Reason being unreasonable

REASON If you look at the political links and blogs along the right hand side of my site you’ll see that there is representation of the Right and The Left. I read from both sides of the isle because I like to be informed when I make a decision and I do not feel either side has a lock-downed perfect version of what works.
If I had to select a political philosophy that most matched my own it would be libertarianism. I have a passionate belief in individual rights and treating all persons equally. Sadly the Libertarians can go too far in the their quest for a pure philosophy and pursue ideas that simply are unworkable in the real world.

Recently I read an article on their blog about health-care and it showed a number of errors, false assumptions, and distortions about health-care in America. The Health-care system in the country is broken and getting worse. Sadly the Republicans forfeited the field to the Democrats by not perusing any reform when they could have.
In this article they argue that if people chose who service they want to spend their money on it is not rationed.
Rationing is all about who gets to make those choices. {Emphasis in the original.}
That’s true in a command situation. The officer in the life boat determines who get how much of the limited supplies, but it’s also rationing when it is not a command situation. Any limited resource is rationed by some mechanism. Price is a form of rationing. It limits the resources to those who can afford it. It is not command-oriented so it is not about who makes the decision but about who is even allowed to.

Moving beyond lakefront homes and steaks, Leonhardt eventually gives readers three examples of current health care “rationing.” The first example is that employers are forced to decide between paying higher wages or providing higher health care benefits to their employees. He notes that the tradeoff between wages and benefits is often “invisible” to employees and thus it appears to them that their compensation is not increasing much.

Of course, the way to avoid this kind of “rationing” would be to just pay the employees all their money and let them buy their own health insurance. Thus health insurance would become “rationed” just the same way that we ration cars and cellular telephones. Allowing consumer choices in health insurance and health care will also help drive down prices and increase the range of health insurance products in just the same way consumer choice operates in other areas of our economy.

This only creates a different form of rationing. Health Care insurers take all sort of measure of eliminate people from the rolls that would cost them money. They deny policies to people with pre-existing conditions, they charge rate so high as to make policies unaffordable to people with health issues, they cap benefits and find way to break the policies people have purchased. If you are making twenty thousand a year you simply can’t afford to pay a thousand a month for health insurance. (And these are numbers I have seen every day at my work.) All of this is rationing and it wouldn’t help our system at all.

The current provision of medical care to the uninsured is Leonhardt’s second example of rationing. This example is closer to the mark since health care for the uninsured is already mandated and/or paid for (Medicaid and SCHIP) by federal and state governments.

This is a argument I see a lot at Reason. The poor can get covered via Medicaid. The writers either are ignorant of how restricted Medicaid rolls are or are simply lying. Everyday I tell patients to attempt Medicaid and I have seen people who are earning less than seven thousand dollars a year with a debilitating disease be denied coverage by Medicaid.

Leonhardt’s third alleged example of current health care rationing is the “failure to provide certain types of care, even to people with health insurance.” The fact that certain health insurance policies chosen by individuals and/or their employers don’t cover certain treatments is no more “rationing” than it is when people choose not to eat a USDA prime steak or pay tuition for a private college education.

It is rationing because it limits the distribution of the resources. The author’s argument about Steaks and Colleges assumes that the people in the arguments have the resources to have those products and chose not to. If you cannot pay for them, the money doesn’t exist for you, you are rationed out from that distribution.

Imperfect as private health insurance markets are, if a customer doesn’t like the decisions made by Blue Cross Blue Shield, Kaiser Permanente, or Golden Rule insurance bureaucrats, he can look elsewhere for his health insurance coverage. But if the government health care scheme becomes a monopoly, when the bureaucrats at the new Health Benefits Advisory Committee decide that a treatment should be withheld, that treatment will be withheld. That’s rationing.

But if all the played in the market are using the same distorted playbook, the buyers don’t have a choice. It is easy to afford health insurance if you are young and health and do not need it, it is nearly impossible to afford it on your own if you are not. Of course insurance is supposed to work on polled risk. The idea being that you have a large pool of people paying for a service that most of them do not need and they cover the costs of the small number who do need the service. To make such a system work you have to have large numbers of people in the pool and all paying. Right now people can opt out and that causes pressure on the insurers to select only those who do not need the service because the pool is too small to sustain the program profitably.

Personally form what I have seen I think Switzerland has a workable system, sadly no one is talking about importing it here and even if they did it would still be demonized as “Socialized Medicine.”


One thought on “Reason being unreasonable”

  1. I think the point that all resources are rationed is lost on most of us today (us being citizens of the US). The fact that the rationing here happens based on our willingness to pay doesn’t register, unfortunately, because that is exactly how things get rationed here.

    I just finished watching “1940’s House”, about a family that agreed to go back in time and live in WW2 England. The series did a great job of simulating many of the conditions that families dealt with during the war and it is one of the few series like this where I think the individuals who went through it actually experienced a great deal of personal growth. I bring it up because rationing figured heavily in to the experience and was discussed at length. According to this show, rationing was being asked for at this time in England because it was perceived as being fair and equitable, as opposed to the persons with the most money buying up as much as they wanted of anything and leaving nothing for poorer folk.

    Regarding Medicaid: It is not that great, folks! I have personally witnessed life-saving dental care being repeatedly denied to a student down here who eventually had to have a g-tube put in because he could not eat safely. Surgery would have given him a much better quality of life and a longer life (he dies before reaching the age of 25) but what was being proposed was being perceived of as being “cosmetic” in spite of the statements of doctors, speech-language pathologists, and teachers that this was not the case. I’ve seen more, but I’ll be brief and stop with this one. I’ve also talked to doctors about it. Both of the doctors report two problems from their end 1) poor compliance with the keeping of appointments by patients and 2) complicated reimbursement processes that caused them to hire additional staff just to deal with the capital to get reimbursed.

    It IS broke. We MUST fix it!

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