Patients are not the customer

Number One problem with American health care:  Everyone is spending someone else’s money.  There is no incentive to economize, no cost-benefit calculation.  The pricing mechanism is broken, and has been broken, for decades.  The result is precisely what you would expect:  Unhappy customers, soaring prices, unsustainable trends.

If we want to fix it, we have to put 310 million people in charge of being watchdogs of their health care, on both sides of the equation.  Putting government in charge of it will only exacerbate the problem.

Well, it’s not OUR money, it’s our children’s money:

http://news.investors.com/article/607184/201204100801/obamacare-will-explode-deficits-study-shows.htm

Jeffersonian,

While I wouldn’t necessarily disagree with your first statement, I was under the impression that it was precisely the possibility of government bureaucrats making cost-benefit decisions about what treatment an individual should receive that was behind free market objections to government oversight of health care.

I’m also curious to know how, beyond encouraging prevention over treatment (for which many employers are already providing incentives), how putting people “in charge of being the watchdogs of their health care” can avoid the emergence of tiers of care based on financial ability (not that this isn’t the case under the present system, but sometimes it seems as if proponents of a more pluralistic spectrum of insurance plans believe that this would be health care’s silver bullet). Maybe that’s a necessary price to pay for reform, but if so it should be acknowledged as an unfortunate but unavoidable consequence.

As one who has benefited over the past eight years from a good health insurance plan by virtue of his wife’s employer, I am exceedingly conscious that this care was not the result of conscientious planning on my part. Perhaps, though, at least by your definition, I am part of the problem.

Indeed, Mr. Bonner, that is one primary objection since, of course, the consumer of the health care and his/her wishes are almost entirely factored out of the calculation.  Able and Baker deciding what Conner will receive are almost predestined to get it wrong on either the cost or benefit side, or both.

And what is wrong with tiers of care?  It’s the fatuous declaration that A - there will be only one tier and B - that it will be mandatory that have us in the predicament we’re in.  I invite you to imagine what other commercial fields might look like if we adopted this model.  I daresay they would look a lot like health care today, with massive free rider problems, cost-shifting and an utterly broken price/cost-benefit mechanism.

Health care would look far different, true, under my ideal world.  Individuals would be as versed in it as they are of, say, Facebook, cell phone plans or sitcoms today.  The reason they (and you) are not is that all the decisions are not made by them, but others.  That simply has to change, and health care must become a commodity much like any other.

Jeffersonian,

I suspect that you’re right and that it will become a commodity; perhaps that’s an economic reality with which we now have to live. What I find irritating is that certain people find government “rationing” of health care offensive and yet don’t seem to balk at such “rationing” when it comes from the private sector (just as those on the Left condemn private insurers, but find no difficulty in government bureaucrats behaving in just such a manner). Rationing is either inherently bad or an inevitable consequence of distributing a finite resource.   

But is such commodification something to be welcomed? (as opposed to being grudgingly accepted as another aspect of a fallen world). Surely the fact that we recognize that the Third World must operate with a much more primitive standard of health care than does the First World does not mean that we believe residents of the former somehow to deserve that state of affairs?

To declare health care simply a commodity (and nothing more) says something about our understanding of the value of human life. That might be acceptable in a Libertarian; I wouldn’t regard as desirable in a Christian.

To call a free market for health care “rationing” is to drain the word of all meaning.  By that standard, everything on Earth, short of God’s grace, is rationed. 

And making health care a commodity does say something about our view of human life:  That the labors of a person are not to be confiscated for the ends of another, that a person is not a slave, not a tool to be commanded at bayonet-point.  If you find people using dollars to persuade people to give them health care objectionable and not particularly Christian, what do you think about compelling them to do so under a whip?

I fail to see how a lifetime cap by an insurance company on what it will pay for any one individual is not rationing. That doesn’t mean that the company should refrain from doing so, since it must at the very least balance its books, but it doesn’t make the way it operates inherently better than government-run healthcare (just flawed in a different way).

I have very little faith that the Affordable Health Care Act would have the result desired, but I’m equally unconvinced by what seems to be the proposed free market alternative. There would be much to be said, however, for orthodox Christian churches beginning to establish group insurance schemes grounded less in cost-benefit analysis than in the value of the whole person, and accepting those high risk individuals that most insurance companies are so reluctant to contemplate. If the Obama administration’s scheme is so dangerous, let ACNA (and the NCCB and SBC) begin to make it unnecessary.

Jeffersonian

The cost of modern health care is simply too great for individuals to carry on their own.  The cost must be collectivized in some way or other or there isn’t going to be any modern health care.  So how do you think the cost should be collectivized?

Understand also a couple of facts about my life.  I have a daughter who is uninsurable.  She has been quoted monthly premiums of $1800 with a $10000 deductible.  What is she supposed to do?  I suppose you could tell her “Sucks to be you in our libertarian paradise.”  That isn’t much of an answer. 

