One of the big problems — I think the biggest problem — in discussing the health care situation is that the “uninsured” are all considered in one category, while there are a lot of different reasons that people are uninsured.
There are those — mostly young and healthy — who are pretty certain that they are not in the near future going to need medical care, so it is economically a stupid thing to do for them to get health insurance. They are certainly right, by and large. Most of them make little use of the health care that is available, and making them buy insurance, against their will, as Obamacare does, is clearly and simply a confiscation of their money that is the worst feature of the law.
There are people who have been denied insurance because of pre-existing conditions, and it is this group that Obamacare tries to help. But surely, the argument that you can't help this second group without forcing the first group to pay is specious. There must be a way of supporting the insurance companies — perhaps by a fund supported by general tax revenues — enough to compensate them for the additional cost associated with covering these people, without specifically hitting the young and healthy with a burden targeted at them.
Neither of these two groups, however, is the most important. There are those who simply do not have the kind of job that carries health insurance benefits. And the reason this is a problem is that we have uniformly depended on employers to provide health insurance, as a result of World War II wage controls! Yes, back in World War II, it was decided that wages had to be controlled, but to allow employers to provide health care benefits instead of increasing wages was all right, and tax benefits were put in place to encourage employers to do that. This leads to three bad results: (1:) Except for Federal employees (who have a plethora of choices!), people who are employed are locked into a single plan (or occasionally a small number of plans), without the ability to comparison-shop to pick the one that best suits them, (2:) People who change jobs have to go into a new plan, often needing to change their doctors, and (3:) people who are unemployed have no coverage, or can only buy it at a price far beyond their ability to pay, because they do not get a tax-subsidized rate like an employer or a group-based rate. This at a time when their income is reduced or eliminated!
It seems clear that the only way to fix our health insurance system is to detach it from employment. And Obamacare does not begin to consider this.
There are those — mostly young and healthy — who are pretty certain that they are not in the near future going to need medical care, so it is economically a stupid thing to do for them to get health insurance. They are certainly right, by and large. Most of them make little use of the health care that is available, and making them buy insurance, against their will, as Obamacare does, is clearly and simply a confiscation of their money that is the worst feature of the law.
There are people who have been denied insurance because of pre-existing conditions, and it is this group that Obamacare tries to help. But surely, the argument that you can't help this second group without forcing the first group to pay is specious. There must be a way of supporting the insurance companies — perhaps by a fund supported by general tax revenues — enough to compensate them for the additional cost associated with covering these people, without specifically hitting the young and healthy with a burden targeted at them.
Neither of these two groups, however, is the most important. There are those who simply do not have the kind of job that carries health insurance benefits. And the reason this is a problem is that we have uniformly depended on employers to provide health insurance, as a result of World War II wage controls! Yes, back in World War II, it was decided that wages had to be controlled, but to allow employers to provide health care benefits instead of increasing wages was all right, and tax benefits were put in place to encourage employers to do that. This leads to three bad results: (1:) Except for Federal employees (who have a plethora of choices!), people who are employed are locked into a single plan (or occasionally a small number of plans), without the ability to comparison-shop to pick the one that best suits them, (2:) People who change jobs have to go into a new plan, often needing to change their doctors, and (3:) people who are unemployed have no coverage, or can only buy it at a price far beyond their ability to pay, because they do not get a tax-subsidized rate like an employer or a group-based rate. This at a time when their income is reduced or eliminated!
It seems clear that the only way to fix our health insurance system is to detach it from employment. And Obamacare does not begin to consider this.
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