CC said that it would be preferable for everyone to be in the system (a public option) because that way, healthy and sick, young and old, each would balance out the other thereby making the cost of the insurance more affordable to all. "[That's] what makes an insurance pool work." Exactly right, you need the one to off-set the other. However, the coersive nature of government (id est, government's power to force compliance) makes it dubious insurer. If I can force you to pay for my services, I've nullified the very foundation of a free-market. Where is my incentive to keep my prices low? How long before the public option becomes onerous and used only by those who are sick or cannot afford other options?
I think it's useful to understand the purpose and definition of insurance. I spent some time in the financial sector (I was licensed to sell both securities such as stocks, bonds, mutual funds, and yes, health insurance.) In the definition of "insurance" is the phrase "the transfer of risk." In other words, you the Insured tranfer the risk of your death, auto accident, or medical problem to the Insurer. We can debate the purpose and function of government all day, but I do not think any of us would be particularly comfortable with the notion of tranferring the risk of an entire population's health onto the federal government. That's not a function of government. That's why we have Insurance Companies.
CC zeroes in on a major priority of any health insurance overhaul: cutting costs. I concur, advertising of pharmaceuticals is a problem. It artificially drives up costs. I will add to this with another commonly mentioned cost -- malpractice insurance. This must, must, must be reduced and drastically. There needs to be limits on the awards that plaintiffs receive in court in situations where criminal negligence is not involved. If a doctor misdiagnoses your condition, and has done due diligence, it's unfortunate, but it's reality. Americans need to accept that medicine is not a simple and exact science. The human body is far more complex than a PC, yet no one expects the Geek Squad to buy you a new house if they fail to retrieve your data from a crashed hard disk.
Another point I think needs to be made here in regards to this sense of "entitlement" that I see in Americans. There is a disdain for the fact that rich people can afford better care than can poor people. Americans look at this and immediately say, "That's not fair. Everyone has a right to equal healthcare.
They do? Says who? Where is this written? Under which philosophy of ethics is this implied? As an American, you and I have equal opportunity to be as rich or as healthy as our own individual talents and abilities allow. If you have more money than me, why shouldn't you be allowed to use your lawfully obtained resources to benefit the lives of you and your family? If I do not have the same resources, how is it justified that others be forced to pay for my care? I do not understand this thinking. It's un-American and it's unrealistic. It is that sense of entitlement that has driven our government and our society toward economic unsustainability.
AsterixChaos suggests that costs can be cut by simply cutting off care to those who are beyond helping. Well, I can see the reasoning behind this point, but I do not see it as a major change in our current system. I do not believe that there are masses of doomed people who are artificially being kept alive against their will. In this country, when you say, "That's enough," then that's when your care ends. The only time the state can intercede is when its determined that you're unable to make that choice yourself. And, despite what we may see anecdotally in the news, those cases do not make up much of the overall costs of healthcare.
CC makes a great counter argument, one I agree with, that if we allow our society to become sickly, then we put our country at risk and we become a burden upon ourselves. Well said, CC. In this sense, yes, I see the Federal Government as having a stake in this argument and an interest in promoting "the general welfare." (This, however, is not the case right now, but if it were, certainly the government should act.) Moreover, I believe strongly that the morals and ethics of our country do not allow this policy to be employed. What benefit is there to being a member of a society that denies care to those in need if they have the resources to obtain the care? Beyond this, I believe there should be some nominal "safety net" to care for those who lack these resources.
OK, so let me get to the heart of the matter: What should we do?
Again, the caveat holds true that I mentioned before. I don't claim to know for sure what to do. However, I think each of these points need to be a part of the solution to this pressing problem.
First, costs must come down. Malpractice insurance, advertising of pharmaceuticals, jury awards, outrageous and inequitable hospital charges against different types of patients (depending upon the insurance they carry) and other costs must be examined and addressed. And lowered.
Second, (for those who like Federal Government intervention) Americans need to be taught and "socially engineered" to understand that healthcare starts and ends with prevention. No, you don't get to have a heart transplant if you've spent your life at McDonalds and you weigh 400 pounds. No, you don't get a new liver, Mr. Mantle, if you've spent your life drinking like a fish. If the government wants to intercede in this situation, let's spend money on physical education and getting people healthy. THAT would be a legitimate govnerment interest. Paying for people's problems after the fact is a poor social program that has no end to it. Let's start with this and see how we do before we start re-defining our Constitution and throwing HUGE gobs of money at the problem. Also, let's stop perpetuating the myth that the government will bail you out when you've soiled yourself. God help this generation of Americans.
Third, rather than pumping this mess up to the Federal Government, let's push it down to the communities where we can have some control and some accountability over it. Lets fund and staff local clinics in our towns to intercept the small problems rather than overwhelm our hospital emergency rooms with people who need naught more than an aspirin and a Kleenex. When I smashed my pinky finger with a 4lb hammer as a 17 year old, I went to the local town clinic. A doctor gave me a prescription for a pain killer and stitched up the wounds. I didn't need an ambulance ride and an emergency room visit at the hospital that would have cost ten times as much and would have taken ten times longer to see a doctor. Our baby Benjamin had trouble breathing recently in the middle of the night and we took him to the hospital at 2am. SIX HOURS LATER they finally had a doctor see him. What the hell is that?! If I have to pay another tax, I'd rather it stayed in my town and bought me a local clinic that can care for the needy and provide routine medical procedures (flu shots, bandaging, burns, cuts, etc.) Having trouble paying for it? How about a "Peace Corps" like program that enlists new doctors to serve in such clinics in return for some loan forgiveness?
Fourth, let's listen to our Insurance Companies. Let's see what they can tell us about why costs are so high. They're the ones paying the bills, perhaps they might have something to add to this conversation? (Ya think?) Before I'm going to listen to Sen. Frank Lee Blowhard, the junior senator from Idaho, I'd like to hear what the professionals have to say.
In short, there are a lot more and better ways to fix this mess than for the Federal Government to usurp and entire industry with socialism. Why don't we try a few before we start re-defining the U.S. Constitution?