I also had a brother-in-law die of brain cancer a few years back.  The very first thing that happened to him in the course of his illness was that he lost his job.  When he lost his job, he lost his health insurance.  He was a University professor at a major state university.  He did everything “right” his whole life, but when he most needed that insurance he found out he didn’t have it.  The typical person reading this thread has no idea how vulnerable he is to financial devastation from just such a circumstance.  So what should my brother-in-law have done - besides die quicker, I mean?  Because a quick death was certainly the economical solution to the problem as any libertarian cost-benefit analysis will tell you.

carl

Its helpful to remember how and why health insurance became a “benefit” instead of income.  Large companies, wanting to keep employees during WWII needed a way to raise income to keep workers, but FDR’s socialism put a cap on salaries.  So, a few biggies used health insurance as a way to do an end run on the wage controls.  The fundamental reason for the destruction of the price mechanism is that people do everything they can to avoid taxes!  This current system favors large established businesses.  Like the minimum wage, it knocks out the bottom rungs on the ladder to financial success.  If individuals could buy health insurance on the open market, and put in their plans what they want, the whole thing would change radically. 
There is, as Jeffersonian points out an “opm” problem.  In the mind 1970’s the federal government spent $80 million on a five year research project.  The question: what’s the effect of co-payments on the choices people make.  Some had a $0 co-pay, others $25, $50, and $95.  And of course, the higher the copay, the less people went to the doctor, the more careful there were about tests and medications and their own health.  There’s a lot more to it, but basically, there’s no incentive for patients to attend to costs in the current system, and without patients asking for prices, and negotiating prices, medicine providers have little motive to match cost to demand. 
This, of course, favors insurance companies.  It guarantees them income, and drives out any possibility of competition.  It’s the essence of crony capitalism—a few companies have a lock on the business.  And Obamacare guarantees them even more customers.  That’s why, despite all of Obama’s accusations against the special interests, those companies gave to his campaign at levels never seen before.

Carl,
Collectivism per se never leads to abundance, but scarcity.  That said, there’s nothing wrong with people joining themselves to any number of voluntary societies to pool their risks.  That’s what people did before health insurance became a way for people to avoid taxes.  And the cost itself has been driven up government programs (medicare and medicaid have a horrible effect on the cost of health care).  The sad reality is, with government so involved in health care, costs are inflated like crazy. 
Then, there’s the assumption that in a free market, people who are going through what your family is and has endured, will be thrown under the bus.  Why?  Will they really be better off if there’s only a handful of insurers who have a lock on the business?  Will they be better off with what Obama himself really wanted—state controlled health care?  Of course not.  Free markets aren’t a libertarian paradise—price controls by the state as a fix life’s problems is utopian. 
Doctors, hospitals, and pharma companies can be charitable.  Their wages are out of control now because of the “opm” effect.  Moreover, we know that as government takes over a “charity” the private, voluntary sector retreats.  Charity supported health care would of course be more humane than government rationing.  Care providers themselves have a better motive to provide good care when its a free exchange rather than a forced transaction.  That’s not “libertarian paradise.” 
And on the tragic situation of your brother-in-law.  You’ve highlighted one of the key reasons why health insurance shouldn’t come through an employer.  It should be something an individual can buy and keep.  This would stop this whole horrible thing of people loosing insurance when they loose a job.  Government regulations and the tax code are the problem here, not freedom.
Unrelated to him, it’s important for individuals to have an incentive to purchase insurance when they are healthy.  This is the “free-rider” problem.  People really do wait to buy insurance until they are sick.  When people know tax payers will bail them out, of course they will be even less responsible.

#7, the differences between rationing and a lifetime benefit cap are many.  Government rationing comes into play at a much lower threshold, for one.  If the treatment you want or need has been deemed inefficient by the central planner, it doesn’t matter if you’ve never been sick a day in your life, your treatment is denied.  Second, under a free market in health care, you’re not debarred from paying for treatment yourself, under a rationing regime you are. 

And I fail to see why you make a distinction between a free market health care system and one where orthodox Christian organizations come together to care for high-risk persons.  In fact, the former is a prerequisite for the latter.  Nothing in a free market system would prevent groups or individuals from setting up exactly those sorts of systems.  In fact, I’d expect that to happen.

#8, I’m sorry to hear of your brother-in-law.  But his case actually makes my point:  His health insurance was bound to his job, not him, because (as #9 correctly points out) of government meddling in the health insurance market.  There is absolutely no reason why individuals and families shouldn’t be purchasing whatever health insurance they want (or eschewing it altogether) as they purchase homeowners, auto or life insurance. 

