Thursday, August 27, 2009


Surprisingly fat mailsack this morning, raising two very discussable questions.

First, from a debonair conservative gentleman: why put the government into health insurance? Why not simply legalize cross-state competition in the insurance market, and enact tort reform?

My answer is that while the two reforms could be useful, neither will nearly be enough to manage costs and provide more care. While cross-state competition (which I mentioned in this post) would certainly make the industry more competitive and could drive down prices, it would also likely increase a problem already acute in the current system: localities that are difficult or unprofitable to serve could still have one or two large for-profit insurers, and it has been pretty conclusively proven that the insurance industry will shake down communities where there is little competition in the attempt to maximize profits. The only difference for these citizens would be that they'd now be dealing with a much larger corporation, and one unregulated by state law. To see what the possible changes/efficiencies from a plan like this might be, consider insurance costs in extremely large states (since we would essentially, where insurance is concerned, be making the country one big state market) -- for example, this argument by Governor Schwarzenegger that California's health care system is broken, in part because of unstoppably rising costs. That's a big, unified market -- but costs are still out of control, and people are still uninsured, and the state and taxpayers are still footing the bill for insurance industry profits. The Terminator, who is not exactly a socialist, is exactly right when he says that Californians already pay a 'hidden tax' to provide care for the uninsured -- it's just done in the most inefficient, secretive, dehumanizing way possible.

Tort reform, although it could also help control costs, would have an even smaller impact. Several states (and there are conservative thinkers in favor of tort reform that believe that a state solution, instead of a national one, would be best) have made significant strides towards reform, foremost among which is Texas. There are some positive indicators that their reform has helped increase numbers of doctors in the state, and decreased the cost of malpractice insurance, but Texas still has four of the top ten most expensive health care markets in the nation, 25% of its citizens are uninsured, and its costs increased 6.1% in 2007. Maybe, it stands to reason, a combination of a national health insurance market and tort reform would decrease costs, but Texas is a pretty large state, too -- its GDP is the size of Canada's.

Long story short, a national health insurance market and tort reform might both be great, but neither is more than a small and incremental improvement to a system which is methodically and swiftly bankrupting and sickening America. The insurance industry, in my opinion, will allow the passage of both types of reform -- neither is likely to cut into their profits in a significant way, and backing them will make the industry look like it cares about us while it blocks the reform we need -- a government-run health insurance option for all Americans.

That brings me to the other piece of mail that was lodged in my bulging mailsack -- an east-coast liberal contrarian/grammarian who wants to point out the difference between health care and health insurance. The public option is a government provision to provide health insurance -- what we are debating, in most cases, is reform to the national system of health insurance -- basically, who pays for treatment, and not who delivers medical care. I'm roundly guilty of confusing the two, because I think that one of the reasons me and mine have received such poor health care during our young adulthood is because we had completely shoddy, or no health insurance. But he is right that even though health insurance might affect health care, we are actually engaged in a very unsexy movement to ensure equitable and affordable health insurance. "National Health Care" in the Canadian or British sense, where government owns the overwhelming majority of care providers, is not under consideration by either house of Congress and makes up no part of the current debate.

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