Friday, October 31, 2008

Universal Health Care

On Sally's last visit here, I admitted to being more or less in favor of universal health care in America. I had neck surgery last year, and one thing that I said was that, yes, I might have had to wait longer in Canada or the UK (though it's hard to be sure, of course), but if the only reason I don't have to wait longer here is that other people can't get into line at all, that's not such a good thing. I think we actually were talking about knee surgery, but the principle is the same.

I got mocked for this later, but I stand by it.

Sally asked me if I then see health care as fundamentally different from something like a widescreen TV, which people may also want and not be able to afford? And yes, I do. The reason I do is that the thought of not being able to obtain life-saving (or -extending or significantly -enhancing) care is intolerable to me, while the thought of not being able to buy a Hummer or a yacht or a particularly nice piece of wall art or a house is not.

"Intolerable" really has to be judged relative to overall wealth. I would not bankrupt the country by having us provide universal health care to, say, all of Africa, even though the illnesses and deaths of people there are just as real and pressing. Lines have to be drawn for practical reasons. But when a country can afford to meet a vital and universal need, that will otherwise remain largely unmet, I think it ought to do so.

What about food? Well, on a kind of basic level, the vast majority of Americans seem to be able to obtain sufficient food. We do have food stamps, and I'm in favor of that. I would not actually mind if there was "universal food" - maybe some kind of flat government food allowance that everyone could get - but it doesn't seem like it would add much to what we have now. But I do think the government should act to prevent starvation in a rich country like ours.

Health care is different from food in that it's not a fully predictable flat cost type of thing. The cost varies hugely from person to person. And, unlike food, it can be very expensive even by our standards. (Food is expensive for some people in some places, but even high-quality, high-convenience groceries would cost me less than 5% of my gross income.)

It is difficult to get private insurance, at least for a lot of people. Among those not covered by the companies they work for, generally only the older and sicker actually try to buy private insurance, which means it's bound to cost more. Without being part of a "pool" some people just don't make any sense to insure. (Take my dad, for instance. At age 50 he'd had two heart attacks and had uncontrolled Type II diabetes. He could never have been insured profitably at any cost he could have afforded.)

For an individual, it might make sense to try to get a job that comes with insurance, but there are millions of jobs that don't provide it, and someone has to do those jobs. And I don't think forcing more companies to provide more insurance is a good solution at all.

So, despite the problems involved, I am in favor of some kind of more universal solution run by the government. I don't know how it can best be done, so I hope that Obama, if he's able to do this, has good wonks. (I think he actually does; he seems very pragmatic and reasonable in general.)

Going back to the "Would you really want to have to wait six months or a year for a surgery you needed?" question, although I don't think you should vote exclusively based on what you'd personally prefer, I would personally far prefer to live in Canada or the UK in terms of health care, despite that I've always had good insurance and gotten excellent care so far. And I mean that from a purely selfish perspective.

1 comment:

Debbie said...

I have two problems with universal health insurance. One is that you get rid of many of the advantages of the market system. Even our current insurance system has the same problem. How much do you shop around for the best healing for the buck?

The other problem is that people want the insurance to apply to everything. On the one hand, I really do want everyone who could be greatly helped by cheap things like aspirin and asthma inhalers to be able to get that. But does that mean I want everyone who's 90 years old to get a treatment with a 10% success rate that costs over $1,000,000? No. I'd rather no money went to that, even if the 90-year-old was me and I wasn't ready to die. (I think.) That kind of money could do a lot more good in other ways.

Of course I don't know where to draw the line and it's not fair that some people have expensive diseases or injuries, but that's how I think about it. I don't have good ideas on how to implement my ideas either. Maybe a certain small amount ($100? $500?) could be provided to everyone to spend as they wish or save in a health savings account?

One of the reasons that health insurance is so crazy expensive right now is that a lot more treatments that are expensive exist now (such as AIDS-fighting drugs and heart surgery). I'm not sure what to do about that. Pretending those expensive treatments don't exist doesn't seem right. But paying for anything for everyone is getting awfully difficult.