Who does not want health insurance? Raise your hands.

Posted by BMS on Monday, January 7, 2008 at 2:53 am

In a recent opinion piece (or here), Betsy McCaughey, former lieutenant governor of New York and current adjunct senior fellow at the Hudson Institute, raves against mandatory health insurance, in fact she claims to know the “Truth About Mandatory Health Insurance”! This is accompanied by a caricature by Chad

Crowe, worthy of a feature in ‘How to Translate Polemics into Art’.

“Requiring catastrophic coverage (our parents called it major medical) probably is smart“, Betsy muses, but, in brief, comprehensive coverage would not solve overcrowded emergency rooms, and anyway many uninsured are immigrants (and – sarcasm intended – we know most of them are illegal = do not deserve health care) and healthy people should not be made to pay premiums covering the risk of sick people.

First, I doubt (and for her sake I hope) that Betsy has set foot in an ‘overcrowded’ ER in an inner city hospital recently, other maybe for a brief cameo appearance. I am not saying that giving everyone health insurance tomorrow would make this problem go away. But as someone who has trained at institutions running such ERs, I can attest to the fact that many (not all) visits are due to lack of preventive care, proper education and the availability of health care providers that actually see patients (the one’s that cannot pay beaucoup $$$).

Second, the notion that healthy young people should not pay more for healthcare than they consume is exactly the problem that has been bogging down the US system. Other countries have widespread or mandatory insurance – backwards places like Western Europe, you know – many of which the WHO rates better than the US on healthcare (France is No 1, Italy No 2, Spain No 7, Austria no 9, Netherlands No 17, UK No 18, Germany No 25, Canada No 30…. the US is a distant 37th). And by the way, the US also is not top of the list when in comes to fairness of financial contribution, as stated in the same report (the front runner here is Colombia, and there are 7 European countries in the Top 10). In Germany, for example, everyone shares the cost of healthcare, insurance is mandatory – the underlying principle here is called solidarity. And no, Germany does not have socialized medicine, and if you think solidarity sounds socialist, then read its definition here and un-wash your brain! It is basically risk sharing. If only the ones with the risk end up paying for it then healthcare can never be affordable for anyone even with a decent income – unless your are young (i.e. low risk) and healthy, which is not the majority of US citizens. Thank goodness that in the US, most young people will become old people later in life and thus consumers of healthcare (it would probably help if you could take your insurance from job to job). And yes, if you make lots of money and do not buy health insurance, you are probably either extremely shortsighted or fatalistic.

However the mean household income in the US is a somewhat meager $40+ k, and provided you do not have insurance through your employer, according to the Kaiser Family Foundation, an average family plan will run at ~ $11,000 (Oh, and a few thousand on top of that may be your deductible/co-insurance). Does that sound affordable?

That is not to say that healthcare consumers should not share responsibility , i.e. live healthier lives, for which many may need incentives (not punishments).
I think if US citizens – and their leaders – are not able to think out of the box of their Suum Cuique (“to each his own”) mentality, we are heading for healthcare Armageddon. And it won’t matter if we start with 23.7 million uninsured (Betsy, how is that number any better than 43 million?) or more, it’s going to go up, fast.

Crossposted at Stupor Cordis

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Category: a day in the life of a practicing physician,integrity & the medical profession,medical education,public health

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