As for your daughter, I’m not sure what to suggest.  I would think $32,000 (the annual cost of premiums plus dedictable) annually could buy a lot of health care.  Perhaps the Shriners or another religious institution could offer help.  But I don’t see what marching people into coercive contracts has to do with Christian ethics.

Jeffersonian (#11)

It is not a good commercial proposition for an insurance scheme to include someone like Carl’s daughter or brother-in-law.

Employer-based insurance was predicated upon the 1950s assumption that large employers would dominate and the resulting economies of scale of their health insurance programs would take care of the high cost outliers. Outside the federal government - and some parts of the healthcare industry - that has not proved to be the case in the long-term.

Without compulsion how could one expect a regular insurer to take on what is essentially a losing proposition. What economic incentive could there possibly be to insure a high-risk category?

And of course you’re not debarred from paying for treatment for yourself under a free market system . . . but only if you can afford it!

One of the real ironies is that some posters here love to make the British National Health Service a punching bag because it offends their free market sensibilities. Just so you know, there have been private health insurance schemes in Britain since the early 1980s and people frequently get private treatment in order to bypass waiting lists (largely because the NHS tends to privilege acute conditions over chronic). So, notwithstanding the iniquities of central planners, in the Socialistic dystopia that is my mother country, it is still actually possible to obtain private treatment if you have the money to do it. The NHS has its problems and varying standards of care, but then so do heathcare systems across the United States.

Theron Walker✙

Whatever else you want to say about Obama’s health care law, please understand this.  It saved my neck.  The first semester my daughter was in college, she developed some severe health problems.  It got so bad she couldn’t stay in school.  It took three surgeries over almost three years to solve the problem.  So what was the difficulty to my neck?  Before Obama, shouldn’t wouldn’t have been on my insurance past 21 unless she could stay in school.  But she couldn’t stay in school with all her problems.  In order to treat the problems for which she had to leave school, we would have had to return her to school so we could afford to treat her problems.  I as her father have a positive duty to provide care.  My only options would have been:

1) a very fast bankruptcy

2) deny my duty, and leave her as a permanent invalid in chronic pain for the rest of her life.

I agree with much of what you said.  You are right about the basic economics of the situation.  But there remains this hard fact.  Insurance companies of any type operate according to financial incentives.  They all operate according to the same interests.

1.  They will never want to insure those who will never pay in premiums what they will cost in expense.

2.  They will want to remove from their roles all those who develop illnesses that incur high treatment costs - especially when they consider the condition terminal. 

Those are both sound business decisions.  I can’t fault the companies in the abstract for thinking in those terms.  But it amounts to this:  “It is the most cost-effective decision for us to throw you under the bus.  Sorry about that.  You can still take comfort in knowing that many other people will continue to receive good health care from us because of our sound fiduciary practices.”

Against this, you offer charity.  One of my daughter’s surgeries cost upwards of $500,000.  That’s a lot of charity.  Even if you say that medical costs could be halved, you still haven’t got the price into an affordable range.  So then what?  The current system is designed to treat healthy people and keep them healthy.  It is designed to remove people who cost money to someone else’s ledger.  That’s the game everyone plays.  That’s what my sister discovered when the university that gave my brother-in-law tenure chucked him out the door as fast as it could.

carl

A century ago, William Lawrence was able to produce a functioning system for the Church Pension Fund predicated upon “the elements of the strongest moral compulsion under the circumstances” (his words) that is still going strong today.

Can we not therefore begin to ponder how to address a problem that faces clergy and laypeople (within and without the churches) from a structural perspective?
What do those readers more skilled in the mechanics of the market than I, think that a faith-based health insurance scheme should look like?

Carl,
Not long ago, all doctors really did was diagnose problems.  Today, they can heal or at least alleviate what was terminal not long ago.  So, there are new expenses with new treatments.  Obviously, it’s a financial problem to pay for those treatments.  What’s the best way to deal with that issue?  A state controlled health care system creates shortages of care, not abundance.  So, then what?  Back to crony capitalism and infinite demand on the smallest things, adding a third party who gets paid for every physical, every examination for jammed fingers; a system where the AMA has a monopoly on the amount of doctors there are. 
Why on earth is there any law saying who can be on your insurance policy?  Why can’t individuals buy simple catastrophic health insurance and keep it all their days?  Laws that demand that insurers take high risk people drive up costs, and drive healthy people out of the market—further exacerbating the problem of people waiting to get insurance when they are less healthy—driving people into the caring hands of government. 
Costs are an issue in any system, state run or private.  When the state runs it, we’re all on the road to serfdom.  We have more to fear from the state having control over our healthcare than a company that wants to turn a profit. With all these distortions caused by people trying to control what is infinitely complex, it gets worse and worse.  I’d rather put my trust in free people trying to do a good job for their own benefit, augmented by charity, than in government telling people what, when, where, how…  Freedom allocates resources better than control, including to people who are in dire straits.

