Healthcare / health insurance in the US is so disordered right now that no matter what they do in Washington, it’s not going to help, and my Patient Husband pointed out why.
(To be fair, he said he read this somewhere, but it resonated.)
The point where health insurance in the US became disordered was in the 1950s when Congress offered tax incentives to employers who offered health insurance to their employees. Think about that: if you’re like me, an American under the age of about 50, you assume your heath insurance comes through your employer. But there’s no reason it has to be that why, and apparently this is how that situation came to be.
Once employers were the ones purchasing health insurance, rather than individual payers, the insurance companies could drive up prices. They could offer fewer services and the members couldn’t react. Once the prices went up, the doctors and hospitals knew they could charge more too.
You’d see the same thing happening if you had offered employers a tax incentive to provide their employees a car. Prices of cars would escalate into the hundreds of thousands of dollars because corporations could buy in bulk; the unemployed would have no cars; the DMV would be administered through the human resources department. Drivers licenses would be given to those with proof of employment. Cars would only be offered in two or three colors and with a couple of option packages. Thus the marriage of two things never meant to go together.
If this is right, then the way to salvage health insurance would be to remove the employer connection and throw it open to everyone to buy his own. That would let the free market determine the prices, let the insurance companies develop plans that would meet the needs of the people and be affordable by most of us. The same way we buy cars based on our needs and our wants, we could do the same with health insurance if it were reasonably priced and the plans were geared toward the kinds of things real families needed.
ANd they would have to be reasonably priced or people couldn’t afford them at all. This pre-existing condition nonsense would vanish if you could choose your plan freely: who would opt for that when another company didn’t have that restriction? And if your plan refused coverage of something they said they’d cover just because it was expensive, you’d find another plan. You’d tell your friends and they’d find another plan too.
But because the unions would have a heart attack about this solution (and did, as I understand, oppose single-payer plans) then the chief disorder about our health insurance crisis is going to remain. Nothing Washington does is going to change that.
Cynical? Yes. But realistic? In this case, I think so.