The Health Care Debate. Do we need more socialized medicine?

I have mixed feelings about this issue.

We have a screwed up system.

For example, I pay around five grand a year for my health care insurance. Just mine. In order to keep my premiums down (!), I have to have a very high deductible -- fifteen hundred bucks.

This results in me essentially not having insurance for anything other than major medical disasters since I'm going to have to go out of pocket for anything which isn't a serious medical problem, and if I have a serious medical problem, I would be able to receive medical care for it whether or not I had insurance.

Huh.

And, in the event that I had a major medical disaster, having insurance isn't going to prevent the inevitable financial disaster, since, like most, I don't have any "nest-egg" to pay my other bills while I'm in the hospital or rendered incapable of working. (Of course, if I didn't have to pay five grand a year, perhaps I could have, over the past several decades of paying that sum, I could have saved enough to tide me over, but, then I wouldn't have insurance and the medical disaster would kill me financially.)

So, in the event of a major medical disaster, I'm pretty well financially doomed with or without insurance.

Huh.

Private insurance spreads risk. People like me who never make claims but pay premiums pay for those who make claims. Private insurance companies (in general) make their profits by taking in more in premiums than they pay out in claims. This provides incentive to delay or deny claims which are properly promptly paid. (Anyone who has had to fight with their insurance company over whether or how much to pay on a claim is familiar with this truth.)

Public insurance doesn't spread risk. Public insurance has a budget. Public insurance, accordingly, rations care. It is the inevitable outgrowth of having a limited budget.

So, no matter if you have insurance or if you're on public insurance (such as Medicaid), you're at the mercy of your insurance provider as to when or whether your particular medical needs will be paid for from a source other than out of your pocket. In the end, both are run by accountants.

Huh.

We all know (or should know) that the government doesn't do anything especially well. Trusting our medical care (a.k.a. our lives and the lives of our loved ones) to the government seems a chancy choice. But, we know that the government will be there tomorrow. (And, if it's not, our medical care is the least of our worries...)

We all know (or should know) that competition between private enterprises results in lowered costs and better service. Of course, it also results in extinction of those who cannot compete or who make bad business decisions. (Ask A.I.G.) We can wake up tomorrow in the hospital staring at an unpaid hospital bill because our former insurance carrier no longer exists.

Huh.

In the end, I have to come down (marginally) on the side of private medical insurance with the "safety net" of public insurance for those who cannot afford private medical insurance -- essentially what we have now.

What "tips" it for me is this: when the bean-counters count their beans and ration care in a public insurance model, they tend to concentrate on rationing (or eliminating) the most expensive care for those who will, if they receive the care, least benefit from it, i.e., those in the last six months of their lives. Further, those bean-counters will ration testing, since much testing results in no medical benefit other than ruling out medical conditions. (Pittsburgh has more MRI machines than exist in the entire country of Canada for example.) Public insurance isn't a fan of "experimental" medical procedures or medicine.

Private insurance companies don't like to pay for testing any more than the government, but, unlike the government, they can be sued in an effort to force them to adhere to the terms of the insurance contract. Private insurers can be forced to pay the huge costs associated with a person in the final stages of their lives -- the government can't. Whether a medical procedure or drug is "experimental" can be decided by a judge or jury rather than a bureaucrat.

So, what tips things for me?

Lawyers.