Health care: How do we pay for it?

Some folks say, "why are we talking about health insurance rather than health care?" The problem is simple: we have to pay for health care somehow. It isn't free. It doesn't grow on trees. Someone has to pay for it.

The problem is that health care currently takes 15% of the U.S. GDP, but sick people do not make 15% of the U.S. GDP. So requiring sick people to pay the full costs of health care is impossible -- you cannot pour ten gallons of dollar bills out of a five-gallon bucket. Thus health insurance -- paying the costs of the health care system today, so that it is available to you when you get sick tomorrow.

The problem with health insurance is that the current situation, where we have three different health insurance systems -- one for those who qualify for government insurance (Medicare, Medicaid, VA, etc.), one for those who qualify for private insurance, and one (or rather lack of one) for those who are uninsured -- is not working. The government insurance programs account for 50% of the U.S. health care spending but are being cut back to the point where doctors and hospitals are refusing to see those patients, and because only poor people (for the most part) qualify for those programs (other than Medicare), the people getting these services don't have sufficient political clout to assure sufficient funding.

The problem with the private insurance part of the equation is that private health insurance is becoming unavailable for increasing numbers of Americans, both because of cost and because insurance companies simply won't write insurance for large groups of people. Insurance companies today are in a death spiral of increasing costs and decreasing participation. To counter that, they keep kicking sick or potentially sick people out. If you forbid them from doing so, they must raise their rates even more, and even more people become uninsured.

Finally, there are the uninsured. First of all, what little health care the uninsured get in emergency rooms is generally being paid for by the insured, causing the price of private health insurance to go up, causing more uninsured, causing the health insurance death spiral to become even worse. And generally if someone who is uninsured becomes seriously ill, he or she is dead. Hospitals and doctors will not provide surgical care for those who require, e.g., a kidney transplant in order to live, and the uninsured have no way to pay for long term care such as kidney dialysis. Even insulin for diabetes, hardly the most high-tech or deadly of illnesses, is hard to come by for the uninsured, one lady of my acquaintance had to make the rounds of various charities every month to round up enough insulin to survive another month, which became even more difficult once she lost her eyesight due to the disease not being properly managed due to lack of consistent monitoring by a medical professional. The problem is that we still provide acute care in emergency rooms -- i.e., we keep them from dying -- but we don't provide long term care to keep the uninsured healthy. This has two problems. First one is social -- people do not willingly accept a death penalty for something not under their control, and the result is social unrest and disorder. The second is that, by providing a reservoir of disease carriers in the population and then providing just enough care to kick back a disease but not cure it, we're causing the creation of drug-resistant diseases that soon enough will start killing the insured as well as the uninsured.

In the end, the only way to fund health care in a way that guarantees that some level of health care will always be available as needed is if everybody pays. Everybody benefits from health care, after all, even those who are currently well will become sick at some point in the future and will require it. We can call it a "health care tax", a "Medicare payroll deduction", or an "insurance fee" (if we adopt a Swiss-style mandate system), but whatever we call it, everybody benefits from having health care available to them when they need it, so everybody should pay. Whether it is a Medicare For All scheme paid for via an increase of the Medicare payroll tax that guarantees that all Americans can participate in Medicare, or whether it is a "don't call it a health care tax" mandate that all Americans purchase health insurance (and regulation of said health insurers to make sure that they are paying for the care they're supposed to pay for), any insurance scheme that does not require all people to pay into the funding pool ends up with a lot of dead people, in the end. That's just how the economics works out -- as we're finding out, slowly but surely. This is simple math in the end, like 1+1. And 1+1 always equals 2 no matter how much we'd like it to be 3, or 5, or something else entirely. The answer always comes out the same -- unless everybody pays, a bunch of people end up dying.

-- Badtux the Health Care Penguin