To solve the health care fiasco in the United States, we have to understand actual health care markets and spending; we need to establish foundational principles from which to build health care policies; and, we need to strip health care debates of politics.
Short of paying cash or trading chickens for service, the private health care insurance market has served its customers relatively well. Insurance providers offer medical plans and consumers choose from those plans or not at all. As with all insurance, medical coverage is based on risk. If you live a healthy lifestyle and do not seem to suffer from a history of illness, you would pay lower premiums for your coverage. The opposite is true if you have chosen unhealthy behaviors and activities or if you have a history of some illness. This is the way insurance works and it will not work any other way.
What we have now, whether from Republicans or Democrats, is not health insurance. The private insurance market will cover anyone who can afford it but not with pre-existing conditions. Covering pre-existing conditions is not insurance; it is welfare. It is assurance but not insurance. Failure to admit that reality is causing all sorts of policy problems.
We also should keep in mind the <a href=”https://www.vox.com/the-big-idea/2017/7/12/15955782/health-care-senate-conservative-ideas-universal-catastrophic-coverage” target=”_blank”>realities about health care consumers</a>. Just one percent of the population accounts for 20 percent of all personal health care spending in America. The top five percent of the population accounts for half of all spending, and the top ten percent accounts for 65 percent of all spending. Half of America accounts for only three percent of all health care spending. So think of that: The top ten percent of the population accounts for 65 percent of all health care spending in America. Our focus should be on that top ten percent responsible for most of the spending – and only politics keep us from that focus.
We must strip all health care discussions of politics. In other words, all solutions must be free of partisan politics. We cannot decide for or against any policy just because the other party or our opponent first thinks of it. We have to set aside such pettiness.
We also have to come to some sort of societal agreement over the very nature of health care. For instance, is health care a right – like a human right? If a human right, medical care becomes an egalitarian ideal and every effort must be made to apply that right for everyone. In other words, medical care must be universal and its application covered under any circumstance. But if it is not a human right, what is it?
Conservatives, like me, see health insurance as a commodity, not a human right. We see medical care the same way we see food, shelter and clothing. That said, we do recognize our moral obligation to those in need. If someone needs medical care, we provide it. If health care is a human right, the answer is universal, single-payer, coverage – we would socialize coverage, meaning we would place the cost of everyone on the backs of everyone. At that point our only concern would be to make sure that everyone, even the poor, contributed to the most efficient system possible.
But, if not a human right, then we are tasked with the moral obligation to care for our neighbors. Charity care is the most efficient and wisest use of societal resources to provide care for those in need. But the reality is that not everyone is moral or even feels the need to help their neighbors in need – from volunteer providers to volunteer financial donors – and when we do not step up voluntarily, we can hardly argue when advocates seek government to step in. In other words, we can hardly argue when failure to volunteer turns into compulsory means. That’s the way it works. There are no vacuums in these affairs. Needs will be met one way or another.
So, if you are a conservative, our health care public policy looks like this: First, ensure a free marketplace for medical coverage; second, emphasize charity care to provide for our neighbors in need; third, define the proper scope of an effective public safety net when charity fails or falls short of meeting needs; and fourth, the hardest part, meet all needs because, for one thing, it is our moral obligation and, for another thing, if we don’t, politics will enter the picture and we will end up with what we see going on now in Congress – failure on all counts.