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Healthcare 101: Part II

In yesterday's Healthcare Part I post I wrote about the basic factors that create the need for an individual mandate if you want to have a functioning private insurance market; particularly one that doesn't penalize people for pre-existing conditions nor engage in denial of coverage shenanigans. But there's another side of this argument. Conservatives will tell you that this is an unprecedented example of government overreach. That it creates a slippery slope towards government forcing us to buy all sorts of things, and that an individual should not be forced to participate in a market they don't want to.
It sounds like a reasonable argument, but in fact it's highly disingenuous. It's the kind of argument that's promulgated by people who are either ignorant of how healthcare works (which is kind of understandable, since it's so durn complex), or by people who are playing politics with the nation's future (which is much less understandable the more you understand what they're doing). Let's start with the latter group of people and think about why their argument stinks.
First, it can't be said often nor emphatically enough that the idea of the individual mandate is in fact a REPUBLICAN IDEA. It was championed by the Heritage Foundation and prominent Republicans like Bob Dole, Newt Gingrich, and of course most famously: Mitt Romney. The idea was pushed forward during the "Hillarycare" debate as an alternative to Bill Clinton's proposal that would mandate employers cover the cost of health insurance. Republicans countered with a proposal that "individuals" should be mandated to provide their own insurance, which fit with their ideology of supporting the business community and promoting individual responsibility.
In fact, Republicans thought the individual mandate was such a good idea that then-Governor Mitt Romney, made it a center-piece of his Massachusetts healthcare reform initiative and lo & behold it worked! 98% of Massachusetts residents and 99% of children now have coverage. Unlike the Affordable Care Act, the Mass law punted on addressing cost controls (though one could definitely argue Obamacare doesn't do enough on this either), but it did manage to expand coverage and apparently improve health. Gov Romney went on to crow that it should be a model for the nation, which it became under President Obama. Confused that this doesn't sound like what Romney is saying today? That's because it isn't. Romney today hates Obamneycare, because...well, because Obama did it. Call it an Etch-A-Sketch moment...
The GOP establishment believes healthcare to be a good political issue for them, and so they've switched sides on their own proposal. Craven? Perhaps. Surprising? Not if you've been observing the recent trend towards increasingly partisan politics in this country. But what about the people who are not political salamanders? The ones who are generally worried about their freedom? I saw a Tea Party leader on Hardball Monday night, who spoke passionately against the dangers of Obamacare. She repeated again and again that the American people "don't want it." Chris Matthews asked her a question about the uninsured. She responded that she herself had once been uninsured and the doctors and hospitals had worked with her - that no one would be turned away.
In that moment she made the other side's argument.
This woman may not realize it, but she's effectively a free-rider in our healthcare system (or at least she was). When doctors and hospitals "worked" with her to reduce her costs, what they wound up doing was one of two things: A) eating the costs themselves or B) passing the costs on to Govt. Either way, the rest of us wind up paying for her care in the form of higher insurance premiums or taxation. If you don't believe me, just look at the case of Mary Brown. She's the lead plaintiff in the Healthcare lawsuit currently before the Supreme Court. She just filed for bankruptcy leaving behind a raft of unpaid medical bills. Guess who's now paying for her so-called "freedom?"
People have talked for years about the sense of entitlement in our society, but this takes it to another level. You want to be free not to pay for health insurance, you figure the tooth-fairy is gonna' pick up the tab anyway, so damn Obamacare to heck right? In the end it seems some conservatives truly love individual long as they don't have to practice it themselves.
To be fair, there ARE ways to have a viable healtchare system without an individual mandate - conservatives just happen to hate all of them (well, maybe all but one). In the next post we'll take a look at the good, the bad & the ugly alternatives to Obamacare.

