Public or Private Health Insurance

How Do You Fight A Primal Desire?

Recently I've gotten in many heated debates about health insurance and the future of any possible public option which is currently being pushed by President Obama.  The divisiveness of this debate can be seen in Facebook discussions and twitter debates in this new age where the public square is universal.

I'm not going to argue that our system is 'the best' and we shouldn't change it; however I will argue that shifting the burden of providing health insurance from the private to government sector is not a good idea for several reasons which I will irresponsibly list below.  Keep in mind these are all opinions, however I believe they can be substantiated if I had more time to survey the literature regarding them:

1. Government has a greater capacity and tolerance for corruption than corporations and correcting government corruption takes longer and is far less efficient than correcting corruption in the government sector.
2. Corporations inherently have to heed their consumer’s wishes whereas governments do not necessarily have to heed their consumer’s wishes all the time.
3. Finally, there is one inherit flaw in our health 'insurance' system that can't be overcome by government or companies and that is our fear of death.

If the first two arguments upset you then at the very least try to catch the last of my three arguments.

1.  Many people cite health insurance companies as being corrupt and driven by profit rather than compassion.  Obama's plea for a public option in contrast seems to be driven by compassion, citing people who are excluded for pre-existing conditions and the number of people who aren't insured.  I'll give Obama the benefit of the doubt on his emotional angle; however I fear a government solution will be less compassionate over time than corporations.

The big difference between how input is given into a health insurance company and how it is given to government is time.  With a health insurance company one can easily vote against a policy change, price hike, or blatant corruption by taking their money somewhere else.  In the corporate world, the voting cycle is constant and a company can be destroyed in a day by a news report of corruption or nefarious business practices.

With a government plan, if I want the policy to change or to get rid of a member of the management I don’t agree with, I am stuck with either writing letters to my representatives or waiting for the next voting cycle, and that’s IF my vote can directly affect the path the plan takes at all. Politicians only have to worry about pleasing their public during elections. Bush was unbelievably unpopular, but in the year leading up to the election managed to convince the populous that he was the man for the job for a second term. Imagine if that sort of dynamic was true in our health care system. Aside from election seasons, politicians are free to do what they feel is for the common good, and if their personal interest influences them in the slightest bit, their end decision is inherently corrupt.

2. My other big issue behind a government plan is that one has no choice to consume from the government; you are obligated by law to pay taxes and fund the government plan regardless of whether or not you want to consume it.  Also, government institutions don't necessarily have to cater to the American public.  For example, the FCC was created by appointment and began censoring public media despite the 1rst amendment.  It is a very unpopular government entity and there is little the average American can do to fight it aside from taking a case to the Supreme Court, which obviously is a very time consuming process.  Also government officials often appoint people that they agree with over those that are necessarily qualified for the job (just look at FEMA).

Health Insurance companies are run by doctors, lawyers, and economic masterminds who strive to bring the most care for the best price because they want to compete in the market.  There are plenty of things that drive up this cost including malpractice law and the coverage of high-end expensive procedures.  It's not a perfect solution, but that's mainly due to external issues, not the basic idea of a health insurance company.  It certainly doesn't sound romantic to say that the capitalist market will bring the best health insurance plan, but by forcing plans to compete with each other, it can and will achieve that goal.

3. Finally, one thing that I think is being overlooked in this debate is the natural human fear of death.  The one thing that is fairly certain is that if you DO have health insurance you have a much better chance of surviving serious illnesses.  However without health insurance, you're likely going to pay a lot of money out of pocket for very expensive procedures.

If I get terminal cancer, without treatment I'm guaranteed to die and the same can be said for several other diseases and disorders.  The one problem I find is that in the face of certain death people are willing to try very expensive procedures with very low success rates in order to try to beat death.  Sometimes people survive and if someone can afford the cost or can willingly go into debt I'm all for that.  However, the cost in terms of resources, red-tape, and teaching someone to perform these high-end procedures is ENOURMOUS and if a health insurance company wants to cover them, it has to increase prices.  What's worse is that if I have a serious condition and want insurance, the company can't afford not to consider that in their cost structure.  Even if an insurance company was 100% altruistic and made sure they broke even and provided the most competitive price, a person with a pre-existing condition would force that company to raise their rates because they have to account for the cost of whatever procedure the person is desperately trying to use to get healthy again.  For this reason most companies refuse to cover pre-existing conditions because economically they're impossible to account for.

Imagine if, instead of trying desperately to live when terminally ill and spending our final days in the hospital fighting bills, insurance companies, and stressing your family with your condition, people simply spent their final days with their family and friends?  This is what people used to do when death was a familiar thing (back when funerals were held in family homes).  This is not to say we shouldn't try to treat these diseases or study them for a cure; however one should consider their quality of life in their final days if they choose to pursue expensive procedures.  If you have the money or are willing to go into debt then feel free to fight the disease.  However, if you're afraid that you will ONLY end up in debt, or spend months undergoing painful procedures like chemotherapy, you may want to consider spending your final days in your bed surrounded by your family and friends.  Five days with your family for the rest of your life likely outweighs months of stress on yourself and others as you undergo treatment.

This is obviously an easy argument for me to make while I'm healthy in a coffee house with health insurance.  Also, I doubt I could tell a loved one or even a random person suffering from cancer or heart disease to just lay down and die.  The need to survive is primal and it is hard to overcome emotional desires like love and friendship even in the face of terminal disease.  As such I argue that this is an insurmountable issue.  People will always fear death, including myself, and will be willing to undergo great cost, great stress, and even go into debt paying to live another day.  By providing coverage for expensive procedures, health insurance programs make it cheaper to fight these very serious illnesses at the cost of raising their rates and, in that sense, they are far more compassionate than most universal health care plans and will likely be more compassionate than a government health option.

Because of this insurmountable issue I don't see a government plan being any better than a private insurance company in terms of what they will be able to provide.  The major difference is that once a government plan is in place it can overcome competition through taxation and subsidy to keep its costs lower than private insurance plans.  It MUST do so because if it is not the lowest cost option then it is broken because the private sector has achieved better and thus negated the basic mission statement pushed by into this debate that insurance companies can't provide good enough health care.  However, because they can tax and lower their cost at will, we will always be stuck with it even if it isn't efficient.  Because it draws its money from taxes, the health plan has no interest in controlling its business expenses; instead of golden toilet seats and do-nothing positions in government institutions, we'll be spending our money on inflated wages for new do-nothing positions and golden bed-pans.

Government has almost NEVER been able to accomplish anything without waste, incompetence and corruption.  Companies on the other hand have inherited needs to avoid waste, incompetence and corruption because if company A doesn't company B will and be able to provide more affordable health care.  Government health care is not a solution; it's a commitment to our current health care problems.