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The Chasm of Abstraction

by Robert Capozzi

Yes, Tarvok, the current "systems" of health and eduction are indeed a mess, and are indeed not free market. Not even close.

Both health and education are, however, aspects of life that people hold near and dear. Free marketeers seem, however, to be stuck in the chasm of abstraction and, perhaps, in denial. They seem to fixate on why single-payer systems don't work all that well either or they make the case the the current system isn't "free market."

These cases should be made. But it should not stop there. Otherwise, it appears that free marketeers are condoning the status quo and insensitive to the plight of the uninsured. Further, I've yet to see a thoughtful response to the point Sicko makes, that insurance companies are -- as a matter of policy -- denying benefits and then hiding behind the legal system, daring poor people to challenge the denial of benefits in the courts.

Unlike education, health often involves life and death issues. With costs escalating as they are, there should be a sense of urgency here, yet I don't see it.

How do we -- as a matter of policy -- allow the uninsured to get at least SOME insurance? We can point to the reasons that health is not free market, how charity is better than force, etc., but until that problem is fixed in a tangible way, I doubt progress will be made.

-Robert Capozzi

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Comments

I think one major improvement that could be made is ensuring that people actually have a choice as to from whom they purchase insurance. As it is, we're basically stuck with whomever our employers choose. Of course, our employers are going to choose the cheapest option, not the best (since they're not the ones that actually have to use it).

You are right. The courts are not an answer to insurance companies that violate their contracts. The potential loss of customers is a much better deterrent; it doesn't require the expense of lawyers and waiting on the courts.

Now, the company suddenly losing a lot of customers doesn't necessarily help the patient that got screwed. For this area, freedom lovers that have money should probably start some kind of a charity to bail out screwed over patients. They can help the patient out and widely publicize the failures of certain insurance companies. In the absence of sufficient charity, perhaps a government bail-out program could work, but I don't trust that idea. Private charity would bail out patients. Government would probably end up bailing out the insurance company.

However, note that the need to do so would probably be a rarity. Most companies, when they became aware that a given refusal to provide care is becoming public knowledge, would probably reverse the decision. An example of a similar phenomenon occurred at Microsoft recently. Their XBox 360 console is a disaster; hardware failures are rampant. Further, these failures are actually occurring just outside the warranty period. However, rather than just say "well, I guess it sucks to be you" and potentially losing customers, they extended the warranty for this particular problem to three years... and their customer service for this particular problem is top notch. (I know. I have a 360. Mine broke. They're fixing it.)

In short, my solution is to break the link between employers and health care. The threat of litigation doesn't work nearly as well as the threat of a loss of customers to bad press. My favored solution is to simply stop requiring that employers provide health "insurance," though I know that'd be a bit much for most people to wrap their heads around. Perhaps the best solution is simply to require employers that offer health care packages (particularly those who do so because of a legal requirement) to give their employees the option to just take the money instead. Personally, I would love this option, and I think a lot of other folks would, as well.

# posted at by Tarvok [TypeKey Profile Page]

Doh, I realized I just responded to your first post, not to this recent one.

The "people without insurance" problem is ultimately but one facet of a larger problem: the immense gap in wealth and power in this country. So far as that goes, I am fond of Milstead's "Citizen's Dividend" as a stopgap solution where that sort of thing is concerned. If there are more insurance options available for direct purchase by the potential patient, AND even the poorest have enough disposable income to be able to afford it, that problem is solved. However, from my perspective, this idea is only a shade less radical or more implementable than a full-out Geoist shift in tax policy. While I do have long-term plans where these matters are concerned, in matters of contemporary politics, I am at a loss as to how to deal with this problem. You are wrong to say that I am in denial (and those that are in denial irritate me), but you are right to say that I don't have any ideas, at least not ones that can be implemented within the decade.

Do you have any ideas?

# posted at by Tarvok [TypeKey Profile Page]