the picture. Bureaucrats and insurance executives have created a system that requires an ever larger percent of the income in order to function, a trend that is obviously unsustainable. Healthcare costs need to be lowered, tort reform accomplished, and voluntary individual insurance must be instituted in order to give the free enterprise system room to function. Competition among insurance companies for business from a captive audience is not to be confused with competition for individual patronage by a legitimate business serving the needs of the people. Let the healthcare providers compete for the peoples’ business by lowering prices. Allow the money to pay for healthcare to remain in the hands of the people and let the insurance companies and government compete for this business. The costs of health insurance and health care will be more affordable because competition and flexibility will be reinstituted into the system.