Health Care: A Philosophical Approach
Health care has been on my mind lately. Renewal time comes shortly, and there’s no little bit of anxiety about: (a) pricing, (b) availability, and (c) just plain getting onto the flipping website. (Tell me I shouldn’t think the site might just crash, right about the time when tens of millions of people—like me—need it!)
Health care means insurance. Wait. What? Care and payments differ? An insurer’s decision not to pay doesn’t prevent someone from getting health care?
Actually, I know the argument first-hand. And it’s clap-trap, plain and simple! Back in the 1990s I represented a health insurer. People sued, claiming that when the insurer failed to pre-certify procedures, it deprived them of health care. I never lost one of those cases, but people did not get care they needed. Laws drew a distinction between care and payment, but without payment there was no care, plain and simple!
My mental meanderings, most recently, began on Thursday evening, October, 12, 2017. I read The Great Unraveling when I got home from work. It followed DJT’s announcement that he was stopping cost-sharing reduction (CSR) payments. Which followed, earlier on Thursday, news that association insurance policy regulations may be relaxed. (Association insurance policies? Non-ACA compliant policies which offer cheap premiums and minimal coverage. And shrink the ACA insurance pools.)
CSRs? Association policies? What are we talking about?
Deep down, we’re talking about the social contract. The notion, in today’s lingo, that “we’re all in this together.” The fundamental basis for modern societies, throughout the developed and developing world.
I’m not a philosopher, although I am a member of the South Tucson Philosopher’s Guild, and my GF has an advanced degree in Philosophy. (No, I don’t stay at Holiday Inns, mostly.) Expertise aside, Thomas Hobbes has always captured my imagination for this formulation, in Leviathan, of a world without a political society:
No arts; no letters; no society; and which is worst of all, continual fear and danger of violent death; and the life of man solitary, poor, nasty, brutish, and short.
Health insurance represents the antithesis of what Mr. Hobbes feared. With health insurance people come together, ideally in very large groups, to share the cost of staying alive. In large enough groups, variances—you’re overweight, she exercises, they’ve got genetic disorders—don’t matter. We’re sharing truly, and my patron saint of modern philosophy, Mr. R, says “You’re listening to me. Finally!”
The whole issue I’ve described hit me in the eyes when, last Thursday night, I called an old friend, retired from the world of insurance. Help, I said, I need someone who understands this Obamacare stuff, right after I read about the CSR cancellation and imagined rate increases and market upsets, even for unsubsidized insureds like me. (My friend was in the insurance business, albeit not in health insurance.) He gave me a name the next morning, but on Thursday evening he made a statement I can’t let pass: “Why should you have to pay for maternity insurance?”
I can sooner imagine snow in June in Tucson than I can conjure up another child who carries my genetic matter. But I gladly pay for maternity benefits for three reasons. First, others kicked in when I showed up, 60 years ago, and when my daughter arrived 25 years ago. Second, I pay because I want healthy babies and children among us. Today’s children won’t likely pay for an old fart like me, but they will take care of my daughter and her peers. Finally, if we only have a pool comprised of women who might have children, we likely won’t be able to offer these women and their families affordable health insurance. Insurance only works when some people take out less than others!
My old friend came around, quickly, and by the end of our conversation—maybe to make me happy, or because he’s more open-minded than he once was—he brought up single-payer health care. Positively.
I understand young people not wanting to pay for health insurance. Exactly what, about it, offers anything to a healthy 27-year-old who will never die … he thinks. I blame the 27-year-old only a little. My upset focuses on DJT (and his fellow travelers), whose spines make Silly Putty seem rigid. DJT, tell these young people the deal requires their participation. That, in return for the goodies they’ll get, they have to throw out a few shekels to make the system work. (Yah, yah, I added this paragraph when I was having my Before Bed Bourbon.)
Sadly, one party thinks the clover field is over there, where there’s lot of: No, Fear, and Danger, and many whose lives are solitary, poor, nasty, brutish, and short. The other offers hope, although its messaging and its candidates seem hopelessly out of date.
We’re better than what we’re seeing. Getting. Fussing about. Health care is not hard. The developed world gets 2x outcomes for .5 cost. (For math-challenged readers, we pay 4X the rest of the developed world for our outcomes.)
So how do we effect changes. We vote! Good night!!!