Thursday, April 22, 2004

Land of the Free and Home of the Brave

Yup, we are the land of the free of insurance and the home of the brave without universal healthcare.

When I was vacationing in Greece, I slid out while driving my rented motor scooter on a gravelly turn. I scraped up my leg something fierce. A taxi (without charge) took me to the nearest clinic and I was wrapped up and given antiseptics and sent on my way without a bill.

When I was living in England, I got a bad sinus infection and went to my local doctor. He examined me and then gave me a low cost prescription for some antibiotics. Oh, and no bill.

Now of course I didn't have a life threatening illness or a major surgery so I don't know how Greece's or England's medical systems deal with those, but I have to admit from my experience that these systems worked pretty well. I was reminded of these incidents while reading the first line of an article on health care in America: "Why can't the richest nation in the world provide health-care coverage to all its people?" I believe that one reason is the well entrenched tradition in America that if you fail there has to be real consequences. Additionally, if you fail, then you personally are a failure and should always be a failure. In other words, there should not be a safety net for real failures. Conversely, if you succeed, then you did it all by yourself and should not have to share it with society (namely failures so unlike you) - that is the consequence of success. It is like this Calvinist predestination has taken hold on Earth rather than Heaven.

There is a real anxiety in America because of this dichotomy. The majority of people know that it only takes one catastrophic illness, accident, divorce or even job loss to send them homeless, insuranceless and bankrupt to an early grave. Employers no doubt relish this anxiety because it makes the workforce a little bit more malleable. But of course they don't exactly like being the gatekeepers of insurance - however that little bit of weirdness ended up. Let's see, only people who have a job (therefore bringing in money) can get cheaper insurance - but if you don't have a job (therefore not bringing in money) then you have to pay for far more expensive insurance if you can even get it.

My father was an insurance executive way back in the days before individual clients could be sorted into all these separate categories all the better to be denied. There was age, sex, and probably race - like a census. But the rates between a 60 year old man with normal health concerns and 20 year old healthy woman were not as extravagantly different than they are now. But now the insurance companies have data up the wazoo and will deny coverage or have incredibly inflated premiums on the weirdest of scenarios.

For profit insurance companies have no vested interest in covering people who really need insurance. People who don't need much insurance have small interest in paying for those who do. Well, guess what. In a world where information can be used against you, if you have anything insurance companies don't like, you are shit out of luck. So, the pool of applicants that a company elects to cover becomes ever smaller and the number without coverage increases.

Well, what's the solution? How about going back to a system where you are a person with only limited information available - for instance, a male of this age, height and weight, and a non-smoker. And a system where it isn't tied to employment. Tax credits and "insurance stamps" (like food stamps) could be used for those with no or little income. That way there will always be a huge pool to share the risk and everybody has a chance to be covered.

But that has little chance of being implemented. Because America is too infatuated with seeing people fail - with there having to be real consequences for not being one of the successful ones. I believe that Reagan pushed people out of mental hospitals in the '80's and devalued other social programs precisely so that we can see these failures on the streets every day. How else can we really know how well we've succeeded if we never see those that really fail?

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