Healthcare 101: Part I

For the past week the media has been abuzz with talk of the Affordable Care Act, affectionately known to most of us as "ObamaCare".  The source of this buzz, is the fact that the legal challenge to the individual mandate provision of the sweeping healthcare law, has reached the Supreme Court.  Today in fact that very provision goes to oral argument before the justices, and the media-fueled rhetoric around it has been heated.  I'd like to take a moment to point out the obvious just for the sake of my own conscience.
First of all, I do understand the reticence many people have about the individual mandate. "The Govt is gonna' tell me what to do & what to buy?? Oh hell naw. Next thing you know, we'll all be wearing jumpsuits & eating broccoli!" This was my own basic & flawed thinking on the topic prior to the 2009 healthcare debate, which is why I supported candidate Obama's approach over candidate Clinton's. But in the end that healthcare debate did indeed change my mind & here's why in plainish English:
If we're going to have a system of privately issued insurance (which we do have, and which the govt has made no moves to get rid of), we run into a basic problem: healthy people don't wanna' buy it. To be specific, young & healthy people in particular  don't see the point. It's a bad investment - I feel good, I take care of myself, the odds of being hit by a car are low so, I'd rather spend my money on beer. This is actually pretty sound logic if you're young & have no medical problems.
If you're old and/or sick, however, you desperately need medical insurance. Why? Because the out-of-pocket costs are prohibitively expensive for the average humanoid to afford. What naturally tends to happen to insurance markets then, is they become dominated by sick people who use up lots of insurance services, with relatively few healthy people to offset the cost. This automatically breaks the system. The only way insurance works, is if 100 of us buy fire insurance and when 1 of us loses a house to a fire, the insurance company can use the money collected over years from all 100 of us to pay the damages. If 50 or 60 of us have house fires, the system can't work.
Private health insurance can only operate if the preponderance of participants are in fact HEALTHY. This is why Insurance companies don't want to insure the sick - the infamous "pre-existing" condition clause. And if you were an insurance company, frankly you wouldn't either. The math doesn't work out. But you're not an insurance company are you? You're probably a soft, carbon-based lifeform that's thinking about eating a chocolate bar right now. In which case, if you determine you need health insurance you don't want to hear from every company you call that no we won't cover you because you have, say diabetes. And if you do have diabetes that is EXACTLY what you're likely to hear if you try to buy insurance. In the midst of the Great Recession if, like many Americans, you lost a job that used to cover you and now you're in the healthcare market on your own, you're pretty much screwed. Pre-existing condition = no soup for you!!
Well since we all hate the pre-existing condition clause, why don't we just get rid of it! Great idea! With a small caveat...if you get rid of it, how do insurance companies stay solvent & capable of providing the insurance promised (instead of weaseling out of covering bills as some have been wont to do)? Remember, only sick people and old people (who by virtue of being old, are more likely to eventually become sick) are interested in buying health insurance. The answer: you mandate that "everyone" buy insurance, thus giving insurance companies the mathematical liberty to actually get rid of practices like the "pre-existing condition" & denial of coverage.
The "conservative" argument against this of course, is that it's an infringement upon freedom - why should the government be able to force me into a market I don't want to be a part of, just because I'm "alive"? Aside from the fact that the individual mandate is in fact a 20 year-old Republican policy proposal, this argument is fundamentally flawed because like it or not, you ARE a part of the healthcare market, and sad as it may's just because you're alive! This is the argument that the government is going to make in support of the healthcare law and it is the correct argument. In part two of this post I will explain why. First I need to go grab a chocolate bar.

Big Gubment - The Bain of Our Existence


Today voters in Florida hit the polls and all indicators show that Mitt "Don't-hate-the-playa-Hate-the-Tax-Code" Romney will win a decisive victory after being trounced by Newt Gingrich in South Carolina just a week-and-a-half ago.  The see-saw of Republican primary politics this year hasn't yet removed the patina of inevitability from Mr 15%'s visage - a face rough-hewn from years of living in the "real economy" - but it has certainly dispatched the idea that anyone would get to enjoy the wonders of bean bag this time around.

In addition to summarily destroying the heretofore stellar reputation of a favorite childhood game, the GOP field has managed to maintain a unified position in one other key issue: Big Government.  It's big, it's bad and it's coming to get you.  And yet there's very little substantive argument  on what exactly "Big Government" is, and how exactly it's going to hurt you.  We hear the recycled mantra of "Repeal Obamacare" on a daily basis, and yet the arguments that the Affordable Care Act's mandate for citizens to buy private health insurance, is some sort of red-scare government-take-over of health care is...well, dumb.   

I heard a dumb person being interviewed on TV earlier today saying that Romney would defend Medicare, unlike Obama who wants us to have "government-run-healthcare."  The reporter didn't bother to inform the individual in question that he was dumb, since as most of us who can read have already noticed, Medicare "is" government run healthcare.  He also didn't bother to point out that Mitt Romney early endorsed the Paul Ryan budget, which would effectively turn Medicare into a privatized voucher system - something that most Medicare advocates would argue is by definition no longer "Medicare."  And finally neither did the reporter have the heart to inform this particular voter that Obamacare is the bouncing brawny baby of Romneycare - how proud is papa Mittens of that?

In the end there's a lot of rhetoric thrown around, designed to get people's waders in a winch about the dangers of "Big Government" in our lives, and frankly I don't know that I want "Big" anyone peering over my shoulder when I'm eating my evening Cheerios. But there's another important point that is oft overlooked.  Lately the media has begun to take note that all of the Presidential candidates who rail incessantly against Big Government, are in fact rich people (one of them being much richer than the rest combined...and their ancestors...and their kids).  The thing no one is bothering to point out is simple:

In the absence of Government, Rich people ARE the government.

I know it sounds simplistic but think about it historically: who ever heard of the King of France, the Queen of England or the Sultan of Brunei struggling to make their horse & carriage payments? No one.  Why?  Because they got PAPER son (or as Ron Paul prefers it, they got Gold for every rainy day in the almanac).  If they were broke their kingdom would eventually be taken over by the army of some other rich person, and they would either be sent to meet their maker (as Mittens would love to do to Castro), or they'd be turned into some sort of sub-king or duchess in the interests of saving face.  But the bottom line remains, historically, rich people have run things.  Over time they became clever enough to say, "I run ish because God said so," rather than the proverbial "I run ish because I got guns n scimitars" which always frightened the children.

I can't even pretend to be a proponent of government largesse, as I think there are a world of sensible reasons to curtail the power of the State.  That said, the next time some multi-millionaire candidate tells you he or she is here to protect you against the ravages of Big Government, take a moment and ask yourself: after Richie Rich has finished drowning "government" in his golden bidet, who will protect you from him



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