RE: “I was under the impression that it was precisely the possibility of government bureaucrats making cost-benefit decisions about what treatment an individual should receive that was behind free market objections to government oversight of health care.”

Yikes.  There are so many reasons behind why individuals would be opposed to government oversight of health care that it’s hard to list them all.  I can categorize them into three broad categories: it doesn’t work and causes more massive pain, cost, and denial of health care, it’s immoral, and it’s unConstitutional.

RE: “I’m also curious to know how, beyond encouraging prevention over treatment (for which many employers are already providing incentives), how putting people “in charge of being the watchdogs of their health care” can avoid the emergence of tiers of care based on financial ability . . . “

I’m not sure why this is the big bugaboo that political liberals act as if it is.  After all, there are “tiers of care based on financial ability” for far far far more primal and desperate needs than healthcare, food and shelter to name just two.

The key thing is to make the commodity as cheap and as plenteous as it possibly can be—and the only way to do that is through the free market, which we currently do not have and will have even less of under ObamaCare.  Thus the commodity will be even more expensive and even less plenteous as this year, and the next year, and the next year drag onward.

Once you are able to make a commodity cheap and plenteous, the “tiers” are less important than when the commodity is expensive and rare.

There are so many necessary changes that could bring us closer to cheap and plenteous—most of them have been named before—and none of them that I can think of have been implemented.

—allow the health insurance to follow the person, not the company
—allow individuals to form as many or as few health cooperatives based on any number of criteria that they please
—eliminate mandated coverage of *anything*—allow insurance companies to look at the market and then create policies that serve those markets rather than create policies larded up with stuff that serves very few to none—instantly the costs of those policies plummet
—eliminate the bogus “certificates of need” that deliberately decrease plenty and competition
—institute tort reform
—eliminate the thousands of onerous regulations that force private or individual health services out of business—for instance, physician labs, to name just one of *hundreds* of services that have been driven away from private companies and TO hideously bureaucratic, poorly run, massive hospitals—and to name another for instance, the entirely bogus “ECR” which adds upwards of 100K to private physician’s practices—there are thousands more out there that add infinite amounts of unfunded mandates to the cost of healthcare

I could go on and on and on and on.

Ultimately, none of it matters anyway.  The American people prefer less plenteous, more expensive healthcare as long as the State can force “other people” to pay for it.

Sarah,

My country’s experience with privatization of public utilities doesn’t exactly suggest that it has led to those services becoming more “cheap and plenteous.” That may not have been the primary aim of those promoting privatization but it does at least call into question the assumption governing your analysis.

Parenthetically, it was assumed that privatization of the railways would finally result in the sort of investment in infrastructure that had been neglected in the days of British Rail. In practice, while the price of travel has been steadily rising, infrastructural investment has declined even from the levels observed under public ownership. It makes sense, since the railway companies have investors to satisfy and a largely captive consumer base, but there is no real competition driving down prices, just regional monopolies exercising the same sort of tyranny that is supposedly the preserve of the servile state.         

Of course, this might just prove that the British can’t even get privatization right.

RE: “My country’s experience with privatization of public utilities doesn’t exactly suggest that it has led to those services becoming more “cheap and plenteous.”

“Privatization of public utilities” =/ “the free market.”

Well then what does?

The Thatcher years were celebrated for “rolling back the frontiers of the state.” If you don’t consider Britain in the 1980s to be a paradigmatic example of restoring the market to its rightful place (and privatization was the linchpin of that undertaking) then the “free market” would seem to be an ideal state that can never be attained.

The cost of modern health care is simply too great for individuals to carry on their own.

Turning it over to the government does not reduce the cost.  In fact, due to the inefficiencies of government, it will increase the costs.

What we need is insurance reform:

Patients (not employers) pay insurance companies.
Patients pay doctors.
Insurance companies pay patients.

If the government wants to ensure a certain level of health care is available to all, it should be done directly by the government, not through insurance companies.

Hi Jeremy Bonner—it’s hard for me to conceive of the transportation industry in the UK being a part of the free market when you have the ungodly tax on fuel, to name just *one* horrific government intervention, along with scads of others.

It does no good to attempt to harness the power of markets and competition to make things cheap and plentiful when you tax or regulate competition away and do not serve the actual markets with the actual money to purchase the products/services.

I mean—if the present transportation industry in the UK is your vision of a “free market” for transportation of human beings, then I guess we don’t have much we can talk about regarding free enterprise. The gap in reality and definitions of words is just too great.

“If the government wants to ensure a certain level of health care is available to all, it should be done directly by the government, not through insurance companies.”

