Health Care and Health Insurance

So now the Senate will delay, slightly, the introduction of a bill to repeal and replace Obamacare, which the bill is not actually going to do, which is one of the reasons that is, in fact, being delayed.  At some point, the Senate may come up with something that it is willing to vote on.

As I wrote earlier this week, what they actually end up voting on will be a bit different from what the initial bill was, and will be further altered -- if it does pass the Senate -- when it gets into a conference committee with House members to settle on something that both houses can support.

But that's not today's point.  As I wrote before, we can't debate the quality of a bill today that won't be what becomes law.

But we can debate the overall implications.

You see, this is perpetually referred to as a "health care bill", which it is not.  The bill, like Obamacare was, has little to do with health care at all, and everything to do with health insurance.  Much like earlier comments about opposing forces talking past each other, here both sides, in referring to it as a health care bill, are talking past reality.

"Health care" is what doctors and other medical professionals offer patients.  There is "healthy care", like physicals and preventive actions, and there is "sick care", rendered to those in need of treatment, but it all comes under the umbrella of health care and that discussion is different.

When people say they have a "right to health care", they're still saying they have a right to "treatment", and that has to be properly regarded.  I actually don't think we should say that anyone has a right to health care.  I prefer to think of it that a just and kind society takes care of those unable to afford treatment for their ills, by offering at least a modicum of care.

"Modicum", of course, has to acknowledge that the delivery of health care to the poor, like any other charitable act of government, must respect government's stewardship of the taxpayer's dollars.  Obamacare, for example, ignored that by trying to make an unlimited transfer of taxpayers' dollars into the health care system funneled through the government, even though government has never shown the capability to improve any such system.

What people have to distinguish is a "right to health care" vs. a "right to health insurance."  They are so not the same thing.  The left, which creates rights out of thin air, would have you believe there is a right to insurance, which is relevant because the bills being debated are about essentially the regulation of the insurance industry.

The attempt in Obamacare was to give everyone access to insurance by forcing everyone to buy it or pay a fine.  The CBO scoring of the Senate bill talked about 20 million Americans "losing insurance", but that's only because they assumed that the 20 million, formerly forced into buying something that didn't make sense and was too expensive, would make the sane judgment and not buy it.  To me and, hopefully to you, voluntarily declining to buy something is not the same as having it taken.

To me, health care becomes better and more affordable when the goal of the insurance industry is properly aligned with what is best for the country.  If you really step back and separate care from insurance, I think you get this:

- There is a network of health care professionals out there available and physically accessible to all Americans to treat them.
- There are gradations of care that can be delivered, from basic to incredibly aggressive, with costs relative to the level of aggressiveness.
- Health care is a commodity.

- Because most people find it preferable to pay for health care monthly and predictably against periodic but unpredictable needs, we have insurance.
- Insurance is a business, predicated on the notion that people will pay in more in those monthly premiums than will cost the insurer over the life of the policy.
- Health insurance is also a commodity.
- The government's role in health insurance is not to provide it, but to do whatever is possible and constitutional to ensure that it is accessible to those who want it, at a price reflecting an open and competitive marketplace.

I grant you that starting from those principles is difficult, precisely because Obamacare made it so difficult to be dismantled.  But we need to, if only so the American people can envision what a well-constructed, reasonably regulated health insurance system can even look like.

Start with access to insurance.  To get prices down, you need to do two things -- lower costs (the costs of health care itself) and insinuate competition to the greatest extent possible.  Health care costs can come down, of course, as soon as it is allowable, or even mandated, for those costs -- in physicians' offices, clinics and hospitals -- to be published and readily accessible to the public.

More importantly for this bill, health insurance needs to be as competitive as possible.  Obamacare premiums are skyrocketing in most areas, precisely because competition has dropped to, in many places, no companies at all, and it has dropped because the Obamacare law made it impossible to make money selling insurance.  So clearly, we have to work toward there being a larger number of companies, competing wherever they feel they can establish themselves.

But even as I write this, Chuck Schumer is on TV saying, "Sure, we Democrats will work with you, but you have to abandon tax breaks for the wealthy [sic], abandon cuts to Medicaid [of which there were none], and abandon repeal [of Obamacare]."  Schumer clearly doesn't get it.  The nation soundly rejected the Democrats in 2010, 2014 and 2016, predominantly because of Obamacare, yet in order to be blessed with St. Chuck's presence in a discussion, the Republicans have to abandon the notion of getting rid of the reason the Democrats were repeatedly rejected.

Aaaarrrgh.

We have to start with the insurance marketplace we actually would be best served by, which is one with the most competition, in which case the companies can actually provide insurance profitably but at competitive rates for the citizenry.  We cannot mandate buying insurance, simply because it is remarkably unconstitutional at best, and odious at worst, that the Federal government would force the purchase of a commodity (the States, of course, can; q.v. mandatory auto insurance in order to register a car, but they have their own constitutions).

The work on the health-insurance bill appears to have been generally trying to pick apart at an entrenched Obamacare system, but that is like writing spaghetti code.  They need to repeal and start again.  Put a death date on Obamacare, like 31 December 2017, and that it will be repealed effective that date.

Then have something else ready that reflects reality, the Constitution, competition in insurance (like across state lines), and a capacity to provide health care through insurance for all who seek it.  You've got time and a mandate from the people to do it right.

Not going to happen, but at least some thoughts there to consider, folks.

Copyright 2017 by Robert Sutton
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