August 20th, 2009 — Wordman
I’m putting together a much longer post to present a tortuous metaphor for the state of American health care, but I keep seeing the same theme in the current “debate” on health that is driving me nuts enough to say something about it here.
Here is an example, this one from Mark Steyn:
I think Sarah Palin’s “death panel” coinage clarified the stakes and resonated in a way that “rationing” and other lingo never quite did.…What matters is the concept of a government “panel.” Right now, if I want a hip replacement, it’s between me and my doctor; the government does not have a seat at the table.
Whatever you may think about Palin or the death panel or whatever, the statement above contains a huge glaring problem. Under the system we have now, while it may be true that the government does not have a seat at the table, if you want a hip replacement, it is most certainly not between you and your doctor. It may be between you and your insurance company, and it may be between that insurance company and your doctor, but if you and your doctor, by yourselves, want to decide on your hip replacement, you are totally fucked under the current state of health care in America.
If you don’t like the current health bills being debated right now, fine, but don’t compare them to an idealized system as if it actually exists when it really doesn’t.
Robert Tracinski makes the same mistake in this piece, when he says (with his own emphasis):
Do the Democrats even understand what insurance is? … Insurance is a form of financing. It is a contract under which a health-insurance company agrees to pay for medical bills that could run into the tens of thousands of dollars, if you are hit by a bus or are diagnosed with cancer, so that you don’t have to pay for those bills out of your savings. For younger people, this means being able to pay for catastrophic care even if you haven’t had time to build up tens of thousands of dollars in savings. For older people, this means not having your retirement savings or the equity in your home get wiped out by an unexpected illness.
It is? Really? Great!
The problem is that while this is what insurance should be, present-day American health insurance doesn’t actually work like this. At all.
You try telling a mother of two “sorry, your kids’ check ups are not covered by your insurance. Insurance is only for unexpected emergencies.” I dare you.
And, likewise, when an actual emergency causes “medical bills that could run into the tens of thousands of dollars”, see how likely the “insurance” is to pay it all.
There is a reason HR departments call it “health coverage” and not “health insurance”: because it is no longer insurance. The “coverage” is now used for pretty much any type of health related expense. The expectation involved is similar to imagining a world where everyone just assumed that their auto insurance would pay for their fuel, oil changes and routine maintenance, instead of just a serious car accident.
While the current state of health care in America isn’t exactly socialized medicine, it is functionally pretty close. Does it really matter that, instead of the bureaucracy of the state that meddles in your health decisions, it is the bureaucracy of a set of corporations that meddles in your health decisions? You (and your doctor) have roughly the same level of control over both of them: almost none.