Who Isn’t Covered?
Here’s an interesting paragraph from a Mark Steyn piece in the current print edition of National Review:
There have been two trends in U.S. health care over the last decade. On one hand, a lot of Americans have become, by any rational standard, overinsured: They get tested for things they’ll never get. On the other, there has been an abandonment of health insurance by the rich. If you peel the Census Bureau and DHHS figures, of those alleged “45 million uninsured Americans,” one-fifth aren’t Americans; another fifth aren’t uninsured but are covered by Medicare; another two-fifths are the young and mobile (they don’t have health insurance, but they don’t have life insurance or home insurance, either — they’re 22 and immortal and life’s a party); and the remaining fifth are wealthier than the insured population. Really. According to a 2006 Census Bureau report, 19 percent of the uninsured have household income of over $75,000. Since the last round of government “reform” in the Nineties, wealthy Americans have been fleeing insurance and opting to bring health care back to being a normal market transaction. And if you look at the “uninsured discount” offered by doctors, one can appreciate that, for everything but chronic disability, it’s not an irrational decision to say I’ll get a better deal on my broken leg or my colonoscopy or my heavy cold if I just write a check for it.
That last fifth points in the direction that we ought to head: insurance for catastrophe, and a pay-as-you-go system for regular care. No employer involvement. No broad-based “public option,” except to assist those who cannot afford catastrophic coverage.
The entire structure of the industry would change. Consider, for example, that the majority of procedures and expenses would no longer be tied to negotiated pools, because the emphasis would no longer be on distributing risk for the great bulk of procedures. Those with preexisting conditions would have less fear of losing their coverage, because their conditions would be partly what the catastrophic coverage is for (and independent from unrelated aspects of life, such as employment) and partly under the umbrella of regular care.
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