Perhaps Jeremy Bonner can tell us of the way GB does it.  NO CABG’s (here, take these pills and go home to die), 4 hospitalizations to get into the queue for a cholecystectomy with a one+ year wait after that, hospitalization with IV antibiotics for ruptured appendix with a 3+ day wait for an OR to get surgery, 6months to 12 wait for joint surgery like knees, ...

It should be quite interesting, actually, to see how its improved since residents I taught spent a year there and came back with eyes rather widely opened.

Sarah (#23),

The point is clarified. Deregulation without tax reform is not true deregulation.

dwstroud (#24)

I never claimed NHS perfection, but if you want to trot out individual cases, we had somebody at an outreach ministry in Pittsburgh not so long ago, who was being denied cancer surgery because they could not afford it. Dramatic anecdotes don’t really make the case one way or the other.

I can only say that my family have used the NHS all their lives and the only instance in which my parents reluctantly - at least in my father’s case since he was and is a high churchman with deeply held ancestral Labour sympathies (though a cultural conservative, so Labour’s recent incarnation holds little appeal for him) - went private was for hip surgery. Perhaps we were lucky in the afflictions we suffered, but I do recall that when I got osteomyelitis at 13, treatment was swift and effective.

I am not calling out individual cases, Jeremy Bonner. I am citing reported because observed systemic practices by the NHS in terms of management of common problems and requesting an update.

I suspect that your father went private because of the anticipated delay in achieving a surgical posting if the information I have by primary observation of two different residents over a year remain correct.

I intended no attack but sought clarification.

As to the last point, very true; the acute is favored over the chronic. If one believes that resources are finite (as I do) then that is a trade-off; if you don’t, then obviously it is reprehensible.

As to systemic failings, I would question whether one can draw definitive conclusions about an entire system based on two professionals’ impressions over the course of a single year. How many hospitals could they have worked in? 

The notion that private and public medicine can’t coexist, however, is clearly untrue in the British case.

#13 - “Without compulsion how could one expect a regular insurer to take on what is essentially a losing proposition.”

Indeed, it’s like an auto insurer taking on a client after he’s had a collision.  That’s why it’s important to get health insurance prior to that moment.

What it comes down to is that everyone wants someone else to pay his bills.  I don’t see that as an ethical position.

And auto insurance is mandatory . . . so now we’ve come full circle.

But none of this solves the very real dilemma that Carl put forward.

Mandatory catastrophic health insurance might address part of the issue, but then you have to define what is catastrophic and what is not - anyone up for that?

Jeffersonian wrote:

Indeed, it’s like an auto insurer taking on a client after he’s had a collision.  That’s why it’s important to get health insurance prior to that moment.

Did you see that subtle assertion of fault?  The auto insurer won’t take the driver who has had a prior accident.  Said driver has proven himself a bad risk by causing an accident.  But my daughter’s conditions are childhood pre-existing conditions that are exclusively genetic in origin.  She didn’t cause them.  She never had the chance to purchase health insurance.  If insurance isn’t attached to a job, she hasn’t a hope in hell of getting it.  So I will repeat my question.  What does she do? 

And it’s not like a free market insurance system will necessarily improve matters.  Consider.  My father could never get life insurance.  He had the misfortune of positioning himself too close to the detonation of a 105mm artillery shell.  (Fired by the American army, ironically enough.)  The concussion of the detonation left a permanent impact on his body.  The insurer didn’t care, of course.  My father was just a bad risk.  It may not have been his fault but the actuarial tables are blind to cause.

This simply reinforces what I said earlier.  The Health Care system is designed to serve the needs of healthy people.  Since almost everyone is healthy almost all the time, most people love their health insurance.  But if you ever develop a serious expensive chronic condition, you better worry.  You have become a cost liability and the insurer will seek to remove that cost to someone else.

carl

RE: “Mandatory catastrophic health insurance might address part of the issue, but then you have to define what is catastrophic and what is not - anyone up for that?”

I think—again—you’re underestimating what a free market does to the insurance industry.  The market can determine what is “catastrophic” and what it wishes to pay for—and fortunately the market is not monolithic as it is now treated—there are thousands of little markets that varieties of companies would choose to serve.

Right now you have a one-size-fits-all industry—with the equivalent of all the rich variety of policies [not healthcare—we’re talking about the health *insurance* industry] that Russian citizens saw of food options back 40 years ago when they entered a Soviet department store.

I’d prefer to have the equivalent of a 21st century American Publix. You can have organic and non-caged chicken—or fatty greasy mashed together fish-like fishsticks.  You can have local farm produce, or frozen orange juice in a can.

That’s *precisely* what would happen if the health insurance industry were allowed to serve free markets. Insurance policies would spring up to serve scads of different groups—the I’m-not-having-sex-baby-free group, the I’m-not-obese-and-I’m-willing-to-step-on-a-scale group, the I’ve-got-one-part-of-my-body-that’s-uninsurable and I’m willing to pay for a special rider group [which would exist], the I’m-otherwise-healthy-but-participate-in-extreme-sports group, the I-had-breast-cancer group, and on.  And on.  And on.  And on.

