Sick of Reform

I know we're all "sick" of the health care debate. I'm "nauseated" every time I think about the healthcare bill passing. Still, I had a couple things to say on the subject. (And these aren't all directed at this particular health care bill)

1. We hear a lot about uninsured Americans. This number fluctuates from forty million to sixty million, which indicates to me that we really have no idea how many uninsured Americans there are. When you break down those numbers, you discover many of the uninsured fall into the following categories: illegal aliens; young, healthy individuals; people who can afford to purchase health insurance but choose not to; and people who qualify for existing assistance programs, like Medicaid, but aren't signed up.

There are probably some people who don't qualify for Medicaid, but also can't afford health insurance, and that's a problem. Here are two things that I think are often overlooked on this insurance point.

 First, not having health insurance doesn't mean you don't get health care. I, myself, purchased health care services without insurance. It's expensive, but doable. True, that's routine care, not serious surgery. But most of these people can purchase a doctors visit if needed.

Second, the comparison always drawn by single-payer advocates is between a free market system that has some people uncovered, and to a government system where everyone gets coverage. But countries that have "single-payer" health care usually have long lines for at least certain kind of tests of treatments. When you're waiting in line, you have less access to health care as a person in the U.S. with no health insurance.

2. Legislating is an ugly process. Everyone is rightly disgusted by the size of the payoffs that senators Landrieu and Nelson got for their states. Now we get to rely on the same institutions to fairly dole out or mandate services and coverages.

3. This particular health care bill mandates that uninsured people either buy coverage or pay a penalty. The bill then prohibits charging disparate premiums to sicker people than to healthier people. The result is that healthy people will subsidize the sick.

That's basically how insurance works in some sense, because it spreads the costs of people who are sick to people who are not. Now, however, insurance companies can hone in on riskier groups and charge them a higher premium. As I understand it, this bill will prohibit that.

One ways to figure out a person's potential need for health care is by age. In other words, insurance companies could charge the elderly more, and the young less. By prohibiting that risk calculation, this bill transfer money from  the young (who are now required to buy coverage) to the elderly. The young are relatively poor, while the elderly are relatively rich. So the bill takes money from the poor and gives it to the rich.

UPDATE: Here is an article making this same point that "community rating" means the healthy will subsidize the unhealthy.