Divide and conquer

The Atlantic Monthly continues its downward spiral with a new writer, Megan McArdle, who fits their criteria for clever writing that leaves aside those quaint notions of morality, as Alberto Gonzolez has said. Entertaining!

The benchmark for this kind of dross ran a few years back, positing that the earth could easily support 30, 50, who knows how many billions of humans! and that our human population could vary by huge amounts — 30 billion to 3 billion! — within a few generations, without problems.

Right. Unless, I suppose, you consider starvation, war, pestilence and economic dislocations problematic.

Megan performs this trick on a smaller scale in "The Morality of Health Care Finance," by accusing those of us who see single-payer financing as a way out of the immoral and deadly morass in which healthcare is now mired in the United States. We are, she thinks, simply in love with government, and would be in favor of single-payer even if it could be proven that private health insurance could do a better, cheaper, more efficient job — "as long as a substantial population remained uninsured."

What?

Huh?

Megan. How is a system better if it leaves "substantial" numbers uninsured? How could that be cheaper in the long run? How more efficient? You've been reading too much Ayn Rand.

That's like accusing progressives of being against torture, even if it could be proven that torture does a better, cheaper, more effective job — "as long as a substantial amount of the information gathered turned out to be false."

See, the fact is that torture is wrong because it's immoral AND it doesn't work. Same as our private health insurance system.

Megan's argument that single-payer is a way to transfer money from the young and healthy to the old and infirm sounds like a trial balloon from the health insurance industry. Will we learn in a few years that she was lavishly compensated by that industry for this bit of "journalism"?

The fact is that our current system transfers money from the young and healthy to the old and infirm without benefit to the young and healthy. A single-payer system does collect from everyone, but its efficiency and appeal lie in the fact that there is benefit for the young and healthy. They have the security of knowing that if they hit a tree snowboarding next winter, they'll be cared for. They have the satisfaction of knowing that if they're one of the unlucky few who wake up tomorrow morning suddenly transformed by a diagnosis of cancer, suddenly no long one of the healthy but one of the stricken, that their children will continue to have a parent, and they can concentrate on recovery, not the consequences of bankruptcy.

Shame on you, Megan, for working to divide people, to set the young against the old, and suggest to them that their interests are served by turning their backs on others. She complains that liberals have been calling her "evil," but in fact, to work to divide people, one from the other, is an evil action.

First they came for the Socialists, and I did not speak out -
because I was not a Socialist.

Then they came for the Trade Unionists, and I did not speak out -
because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out -
because I was not a Jew.

Then they came for me - and there was no one left to speak for me.

Shame. We're in this together, Megan. Because it's moral, and because it's what works.

Uninsured just as misguided

This USA Today story on the uninsured does a good job of illustrating some of the wrong-headed notions we Americans have about healthcare, and paying for it.

The reporter focused on middle-class people who aren't stereotypes of the uninsured.

She didn't do a good job of describing possible solutions. You have to go all the way down — way down — into the comments to find mention of the only way most other industrialized nations have discovered works to cover their citizens with quality affordable care. Single-payer.

Her depiction of people's attitudes towards the question of whether they agree philosophically with "we're in this together" or "you're on your own" was great, though.

Take her interview subject Diane Stewart, a 57-year-old woman who "says she made a six-figure income" working as a marketing person for a Charlotte television station. Stewart quit that job in 2000, worked for a smaller firm for a couple years, then quit that job and lived off her savings while she unsuccessfully looked for another job — and insurance.

"For a while I had a policy and was paying $400 a month," says Stewart, who is relatively healthy but takes a thyroid medication and drugs for blood pressure and cholesterol. "I paid them more than they paid back in benefits."

Now I agree that $400 a month is high — and it's high because it was rated in a for-profit, cherry-picking, falling-apart system for a woman her age — but in order to make ANY system work, we all have to most of the time pay a bit more than we receive in benefits.

In a single-payer system — or a multi-payer system like France's or even a healthy private insurance system like the U.S. had back in the 1950s and '60s — you pay more than your typical monthly health expenditure because you understand that one day you'll be the sick one needing extra care. And in the meantime, your extra dollars go to help take care of the little hemophiliac kid down the street, or the klutzy woman who slipped on the ice and broke her ankle, or that grampa who had a heart attack. We're in this together. One day, it will be you needing the help.