Companies would specialize in “we’re the healthiest people in the world” markets.  And companies would specialize in “we got a lemon body” markets.  And everything in between.

That’s the nature of free enterprise.  Entrepreneurs see groups of people who have special needs.  And they think “hey, I could do way way better than charge these people 1000/month—AND make money on it too!”

Instead—we continue to have Soviet Fashion Show:
http://www.youtube.com/watch?v=5CaMUfxVJVQ

And auto insurance is mandatory . . . so now we’ve come full circle.

**Liability** is mandatory in most states.  Comprehensive isn’t.  When you get that type of auto insurance, you’re protecting others, not yourself.

Carl’s situation is an ethical dilemma for Christians.  It should not be a legal obligation for anyone.

Did you see that subtle assertion of fault?

It wasn’t an assignation of fault, but one of sequence.  Forcing insurers to issue policies to those with preexisting conditions makes a farce of insurance, as the insurer is no longer hedging your risk, but simply paying your bills as the probability of the covered event is 1.0.

I’m very sorry about your daughter’s condition, Carl, but the fact that it’s not her fault does not place a legal obligation upon others to alleviate it.  Morally, I agree that we Christians should use whatever means we can to do so, but you lose me when you start using force to get what you want.

My daughter isn’t supposed to exist, you see.  She really screws up the neat tidy world of libertarian propositions where everything is supposed to fit the pre-defined syllogism.  There isn’t any rule for her case.  And so people ever so gently, quietly, euphemistically say “It’s unfortunate, but she is acceptable loss.  Her misfortune is the greater good.”  Of course, they don’t use those words.  They say “It’s an ethical dilemma.” Or they list 20,000 pollyanna-ish options possessed in an imaginary future that has no prospect of being realized any time soon.  (“Pay Day Health Insurance!  All you need is your last two mortgage statements and we can put healthcare in your pocket TODAY!”)  But when it comes to answering the more pedestrian concern located at the center of my question, they have absolutely no answer whatsoever.  Well, in fact they do.  They just don’t want to say it out loud.  What does my daughter do?  She goes without.  She suffers.

When you stare into the eyes that beast; when you comprehend what it means to see one of your children facing life locked out of the prospect of healthcare; facing a life of invalidity and chronic pain that cannot be treated because treatment requires insurance and insurance refuses to cover her, then you will understand.

carl

I generally don’t contribute to these, because I don’t live in America.

But I will make two comments:

(a) I am disagreeably surprised at the tone of some of the responses to Carl. I don’t mean that anyone is being rude to him, not at all. But some people seem to think they have given an adequate answer to his point whereas in my view they haven’t come close.

(b) Like the Brits, we in Australia have a national health insurance scheme. I am sorry to report to all the doomsayers that, generally speaking, it works. Yes, you could come up with various anecdotal bad stories about how it hasn’t worked optimally in this case or that case. And yes it goes through bad patches. But it does work.

RE: “But some people seem to think they have given an adequate answer to his point whereas in my view they haven’t come close.”

Hi MichaelA—there’s never an “adequate answer” to individual examples of suffering and woe.

That’s what the political liberals over here know when they wheel out the Birth Control Woman talking about all of her friends with dire diseases who need very expensive medicines which can ONLY be funded through the Federal Government forcing Roman Catholics to fund abortifacients.  That’s what political liberals over here know when they wheel out the small child who, IF the federal government cuts the rate of growth in food stamps at Kids At School Lunches will DIE IN THE STREET.  That’s what political liberals over here know when they wheel out Granny in the wheelchair and the evil conservatives push Granny over the cliff because they’ve decided to allow those under 50 to opt out of Social Security.  That’s what political liberals over here know when they say “my son would have looked like Trayvon” and pop hoodies over their heads.

The “adequate answer” is always to throw up one’s hands and say “oh, okay, alright . . . let’s extract more money from more individual citizens and add it to our bloated Federal government and run it all through the Grand Central Mechanism and force them to pay for the individual suffering . . . do it for the children.”

That’s the Adequate Answer—and a paltry one it is too.

Other than that, there’s not gonna be an Adequate Answer.

One of the problems is ObamaCare does not provide for medical care for everyone.  It attempts to provide ACCESS to medical INSURANCE to HALF the people that don’t have it now.

You still need to pay for the insurance, it won’t be cheap.
You still need to pay deductibles and co-pays, they won’t be cheap.
You still need to find a doctor that will accept the insurance you can afford.
There will still be HALF the people that are not insured now still not insured.

