NTs Are Weird

(this is US-Centric – if you aren’t intersted, no need to read on!)

There’s currently an ongoing debate on whether the US needs to keep the current private-insurance system or whether the US needs universal public insurance.

The whole debate shows that we aren’t understanding health care. We don’t need one problem solved, we need *two* problems solved.

First, there’s routine care. This is the type of stuff, like food, which is somewhat predictable but also essential to life. This is things like dental checkups (not restoration), physicals, vaccines, even non-complicated pregnancy. We have a problem some cannot afford this routine care, and we do need a system – like we have with food – for those who cannot. It would be paid for by people who can afford it. By the nature of this type of need, whether it is privately, publicly, or otherwise universally provided, the vast majority of people will need to pay 100% of what their costs are, plus some to ensure that people who can’t pay 100% can still access basic routine care. Unfortunately, people believe insurance is supposed to make routine care cheap – it cannot do that, as that is a mathematical impossibility. (what can be done is to lower costs of this routine care, but that can be done with or without public insurance – the government can set price caps like they do for utilities, for instance, even when they aren’t the only payer). This has complicated the debate. We need to accept the fact that most of us will need to pay for our routine care, whether that is through a check to Uncle Sam (US Government) or directly paying our doctor or paying some random HMO.

Once we realize that the universal insurance question isn’t about lowering most people’s cost (other policies address that), and that we’re going to have a bit less money each, not more, I think we can start focusing on the other need for financial coverage – emergency, unplanned, and extremely expensive care. Few of us could afford, say, years of aggressive cancer treatment. But, that should be something that all of us can financially access. Doctors should get paid for providing this care. Obviously, some people can afford more than others (some might be able to afford routine pregnancy, as mentioned above, while others would find this amount far too expensive to pay for out of pocket). But the point is that this is a separate issue than routine care. And we can all expect, if able at all, to be paying more taxes or insurance premiums to cover this. But the amount we pay would be small compared to the potential amount we could conceivably use if something bad happened (that’s the point of insurance – not to save money, but to recognize that sometimes an unexpected expense couldn’t be budgeted for, while insurance could be budgeted for).

I truly think we need to ask “Which one of these are we talking about? Are we talking about making routine care accessible for people who can’t afford it, or are we talking about emergency care?” There is a difference, and it does affect public policy. It’s very similar to the social security debate a few years ago – few recognized that there were two programs (a retirement program, where savings could work in many cases; and an insurance program for things such as death and disability, which probably couldn’t be budgeted for by almost any workers).

Now, I’ll give my opinion: We need universal medical *care*. That may or may not have anything to do with universal financial coverage – I really don’t care one way or the other. But everyone has the human right to proper medical care, and we need to change the system to make sure that happens.