The recent republican healthcare debacle has had me thinking about my views on healthcare - what it should look like, and how it should work.
As always. I think I am somewhere in the middle.
No child should have to go without basic healthcare.
That just seems basic, common sense to me. How could semi-civilized human being refuse basic care for a child, just because his parents decided to spend their money foolishly? Or abandoned said child altogether?
From an economic perspective, a few dollars of prevention now could save thousands of dollars later. So at least for children, universal healthcare seems like a no-brainer.
But what about the rest of healthcare? Certainly it would seem there are some places for cost savings. imagine if victims of automobile accidents were covered by a universal plan. Considerable savings could be found in avoiding all the legal back and forth that goes on in our current system. We would pay for the cost of recovery from the accident, instead of that AND the salaries of the several lawyers involved AND the bevy of insurance claim handlers AND the extra "pain and suffering" damages that are frequently awarded AND...
What about terminal diseases? Or Chronic illness? Those are just plain expensive. Those are what insurance was really about, back on the 'good old days'. Everyone paid into a community chest, just in case. The money was then available for the poor unlucky soul (That is a lottery you really don't want to win). In theory one much larger pot would be more efficient and effective than lots of little ones, right?
But... What if someone gets emphysema as a result of chain-smoking in spite of all the health warnings? What if someone gets diabetes and a flood of related illness because he just flat-out refused to stop drinking 64 oz. of mountain dew and inhaling a box of Twinkies every day? Is it really fair to those who try to take care of themselves, that they have to pay in more than is actually necessary because of members of the population who don't take precautions?
I suppose you could try going all New York and ban every potentially harmful substance ($114 Billion annually for alcohol related accidents based on numbers from 2000. You ready to try prohibition again?)
What about coverage for abortion? Birth control? No matter where you draw that line you are going to make some group very unhappy, and infringe on someone's religious/civil rights.
What about cosmetic surgery? Breast implants, or I understand calf implants are the rage among men. No? What about in the case of breast cancer? What about those born with disfigurements? How "disfigured"?
What about ageing?
The problem with paying for healthcare, it can consume essentially as much money as you are willing to give it. It has an infinitely large appetite. And we are getting better and better and keeping a corpse mostly alive. Sooner or later, you have to start drawing lines - some of those lines people will draw for themselves, based on quality of life, some don't want to be a financial burden to their kids. Others, well.... Who do you want making that decision for you? Obama? Trump? Whoever the next guy happens to be?
I'm inclined to think there are some aspects of healthcare which are a easy yes for a universal system. Preventative care, Child healthcare. Emergency care (Though perhaps in the case of self inflicted due to crime or blatant stupidity, they would be required to reimburse).
Others are less clear, and perhaps would be better served by old fashioned insurance, or voluntary, charitable contributions.
But, even though I am inclined toward socialized care for some things, I still have one concern which gives me considerable hesitation.
That concern is the money. Specifically, who manages it? Consider for a moment our Social Security system. It is meant to be a safety net for retirement. It is in trouble, in part because the old are living longer and the supply of young is slowing. It is also in trouble because the government keeps raiding those funds to use for... other projects.
Healthcare is a REALLY big number. A number from which literally millions of dollars a year could get lost as rounding errors (I have enough experience with large corporations to know that this is not an exaggeration). In 2011 I wrote a post titled "A Case For a King". I think it applies. When I consider the kinds of things well meaning people have demonstrated they are willing to do for the sake of "The greater good"... (let me refer you to "The Lucifer Effect", "Edward Snowden", "MKUltra" as a bit of reading material.)
The problem with things like money and power, the more you give up, the harder it is to reclaim them. And sooner or later someone will end up in charge, that you don't want there....
That said. I am still on board with the idea of socializing certain aspects of healthcare. So long as it is a separate accounting book, fully exposed to the public, with crowdsourced/consensus management.
Then insurance can go back to covering the outlier issues, with different rates and solutions based on individual risk and personal preferences and needs. With government regulation of this insurance limited to basic fair business practices and anti-monopolistic behaviors (possibly some reigning in of excessive litigiousness?). It seems to me that would help considerably with cost of basic care, while maintaining a relatively high degree of choice, flexibility, and freedom.