Stewart, however, that former 6-figure lady who didn't believe in paying out more than she was getting back during a healthy time:

is studying for a health and life insurance broker license. She takes the test next week and hopes to start selling health insurance to small businesses...

For medical care, her lifeline has been the support of two services in town. One is called Physicians Reach Out, a group of physicians who offer low-cost health care to low-income residents. The other is MedAssist, a free pharmacy for uninsured and low-income residents of Mecklenburg County, N.C.

Without them, she says she would have had to file for bankruptcy. "I had to have surgery to remove my parathyroid gland three months ago," Stewart says. "We tried to treat it with medication, but it got worse."

Although the hospital tab easily topped $7,000, Stewart says the payments were waived through the program, and she had only small doctors' bills to pay. Every few months they check her income to make sure she still qualifies.

"I thank them from the bottom of my heart," she says. "Because of my medication, hopefully I will live to be 80 at least."

She plans to buy health insurance as soon as her earnings as an insurance broker allow, and no, she doesn't expect to get a break on the cost because she's a broker.

"I'll have to pay the same as everyone else," Stewart says. "Health and life insurance is not something everyone wants to buy, but it's something you have to buy."

I hear now and then that single-payer healthcare supporters really just want something for nothing, and think that they won't be paying for their healthcare "because the government is going to pay for it."

What nonsense.

This woman's attitude is the closest I've seen on that continuum.

It's the private insurance folks — like Stewart — who think they're going to outsmart the system and get something for nothing. The same USA Today article ends with an even more explicit example.

The reporter notes that some of the uninsured, in particular those who are young and healthy, "tend to see health insurance as an expense with little payback, rather than a hedge against financial disaster. So they don't buy it."

Kevin Wurtzbacher, 31, has been diabetic since 14, taking insulin shots. That makes the Valley Grove, W.Va., man an unlikely candidate for private insurance, and his job as a concrete worker is seasonal and doesn't come with health insurance. His wife, Julie, works as a waitress, and the restaurant does not offer health coverage.

Together, the couple make about $39,000. He now relies on a free clinic.

The couple's income qualifies them for low-cost care from Wheeling Health Right, in Wheeling, W.Va., which is funded by state, city and county governments, grants from foundations and donations. It is a popular spot and even draws patients from across the river in Ohio.

Their 4-year-old daughter is covered by a state program. Wurtzbacher's insulin and supplies cost him only $2 a prescription through the clinic. He's appreciative of the program, which also provides him with eyeglasses.

One of his co-workers, a man in his 20s, buys insurance on the private market, a move Wurtzbacher says doesn't make much sense.

"There's nothing wrong with him, and he's paying for health insurance," Wurtzbacher says.

With a single-payer system, every young person working on the books would have a percentage — an affordable, reasonable percentage — of their paycheck taken out for a national health insurance program. Wurtzbacher's attitude would be seen as needing some educating, and his co-worker would be paying less and getting more.

Risk pool explanation

A Philadelphia Inquirer columnist, Andrew Cassel, gives his readers a good explanation of risk pools, something I was struggling to explain the other night. He writes that, “insuring people in large groups can be more efficient because risks are spread out. In effect, healthy individuals subsidize sick ones.
"Ideally, the same thing happens when people buy insurance on their own. Insurers balance the risks by signing up many individuals, expecting that only some will need health services at any given time.

"But there's a catch. In a competitive market, some insurers can focus on attracting people more likely to stay healthy - say, by offering lower rates to the young and affluent.
"That makes it harder or more expensive for those with higher risks to obtain coverage - a phenomenon economists call 'adverse selection.'"

Just one problem here. "Some" insurers try to screen out less healthy potential customers? "Some" insurers?

Cassel continues (before he was so rudely interrupted), "So if the current tax incentive goes away, what then?
"One alternative, of course, would be to put all Americans into one big insurance pool. That's the basis of the so-called single-payer idea: Have the government insure everyone, as Medicare does now for people over 65."

Of course.