So ObamaCare will still have plenty “eyes of the beast” to look into, I think even more than right now. While at the same time creating expensive layers of bureaucracy and giving the government control on what is covered and what is not covered.  It makes a every flawed system even worse.

I think a free marked based system would be best, we need to find a new way to group people for risk and a safety net of government provided HEALTH CARE (not insurance).

I do not want a government run health care system, but it would be better than a government run insurance system.

I should add, MichaelA, that for a conservative in the US who values individual liberty, the Constitution, private property rights, limited government, and free enterprise, an “adequate answer” even for their own individual tales of woe and suffering [which, shockingly, also exist] is never going to be “hey, let’s turn over another industry to the hands of the Federal government!”

That’s just not an adequate answer from a conservative’s point of view.  They’re always going to end up on the side of conservative values and principles, which they believe to be far more effective, and far more moral, not to mention, in keeping with the Constitution which our officials swear to uphold, in dealing with individual suffering.

My daughter isn’t supposed to exist, you see.  She really screws up the neat tidy world of libertarian propositions where everything is supposed to fit the pre-defined syllogism.  There isn’t any rule for her case.  And so people ever so gently, quietly, euphemistically say “It’s unfortunate, but she is acceptable loss.

It doesn’t screw up anything about the libertarian proposition.  It’s just that you don’t like the answer.  I’m delighted that your daughter is covered and seems to be doing alright.  But when you defiantly say you will use the power of the State to compel others to provide her care, don’t expect any right-thinking person to not push back and call it for what it is:  Blackmail and extortion.

“The “adequate answer” is always to throw up one’s hands and say “oh, okay, alright . . . let’s extract more money from more individual citizens and add it to our bloated Federal government and run it all through the Grand Central Mechanism and force them to pay for the individual suffering . . . do it for the children.””

That is certainly not what I would call an adequate answer, nor what I had in mind when I made the comment. But if that’s the boxes that people think in, then so be it.

Anyway I will leave you chaps to sort it out.

Michael,
You know, I thought the exact opposite.  But I’ll hammer a little harder.
There are some 331 million people in America.  Each one of those people make decisions about their property in infinitely complex ways.  The “libertarian fantasy” is nothing more than accepting that fact.  It is supremely moral to respect the property of others.  That is a virtue based ethic, an approach to life built on God’s Law revealed in Scripture and nature. 
Laws like Obamacare end up being 2500 pages long, and are full of “honest graft” and subsidies, winners and losers, because they are utopian.  All of life’s problems cannot be solved with rules by rulers. In fact, the more complex the rules get, and the more power the rulers have, the more death is sown into the system.  The rules end up serving the rule-makers, rather than the very people they were supposed to help.
Collectivism is the most deadly form of social organization ever known to the human race.  Ever.  It is a Babel project.  The Scriptures are absolutely full of rulers thinking they can control the world, and God bringing down the mighty from their thrones.  That is the stuff of “the beast.”  The Word of God tells me to not steal, murder, bear false witness, commit adultery, covet.  It tells me to love my neighbor as myself.  It doesn’t tell me to get a majority of people together to take other people’s stuff, and call that “charity.” Coerced charity is an oxymoron. 
It seems obvious to me that it takes a great deal of faith to believe an infinite number of decisions can be controlled from on high by experts.  “Socialism in general has a record of failure so blatant that only an intellectual could ignore or evade it.” Thomas Sowell
So here’s my “fantasy.” 
1. Limited government because we need government as people do break the basic moral law; but government needs limits because people don’t turn into angels when they get power.
2. Have some trust in the good will of people who aren’t under the constant control of rulers.  People at least want what’s best for themselves, which involves meeting the needs of others.  People are charitable too—the more so when they aren’t drones in a collective.
And unlike collectivism, liberty has a good track record improving living conditions.

Just for the record, my daughter is 22.  She isn’t a child.  She is a young adult, and she is threatened with exclusion from health care by a health care system that has been systematically designed to exclude her.  Here, let me make the general point that I have made three times now:

The Health Care system is designed to serve the needs of healthy people.

See, that is the real scandal.  The system is designed to privilege those who grow up healthy.  It is designed to reward those who stay healthy.  It is designed to punish those who don’t.  But that’s OK for most people because most people grow up healthy and mostly stay that way through most of their insured lives.  And those who don’t?  Well, they are expendable.  The son of one of my co-workers has leukemia.  He is six, and he is doing pretty good considering.  Yes, he is pretty much screwed as well.

And as long as we are talking about expendable:

But when you defiantly say you will use the power of the State to compel others to provide her care, don’t expect any right-thinking person to not push back and call it for what it is:  Blackmail and extortion.

