Health Care

We just gotta do health care, don't we?

My principled opposition to this version of health care reform has never wavered in no small part because the further into the process we delved, the worse the outcome. What we've wound up is, in some ways, the worst of all the available options. The American people have been sold a bill of goods where they've been promised more and better care that won't cost us a dime. It is, on it's face, preposterous, but it's emblematic of all of American politics where we've headed into the chasm of massive budget deficits on the assumption that we can get more and more from government without paying for it.

Now, unlike some, I don't think Obamacare signals the end of freedom and prosperity, but I don't see how it won't exasperate many of the existing cost problems with health care. That more people will be covered is undoubtedly a good thing, but the entire debate has been conducted as if the bill we got (or some version of it) was the only way to achieve coverage for those people. There's been no debate about the costs of other proposals, whether they come from the left (universal coverage or a public option) or from free marketers. No matter how you slice it, you can't keep the structure of our current system, provide greater subsidies for the poor, and mandate coverage of all pre-existing conditions and expect this to not increase health care spending.

My biggest worry is what I've heard termed the insurance death spiral- that the individual mandate won't be effective because the penalties are far less than what it costs to actually purchase insurance and they'll be no incentive for the young and healthy to purchase insurance because it would simply make more sense to pay the fine and just obtain insurance when they actually need it. And insurance companies would not be able to deny them because of the pre-existing condition requirements. So what you could wind up with is an increasingly higher percentage of sick people making up the pool of the insured and higher and higher premiums to cover that increasing percentage of sick people.

Not that this is entirely relevant, but one thing that's killed me in this entire debate is this perception of health insurance companies as evil incarnate- I mean they are evil, to an extent, any third party payer of medical costs, be it a private company or government, is going to make some evil decisions. But to blame insurance companies for the massive increases in health care spending in this country is asinine and defies simple logic. If insurance companies were driving up health care costs in order to enrich themselves and make more profits, we'd see a spike in the profits of these companies. But from what I understand (and anyone is free to use numbers to prove differently), the profit margins for health insurers have remained relatively modest over the past several decades as health costs have soared. Now sure, there could be some blame for soaring costs to be placed on mismanagement in administration, but it's nonsensical that either 1- the government could step in and drastically reduce administrative costs or 2- that this is even a significant problem. After all, if there was billions of dollars to be saved in the better administration of health insurance, surely someone would have put that into effect to, you know, make billions of dollars.

So where does this leave us? In a way, the future of health care is even more volatile then before, as most of the Obamacare provisions don't take effect until 2012 and some don't take effect until after a potential second term is over. Perhaps the most positive thing to be got from the debate over health care is that it's becoming harder and harder to pull a fast one on the American people. People from every corner of the political spectrum demand specific and demand answers and are not content to let politicians just figure it out amongst themselves.