Does it really matter whether the government or an insurance company decides matters of life and death? I think so. by Rimfrel
(libertarian)
Tuesday, August 18, 2009
Some people are concerned that the public option will mean that government will get between a patient and his doctor. Others ask why that should matter, since currently the insurance company comes between a patient and his doctor. What difference does it make who is standing in that place, deciding whether to authorize whether the patient gets the treatment the doctor would like to recommend?
First, not everyone has insurance, and the legislation proposed (HR 3200) will mandate that they must. So those who currently self-insure, or who can afford to pay cash, would then have an intermediary whether they like it or not. If, as is alleged likely, everyone eventually winds up on the public option, then that intermediary will be the government.
Whereas an insurance company representative is just as faceless as a government representative, does it make a difference?
I think it matters quite a lot. The following is my analysis and I would appreciate hearing about any invalid assumptions you notice.
An insurance company is a business. Someone pays premiums and, from time to time, collects benefits. If the individual pays more in premiums than they collect in benefits, the insurance company makes a profit. Since the insurance company only has a percentage of the market share, especially with insurance laws made at the state level, it behooves the insurance company to keep you alive unless you become too expensive. If they have a million clients, each one has a nominal value of one-millionth of their total client base. Not much, but something. If they lose a client, for any reason, they have to compete for a lower-risk replacement within their state.
A government is not a business. It ideally only breaks even, since its income is derived from taxpayers. It would (allegedly) eventually have the total market share of health care clients, since people do not buy insurance across national boundaries. If there are 300 million customers, then each one is worth nominally 1/300th of what the insurance company client was worth in the previous paragraph. Individually, each client is worth less than for an insurance company. It is also true that a government can replace dead clients by granting citizenship to people who have come here from other countries, legally or illegally. This tactic could be used to select for an ideally young and healthy populace between, say, the ages of 15 and 40. If costs are what drive government decisions, where is the fault in a business model that perfects their clientele for minimum cost and maximum profit?
Here is why it matters to me. I have never pledged allegiance to a business. The government is not run as a business, and no one should have to fight and die for a business. Not to mention that, if this country were a business, it's not a very successful one at the current debt levels. If my pledge does not impose an obligation on government to treat me as more than a number, more than a cost in its cost-effectiveness analysis, then government has cheated me. If the country wants patriots, then the patriots have to be appreciated and loved the same way the country is. It has to be a two-way street.
I understand the problem space well enough to expect that there won't be an infinite amount of care provided to an expanding population for a controlled or even scalable cost. I am willing to accept that eventually an insurance company will decide I am not cost-effective anymore and coverage will not be provided. At least I will not die cursing the faceless government employee that decided I wasn't worth it anymore, and the government that chose to let its citizens die to save money.
I believe there are other options. But that is a topic for another column.
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Posted By: Jahfre Fire Eater
Date: 2009-08-18 21:19:31
Hi Rimfrel,
Good article. I didn't agree with some of it as follows:
1. It is not cost that drives government decisions. Policy decisions are driven by perceived need and perceived remedies that are designed to deliver future votes.
2. The government does not want to replace dead "clients". Each "client" is actually a liability. In the insurance world, flawed as it is, the customer is an asset. That is the one huge reason why socialized services and industries always fail. They turn assets into liabilities.
3. I would never pledge allegience to a country or a business.
4. No one should ever be forced to die for a country or a business.
5. The fundamental role of government is to cheat the citizens of their property and wealth to enrich the ruling class and their supporters....which is whey I'd never pledge myself to one.
6. A country cannot want anything and I personally have no use for patriots.
7. The face bureaucrat option (insurance or government doesn't really matter.) There is also the charity and philanthropy options. The government has been systematically opposing and undermining these valuable endeavors for so long that many have forgotten how strong and important they can be.
This is the most vile aspect of the rot that is Socialism and Progessivism. The economics and government policy that foster these choices turn vital assets, such as people and ideas into liabilities . The individuals who comprise the State by being elected into office must forever whittle away at these liabilities to appear politicically responsible ahead of the next election. So benefits get cut, quality gets cut and availability turns into queues. They have no choice but to war against these liabilities in order to continue the illusion that a system of care based on unbounded need can ever be viable.
It is the mother of all moral hazards that the Obamacare promoters are attempting to lure us into. Our generation will be despised for centuries for the damage we are about to inflict on the future.
1. Cost is what they admit to, so that's what I wanted to attack.
2. If there were few enough people, the government would need to replace dead clients so it doesn't go under.
3. Pledging allegiance was the custom when I was in elementary school.
4. Sometimes a country must defend itself against invasion. A given person may actually be dying because he wants to defend his family, but that is often called dying for one's country.
5. Pledging allegiance to a country is not emotionally the same as pledging allegiance to a given government, which might change. Eisenhower isn't running things anymore, and the government has veered way left here lately. I am looking for legal ways to not contribute to its support. We don't pledge allegiance as adults, so I don't think I have pledged allegiance to this government.
6. The government is the mouthpiece for the country, whether we like it or agree with it. A patriot is someone who serves his country. I have a lot of respect for patriots, even when I disagree with them. Liberals tend to view themselves more transnationally. I am glad there are patriots, and supporting the welfare of my country doesn't identically mean agreeing with the government.
7. I only wish there were more people supporting philanthropic and charitable options.
The government is taking an economic view of the people, which is the fundamental reason why I say government should not be making my health decisions. I expect a business to do cost/benefit analysis before helping me. I expect my government to protect me from harm to a point, but not a cost-determined point. When a government starts looking at the economics of having a given citizen, elected officials will be considered more valuable. If the government wants to treat me like a business asset, then I might as well treat it like a business. I just don't care much for what it's selling lately.
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