Health Insurance and Care: An American Strategy
Americans are generous -- period. That is the key to resolving the problems of health insurance and care.
First up is the nonexistence of insurance coverage for millions of Americans -- the uninsured. Presented with the reality or threat of suffering, and given the chance to respond, Americans give their time, treasure, and talent.
Kirsten Powers is a columnist and political pundit who, upon learning her insurance premiums would double as a consequence of the Affordable Care Act, indicated that although it was inconvenient, she doesn't mind if it means the uninsured are covered. Let's take Ms. Powers at her word and reasonably assume that there are millions of Americans who hold similar views -- after all, we have been told ad nauseam that Americans are happy to pay higher taxes. With this in mind, rather than subjecting Ms. Powers to a 100% increase in premiums, why not give her, and millions like her, the option to match up with and adopt an uninsured American? If many can afford to be just half as generous, prepared to endure a 50% increase, then they can match up with and adopt half an uninsured American. If many can afford to be just 10% as generous, then they can match up with and adopt one tenth of an uninsured American.
Or people could contribute to charities whose mission is to help the uninsured. A private-sector InsuranceMatch.com would be built and running smoothly in two weeks, tops. HealthMatch.com and HHSMatch.com would quickly follow with competing services. The uninsured would register, enter the quote received from the insurer, and present their situation -- perhaps in video format. The adopter would browse the site for potential candidates, filtering by premium cost and perhaps zip code, eventually leading to a suitable match. Premium contributions would be made directly to the insurance company, greatly reducing the volume of fraud (but more on that later). Ideally, the donor and recipient would live in the same town or county. There could easily be an option for anonymity at both ends. Nonprofits would spring up, offering to find a good match. Icing on the cake: Ms. Powers and the millions like her would experience not just the joy of charity, but confidence in their sacrifice of treasure going directly to the recipient.
Next up are the many Americans who, because of pre-existing conditions, are unable to purchase insurance -- the uninsurable. Let's be clear: any attempt to force a pre-existing condition on an insurance company is nonsense, be it a crashed car, a burned building, or a broken body. Pre-existing conditions and insurance are incongruent. In all such situations, the uninsurable can be helped only by placing the case before first his family, then his community, then local charitable organizations, churches, etc. -- and on up the line, until the necessary funds have been raised. This is nothing new, and Americans are very good at dealing with it.
Next are the escalating rates of insurance and care -- the cost curve. Regardless of political persuasion, everyone agrees that the situation is deplorable. Conventional practices like including insurance as employee compensation should be abandoned. Employer insurance was ill-conceived at the outset and a consequence of overreaching government through wage and price controls. Regulations, like preventing insurance purchase across state lines, that discourage competition must be removed. Any rule or policy that hinders free-market solutions should be scrutinized. Do obstacles for more medical schools, artificial caps on medical student enrollment, and excessive certification requirements really benefit the consumer?
If your car suffers a fender-bender, you can gather estimates; consider the pros and cons, known only to you; and choose to pay for the repair out of pocket. If you suffer a broken ankle, why are there not the same options? Why isn't there a chain named National Radiology that specializes in MRI and C.T. scans? Why isn't there a National Orthopedics next door? If free-market competition drives down the cost of car repair, why would it not cut health care costs? We get premium breaks from auto insurance providers for good driving records. Why do insurance providers not offer monetary incentives to those who improve their health by lowering weight, cholesterol, and triglycerides, and improving blood pressure? In 1973, a cell phone weighed 2.5 pounds and cost $4,000; forty years, later a cell phone weighs 4 ounces and costs $25. The same free-market forces must be unleashed on health insurance and care.
While these solutions would go a long way to solving the current problems, the situation will never be perfect. There will always be fraud and those who fall through the cracks. One can imagine a scam whereby an individual might arrange multiple policies, getting kickbacks from unethical insurance agencies. But the opportunities for deception pale in comparison to those available within the Affordable Care Act, which involves tens of thousands of IRS employees, navigators, and bureaucrats.
The less space there is between the giver and the receiver, the less chance of deceit. Just as a surplus of beds and shelters does not guarantee the absence of homeless on the streets, there is no flawless solution that will provide insurance and care for all. But we accept less than perfect all the time. Each year in this country there are over 30,000 fatalities and four million injuries due to automobiles. Mandate that all vehicles be restricted to a speed of 20 miles per hour and these numbers would change dramatically -- not to mention the savings to health insurance and care. But it's not going to happen, because we accept the benefits and tolerate the cost.
This strategy is flexible, fast, voluntary, and free of burdensome government bureaucracy and taxes. Better than all that, it's American.