All of us put our money into a big pot, and when you have medical expenses, you take some money out of the big pot.
That—in 25 words—is everything you need to know about health-care insurance.
This is no different from the Golden Rule, originally formulated by Rabbi Hillel, who added, “The rest is commentary.”
But here’s some commentary.
Those who are sick will have enough money to take out of the pot because many who put money into the pot will not be sick and won’t need any money.
Those who typically won’t get sick—the young, a healthy portion of the aged—are buying an insurance policy in case they fall off a cliff or win the unfortunate lottery and get something like cancer or Parkinson’s. (And if you keel over suddenly from a heart attack, you won’t need any of the pot money either.) This is no different from the millions who have been driving for decades, paying their automobile insurance premiums, but never had an accident. It’s nice to know the money will be there, on the off chance you will need it.
If only sick people put money into the pot, there will not be enough to pay for their illnesses. That’s why everyone needs to be in the pot.
Some of us don’t put our own money into the pot, because our employers will do it for us.
Others don’t put our own money into the pot, because we don’t have any money. So we adjust the amount of money from those who have it to make sure there’s enough for those who don’t.
What about insurance companies?
I don’t understand why they need to exist in their current form. Basically, they exist to mind the pot—or their own private pots. They spend loads of money trying to induce people to put money into their pot rather than their rivals’ pots. So, cumulatively, there’s less money in all pots. Since their pots are private, they take some money out of their pots to pay those people (shareholders) who own the pots. And because the pot owners want as much money as they can get, the pot managers come up with reasons why you can’t take money out. Doctors and other health-care providers have to hire people to argue with the pot owners about getting pot money—which means there will be less money for the pot.
All you need is a computer to regulate input and output from the pot.
I tend to believe that there should be only one pot—single payer. It’s simpler. There’s less overhead. You get to choose your own doctor and make your own decisions without government interference.
Medicare, essentially the one-pot system for those over 65, is—along with the VA, another government system—the most popular government program. As a health-care provider, I can attest that it is the most hassle-free reimbursement vehicle, and that if there were Medicare for all, all those people in doctors’ office who spend their days arguing with the private pot owners could be put to more productive uses.
Medicare for all is, in fact, a form of socialism. It is socialized health-care insurance. The health care system itself will remain largely private.
But I am willing to accept the idea that Medicare for all—or another single payer system—may be a bridge too far in our political terrain. So taking a cue from places like France, or Japan, or Germany, or Korea, or Switzerland, I’m willing to accept the continued existence of insurance companies as long as they—like all of the aforementioned countries—mind their pots on a nonprofit basis.
In these countries, everyone is covered, and nobody goes bankrupt. Inability to pay medical expenses is the number one reason for bankruptcies in the United States.
And we rank behind all other industrialized countries in health care outcomes—pesky little things like life expectancy and infant mortality.
What about doctors?
One of the reasons why Medicare works is because its huge pot can demand lower rates, meaning less money is needed for the pot. Doctors like to complain about this, but they don’t imagine a world without Medicare. Would they be driving their BMWs and Lexuses if the millions of the elderly had no Medicare? I don’t think so. Who would be paying for their tax deductible auto leases?
Another problem is that doctors graduate with huge loan liabilities to pay for the hundreds of thousands of dollars their medical education cost. This is why there is a glut of highly paid dermatologists and a shortage of less highly paid primary care physicians.
I’m all for a program that would pay for the medical education of a majority—if not all—doctors in exchange for five years of public health service.
And so they won’t feel deprived compared to their peers who went before them, as part of the deal, they will be granted the luxury car of their choice.
I hope it’s an Escalade.