Monday, February 04, 2008

Health care funding and mandates

One of the secrets to why Medicare is successful at providing medical coverage for all elderly Americans is that it is *mandatory*. If you are employed you pay into the Medicare fund, period. If you are receiving Social Security you must apply for Medicare at the same time and pay into the Medicare fund. Period. You can't opt out and say "oh I can't afford it." You can't say "I'm going to not join Medicare until I get sick, and only then start paying into it." You pay into Medicare, period. It's the only way to insure that there's not a two-tiered medical system for old people -- one for those with lots of money, and one for those without. That's the law -- for Medicare-covered procedures, doctors who accept Medicare must accept Medicare for the full cost of those procedures, regardless of what other private insurance the patient has or whether the patient is rich enough to pay extra. That's the only way to make sure that, rich or poor, everybody on Medicare gets the same treatment, rather than poorer people being shuffled off to second-class-citizen status and warehoused in dingy dirty "Medicare hospitals" while richer people get better healthcare coverage.

The unpleasant secret of universal health care is that if everybody doesn't pay, then it's not universal. You end up with poor people in crowded dirty publically-funded hospitals, and wealthier people in clean elite private hospitals. Take Costa Rica as an example. The single payer system is woefully overloaded because richer people buy private insurance instead of participating in the public system. The result is that they have clean hospitals for wealthier people, and poorer people get typical charity hospital type care, overloaded, dingy, dangerous. This is why most Canadian provinces outlaw private health insurance -- they've seen what happens when you have two medical systems, one for those covered by private insurance and one that is publically funded, and it ain't pretty.

Hillary's plan has been criticized because it mandates that everybody pay into the healthcare system, either via purchasing private insurance or by participating in a Medicare-lite public insurance pool, and, as with Medicare, will take it out of everybody's paycheck for those who do not pay into the healthcare fund voluntarily. "But I'm a millionaire and self-insure!" cries the wealthy millionaire. Tough. If you want the benefits of a modern society provided by a healthy population that is capable of being productive, you have to pay for those benefits. You can't be a freeloader who accepts the benefits of having a healthy workforce, but isn't willing to pay for them. "Don't tax me, don't tax you, tax that guy behind the tree" is not a viable option.

This is reality, people. There is no free lunch. If we as a people want health care for all of our population, for the many good reasons why this is a benefit to the nation as a whole (healthy people are more productive and less likely to spread plagues around, healthy people are less likely to lead to drug-resistant diseases that will kill insured and uninsured both, etc.), we have to pay for it. All the whining about how paying for the benefits you get is somehow "un-American" is the same kind of whining that I hear from a ghetto kid who takes a candybar from a store then, when caught, whines "it's not fair!" Well, kid, you can't just take things for free without paying for them. If you don't want to pay for the benefits of living in a healthy society, fine. Move to Mexico. Mexico's taxes are half those of the United States, so surely that makes it a paradise, right? Right?!

Next up: Why HillaryCare's funding mechanism is inherently flawed... but is still 100% better than Obama's in that at least it is universal.

-- Badtux the Health Care Penguin


  1. Well said!
    O magnificent Penguin.

  2. Did you see this summation at The Left Coaster?

    Holy Cow.


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