freedom of choice medical politics

"It’s not a single payer system, so what’s the big deal?"

That’s a response I got to my last post. It’s true, I don’t know of anyone seriously promoting that, but it can still do what I said in my previous post. Why? It all has to do with the fact that it is a federal program.

Imagine that you have kids and live in an area with lousy public schools. You really don’t want to send your kids to neighborhood school, what to do? Sure, you have a choice, you don’t have to choose to use the state’s school, there are plenty of private schools to choose from. Here’s the thing, even if you choose to not use the public school you still have to pay for it. Your choice to not use the school does not help you out at all. You have to come up with the money for both the public and the private school. On top of that, the public school doesn’t really care if your children don’t go, they won’t change what they do at all.

Facing that decision, most parents go ahead and send their kids to the public school. If they are really committed, they will agitate to improve the school. Of course, if anything ever does come of that agitation, it will only be long after their kids are through that school.

It’s a similar thing with a federal health insurance “option.” It will be optional to use the services, but it will not be optional to pay for it. Faced with that decision, most people will go ahead and use it. Using what you are charged for is the rational thing to do, even if that thing is substandard. The cost of using something else is just too much for most people. This is the mechanism that will cause the federal program to squeeze out the private ones.

Keep in mind that this holds even if you can opt out of the premiums. This is because the inevitable cost over runs and/or cost underestimates will still be the responsibility of the federal government. Without any real reason to worry about profitability, there will be both. It will be like Fannie mae and Freddie Mac, political promises with no incentive to rein in costs or risks. In other words, a disaster waiting to happen.

3 replies on “"It’s not a single payer system, so what’s the big deal?"”

There’s a huge difference between schools and insurers. Insurance is about pooling risk, the larger the pool, the more risk the system can take on and still function. The largest pool you can possibly accumulate in the US is…everyone. Not that that would be my first choice. Back when most of the country was on a BC/BS plan before we allowed for profit insurers into the health care arena, things were far better than they are now.

Yes, insurance and schools are different, but the economics of the situation is similar. I too feel that we need to break up the state by state mess there is now. I’ll admit to not knowing how the older insurance stuff worked, but I sincerely doubt that there’s much comparison between how things are now and how there were then. In other words, I doubt you’d have any trouble affording that care now.

Just to add to that thought… There are some people out there that claim that most of the cost issues we face in medicine can be chalked up to the newest procedures and tests. We could easily afford the care that was offered in 1975, but nobody wants that.

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