Toward Universal Healthcare
In a comment to my recent post about being a doctor in Rhode Island, Old Time Lefty asked (among some insults, statements seeped in common spin, and other junk that I’ll ignore):
Health insurance should not be joined to employment. It should be a right. If it’s not a right, do you think it’s a worthwhile endeavor to establish program or programs to cover them all? What program to do this are you espousing?
I’m always hesitant to assent to calling something “a right” in the presence of left-wingers, because the definition of what a given right might entail is generally more expansive and fluid than I believe to be appropriate. However, I’ll express general agreement with the proposition that access to healthcare is a right, mainly in order to draw attention to my disagreement with the proposition that health insurance is a right.
Plainly put, “healthcare” and “health insurance” shouldn’t be considered synonymous in this discussion. There’s a reason you don’t use your auto insurance card every time you get an oil change, buy new seat covers, and have your car detailed. Insurance ought to be bought against that which is rare and harmful, not that which is habitual and foreseeable.
So, with this distinction made, how would I provide everybody with access to healthcare?
The first step would be to end price-raising regulations and mandates. That would include all laws that push health insurance into the employee agreement. (Ask Andrew about ERISA.) It would also include requirements that insurance cover viagra, sex-change operation, and a whole medicine cabinet of more common procedures and drugs. Make it possible, in short, for the average citizen to purchase his or her own catastrophic coverage, for use in such illnesses and injuries as ought to bring one to the emergency room or the life-saving surgeon.
The second step would be to make that insurance mandatory. Once we’ve agreed upon a bare minimum of coverage (taking into consideration severity as well as cost to the public of uncovered treatment). The price really shouldn’t be that much, considering the rarity of the use, and perhaps those who still cannot afford it could be covered under a government-negotiated plan with a private provider.
The third step would be to create health savings accounts for every American, created upon birth or naturalization. Each citizen (or his or her parents) would select a firm to administer the account, with the government’s role being mainly in establishing the account number and other minor start-up requirements. (The administration would be more akin to bank practices, as opposed to investment practices.) Over a person’s lifetime, the individual, employers, charities, and so on could put money into the individual’s account (tax free), and he or she could use it solely for medical expenses, including doctor visits, medicine, perhaps even plastic surgery and other electives.
At a certain age, the money could be withdrawn to enhance retirement income, and the full remaining dollar amount could be bequeathed to others, placed in their accounts.
This is just a summary, with some debatable points and specifics to be added for a full-throated policy discussion, and there are a variety of costs and benefits (notably an increase in pay when employers are no longer “responsible” for insurance costs) to such a program that would require more time than a lunch half-hour provides.