It makes me wonder.  The state compels hospitals to provide emergency care.  If Bob gets run over by a car, Bob gets taken to the hospital.  The hospital can’t say “Sorry. No insurance, no treatment.”  I assume all right-thinking people will push back and call this what it is: extortion and blackmail.  The specter of Bob being left in the street by the medics might be somewhat embarrassing at first, but there are constitutional liberties to secure. 

carl

Carl,
Actually, I’ve been saying healthcare isn’t “designed” any more than income is “distributed.”  The attempts to make it a controlled “system” are the very thing that causes all kinds on problems.  It’s “I Pencil.” 
And, btw, hospitals and doctors took patients before they were forced to. 
Me personally, I live with high deductibles and co-pays to keep the premium at a minimum for my church.  The tax man treats it as a benefit, but as the employer and employee, I know its income (and I’m grateful to my congregation).  I can do this because Colorado law lets there be business groups of one.  Obamacare will destroy the groups of one.  This will drive up costs to my church, which will effect the church budget, including the salary for our musician, a single mother with a developmentally disabled 20 year old daughter.  Obamacare will wreck the small business of my agent has built.  His business started with just him, and now he employs five people. 
Our policy approach does effect healthcare choices.  I avoid emergency rooms because they cost a fortune.  I haggle with the doctors over treatments and bills and tests, because it comes out of my pocket.  We spent our whole savings on treatments for our son.  It was worth it.  We homeschool, and forego the income my master’s degreed wife could make because he needs it.  It’s worth it.  We’re rebuilding our emergency fund, and just dipped into it to help a family member who cut off all the fingers on his right hand.  It’s worth it.  No “system” afflicted my son, or chopped off my brother in law’s fingers.  It’s life, and I’d rather deal with through personal responsibility and charity; not by creating a Leviathan.

Theron Walker,

If you had told me that the particular issues in USA meant that a state-run healthcare system cannot work, then I wouldn’t have an answer, and wouldn’t try to give one. You live there and know the peculiarities of your own country; I don’t.

But to the extent that your post goes further and tries to claim some sort of universal scriptural warrant for your arguments, in a way that would apply to ALL countries everywhere, then I reject it.  The fact is that we have a health care system in Australia and it works, and scripture says nothing against that.

It seems to me health insurance should be like life insurance.  You should be able to take out a policy on yourself and each of your children at any time at any level.  Regular payments will accrue and perhaps eventually your policy will be worth more than the face value.  But should you die young it will still pay the amount you took it out for.  This is relevant, because everyone dies.  Eventually every insured person cashes in (or his beneficiaries do).  However, unlike life insurance, not everyone uses his/her catastrophic health insurance.  Some will tap into it several times, while others will never use it, leaving a balance that effectively covers other people’s costs.  So in a way it would be more like fire insurance.  Regular medical expenses should be out of pocket. 
The problem with government run programs is they are usually “one size fits all.”  If you have a combination of problems, allergies, or require something out of the norm, forget it.  It simply isn’t allowed.

Michael,
I know nothing about Australia’s government system.  I do know there is a network of doctors in Australia who think its awful.  I do know the general outcome of collectivism, and stand by my Scriptural warrants for liberty over Leviathan.  I also know that power corrupts.  Christians ought to stand for limiting the power of government, as we are able to name sin as sin, unlike utopians.  We also know its universally true that when charity is taken over by government, people everywhere become less charitable.

It makes me wonder.  The state compels hospitals to provide emergency care.  If Bob gets run over by a car, Bob gets taken to the hospital.  The hospital can’t say “Sorry. No insurance, no treatment.”  I assume all right-thinking people will push back and call this what it is: extortion and blackmail.

Yes, it is.  It compels the hospital to provide it even when there is no hope of being compensated for it.  If that isn’t a modern form of slavery, I’m not sure what is.  I don’t expect that you’d appreciate being compelled to provide your labors gratis, Carl, I don’t know why doctors, nurses, pharma manufacturers, equiment makers, etc. should be forced to.  I certainly won’t under threat of force.

Theron Walker, in every country every facet of public life or government is thought to be “awful” by someone. I have grown up with doctors (a mother, sister, aunt and four cousins) so I think I am fairly well informed about the differing shades of medical opinion in Australia. 

What I wrote above was, “The fact is that we have a health care system in Australia and it works, and scripture says nothing against that.” No more, no less.

It compels the hospital to provide it even when there is no hope of being compensated for it.  If that isn’t a modern form of slavery, I’m not sure what is.

Really? Slavery? It used to be called “probono” work and physicians were expected to do some as a matter of course.

SC blu cat lady, Is “expected” and “compelled” the same thing?

Really? Slavery? It used to be called “probono” work and physicians were expected to do some as a matter of course.

And they do.  My mother worked for a heart surgeon who did a lot of pro bono work and wrote off a lot of losses from Medicare and Medicaid patients. 

When you compel someone to work for you without compensation, it’s slavery.