I made a Facebook status update earlier today where I said I hoped that the mismanaged “Cash for Clunkers” program (C4C hereafter) had caused some people to think about whether they wanted the same people in charge of their health care. Of course, with the limited space for status updates, and my double-dose of verbosity (which is genetic, I thnk), I really didn’t have room to flesh out my thoughts on the matter.
A review would be in order here. C4C is a government program that gives incentives for people to trade in cars deemed older and less fuel-efficient on a new car that is more fuel-efficient. A consumer group has a FAQ. A controversial provision of this bill is that these trade-ins must be completely destroyed – no parts can be salvaged at all, no tires, no body parts, nothing. One of my Facebook friends described the process they used – drain the oil, replace it with water, and run the engine until it seizes up. Anyway, this program was funded at $1 billion to go from July 24th to November 1st of this year. Yet, a short week later, the news begins to break that the program is almost out of money. There is talk of adding another $2 billion – that’s $3 billion of our tax dollars to buy and destroy perfectly functional cars, because they don’t fit someone’s idea of a “good car.”
Regarding the way these cars are being destroyed – this is the classic broken window fallacy, the economic theory that says that vandalism is good for the economy. A boy breaks a window; the shopkeeper must get it replaced. This benefits the window maker, which can benefit others in turn. However, the fallacy is that it does not look at what the money that the shopkeeper had to use to fix the window might have otherwise been used to do. For example, while the window maker advances, the shoe maker and baker, who might have received the money the shopkeeper would have spent, are hurt. (As an aside – wouldn’t it be better to keep the window maker in business by providing windows for new business? Oops – that was the greedy capitalist in me.)
Now, let’s look at the health care issue. Nearly every proposal I’ve heard coming from Washington decries the number of uninsured people in this country, how much we pay for health care, and how bad the insurance companies are. There are many ways to go about this; I’ll look at each of these in turn. As we do, keep in mind what happened to the “bad” cars in C4C.
We hear bad, bad things about the number of uninsured Americans – the latest numbers have it about 47 million. That’s a lot, right? Maybe, but maybe not. One thing that these stats do not take into account is the number of people who choose to be uninsured. Many college students are uninsured by choice (or by lack of giving it a thought – that would have been me right after high school!). The census bureau said that the number of college students was 15.9 million in 2004. How about single people? I certainly didn’t worry about health insurance when I was single. The census bureau said in 2007 that of the 92 million single people, 60% had never been married at all, and 15 million were over 65. Certainly not all of these are without insurance, but a good many may very well choose not to have it. That leaves the ones that can’t afford it – we’ll look at ways to make it more affordable in our third point.
Next up is how much we pay for health care. Yes, just like our military prowess, America is #1 in the world at spending per-capita on health care. We are also #1 in the world at medical advances and technology. These things do not come for free – what is the incentive for a company to develop the newest bang-up drug if they aren’t going to be able to make enough money on it to fund the research it took to develop it? Altruism may be nice, but it doesn’t put food on the table. While the exchange of money for services seems to be distasteful to some people, you’ll look long and hard to find a better motivator. Why do doctors put themselves through years and years of education after most people are already out working? For a few, they may just love their fellow man that much, but for the most part, it’s that American dream of making it, and having the things they want. How does one acquire things? Money.
All this talk about money brings us to those evil, horrible insurance companies. I’ve dealt with them just as many of you have, and it’s frustrating to have things denied because a t wasn’t crossed or an i dotted. However, let’s look at what we expect from insurance. Does homeowner’s insurance cover carpet cleaning, painting inside and out, and re-weatherstripping the windows? Does auto insurance cover oil changes, new tires, detailing, and radio upgrades? Then why must any health insurance cover check-ups? The litany of required services on some insurance providers is astounding – and, the consumer has no choice. I don’t think I could go to a state in the Union and get an insurance plan that didn’t cover maternity; as a male, I really don’t think that’s coverage I need. People view health insurance completely different from any other insurance. Why is it that, if something exists, people think that their health insurance should cover it? Some of these treatments or experimental procedures weren’t even in existence when the policy was written, but people think that they’re entitled to them.
This is where affordability comes in. Let insurance companies customize plans, so that people can buy just what they want (catastrophic coverage, for example) and exclude what they don’t (TMJ). End the ridiculous “discounted rate” on the billing – doctors have artificially raised their rates because they know that, for the most part, their patients’ insurance will only pay a portion of it. The price should be the same for someone paying out-of-pocket as it is for the insurance companies. (Back to auto insurance, does Ford offer Allstate a discount? Yeah right.)
What happens with this is the regular free-market benefits. First, the availability of health care goes up, because the people who opted out of “hypochondriac” coverage will not take up a doctor’s time for every sneeze and sniffle. Second, there is an incentive for providers to get into the business, as the playing field is more level and less laden with red tape. Third, people will be so happy that we’ll never have to hear about this ridiculous socialized health care mess ever again! (Well, okay, maybe that last one is a stretch.)
Now, let’s look at C4C health care. You’ll have politicians and government paper-pushers determining what’s covered and what isn’t, with their decisions holding the force of law. The thresholds will be hard – the qualifying line is drawn in the cement as it hardens. It will cost 10 times what “they” estimate – at least. Wait times will be through the roof, as anyone who qualifies for something will get in line for it, whether they need it or not. Over five or ten years, there will be a shortage of providers, because doctors will decide that law is a much more lucrative field. And, one of the founding principles of our nation will have been sacrificed on the altar of good intentions.
I know which one I’d prefer.
It is a crisp late summer morning. A couple is parting ways at an airport. While that’s not an altogether uncommon sight, for Neil and Ellen Mariani, it would be the last time they would see one another. Neil was 59 years old; 4 of those years he had spent serving his country in the United States Air Force, and many more years working for 
I got a pair of sport socks that are themed from Brent's Place - a picture of them is at the end of this post.
Without further ado, I present Dr. Daniel’s Prescription for Health Care Reform.
