The Idea of Health Insurance is Goddamn Crazy
I woke up this morning and went to make myself breakfast. Unfortunately it looked like I was out of milk and eggs. Time to go shopping!
First I made sure I was current on my food insurance. Luckily, I was. Unlike some people, I get food insurance through my employer, so I was spared having to shop on the big exchanges. The premium’s a hefty chunk of my paycheck but I think we can all agree it’s worth it for the peace of mind, right?
I used to go to the Stop and Shop, but it’s out-of-network for my current food insurance, so I ended up going to the Kroger. It’s a bit farther and they don’t have the brands I like, but at least the co-pays are low. This year I splurged a little and got on the Platinum Plan, which covers chips and snacks as well as rice and beans, so I could get some flavor in my cart. I got the milk, eggs, sausages, some deli meat for a sandwich later — I don’t want to have to get Emergency Food if I get hungry this afternoon, the copay is murderous. Basic stuff.
At the checkout, the cashier asked me which food insurance I have. I’m on Blue Stalk/Blue Cow and I handed over my insurance card. Unfortunately, the cashier told me that the brand of sausage I wanted wasn’t covered, and I’d have to get the generic sausage instead. I sighed, but what can you do? Nobody can afford to pay out of pocket for sausage except the very wealthiest. I changed it out and came back. My insurance approved almost everything but I had to put back some Funyuns. That reminds me — I need to make sure they approve my Thanksgiving turkey this year, I don’t want to have to get a letter at the last minute.
Still, as much of as a hassle as it is, it’s better than things were before Obamafood. Used to be if you were diabetic, or fat, or just a gamer, you had a “pre-existing appetite” and they wouldn’t cover your groceries. Not to mention that if you hit a lifetime limit on food, they’d stop paying. Someone with a big family who had to make two trips a week was out of luck. Sure, Foodcare for the elderly was good, but you had to make it to that age. Of course, even with good food insurance you’d have an insurance agent scrutinizing every item on your bill and deciding what to cover. “Do you really need that ham?” I guess not — or not enough for it to be covered, anyways.
Sometimes, I wish we had a single-payer food system, where you could just go to the supermarket when you were hungry, pick out the food items you needed, and buy them, and the government would subsidize it via payments to food producers. I guess that kind of far-left whackjob socialism isn’t possible in a great country like ours. We should be grateful for the freedoms we have.
The idea of health insurance is fucking insane. It always has been. It’s a madness that we grew up with, that slowly seeped into our brains. We can’t see it anymore. We can see the symptoms, oh yes, but we are blind to the disease, so even as it wrecks and ruins lives the extent of our proposed changes amount to tinkering around the edges. Until recently whether or not your body was repaired when it was damaged or malfunctioned was tied to who employed you. That’s bizarre, and speaks to a deep illness in capitalism: the worker as machine, whose owner must pay to have it repaired when it breaks down. Obamacare is a huge step up from that, but still nowhere near enough. It preserves the insurance model for health care, which is the fundamental rot at the heart of it all.
The idea of insurance is simple. There are some catastrophic things that can happen. They’re unlikely, but the potential negative impact is tremendous. Fires, floods, ships sinking: all of these can destroy your fortunes in a flash. You can’t possibly pay for the damage, you can’t begin to repair it. But they’re rare. Most people’s houses won’t burn down, most ships won’t sink. By paying a modest, affordable fee, you and thousands of others pool your resources. Whichever of you are unlucky enough to draw the short straw and suffer calamity, the pool pays for it. It’s a wealth transfer: money flows from the lucky who do not suffer to the unlucky who do. But we all agree to it because there’s no way of knowing, in advance, who will suffer. Maybe it will be us. We hedge against that possibility by buying insurance, hoping we will never need it.
Health problems are not a sudden, unexpected catastrophe. They are predictable and inevitable. Everyone who buys flood insurance hopes they will never use it. Everyone who buys health insurance knows that they someday will. Usually, every year. That’s not insurance. That’s not hedging against an unforeseen future calamity. That’s just a payment plan for an essential service you know you’ll receive. If you are simply paying for your treatment, why bother going through insurance at all? Why not just pay your doctor? Well, nobody can afford that. Medical costs are out of control. So the government steps in with a subsidy, so that the money they provide to insurance companies, plus the money you paid, minus the salaries and administrative costs of running the health insurance, is sufficient to pay for medical care.
So what’s the point of insurance, then? It’s just a middleman. It exists to siphon off money. You know you will need treatment, you just don’t know exactly when. You’re not hedging against a risk; you’re making regular payments for a service, except they have to pass through a separate organization first, where a percentage of them are peeled off to pay employees and shareholder profits.
We don’t do this for any other essential service. We don’t do it for food, even though it would make exactly the same amount of sense: everyone needs food, although they don’t know exactly what food they’ll want in advance, or when they’ll be buying it. We don’t do it for police protection. We’ve tried it for fire departments and it ends up with a lot of savable houses burning down while a lot of angry homeowners have to be restrained by the cops.
If that was all that was going on, it would be merely inefficient. That’s bad enough when you’re talking about people’s lives. There’s more, though, and worse. The insurance companies are not motivated by a sincere desire to help people. They are motivated by profit. It must be profitable for them to provide insurance services, otherwise they would go out of business, which means by definition they take in more money than they put out. For their investors it must be more profitable than doing something else productive with their money, so health insurance companies take in a lot more than they pay out. They do this by denying care to anyone they can, however they can. Insurance is just a word for pooling your resources so any small individual can survive a sudden catastrophe. But medical insurance companies are on the side of the catastrophe; they’ll take your money, and they won’t pay out unless they have to. That is more than just inefficient. It is evil.
It is a moral abomination that millions of people will sicken, suffer and die because they cannot afford treatment. It is not “sad.” It is “evil.” The problem is not that these people cannot afford treatment. The problem is that they are not getting treatment. That they cannot afford treatment is a cause of the problem, but the problem itself is that they are denied health care. Therefore, helping people afford treatment, as Obamacare does, is at best a second-order solution. The best and most efficient solution is to just give them the treatment they need. This is the dreaded Socialized Medicine, and here’s how it works: when you are sick or hurt, you go to the doctor, and they treat you. That’s it. That’s everything.
This is paid for by the government. The government doesn’t give you money and then make you give it to an insurance company who gives it to the doctor; the government doesn’t sign you up for a Silver, Gold or Electrum plan. They just pay the medical team, and the team fixes you. We currently pay a staggering amount per capita on health care, and yet our health outcomes — what we are getting for this money — are terrible compared to countries spending a lot less than us. Currently, we give the money to health insurers. If we just gave that same money, or even less, directly to a national health service we would notice no impact in our paychecks, but we would no longer worry about medical care, losing insurance, being denied a treatment, or any of the other million indignities that must be suffered every day in the pursuit of the basic human right of health.
Other people have made this argument and similar ones for single-payer or universal health care. I’m not breaking new ground here. But my point is that the idea of for-profit health insurance is disgusting and abominable. It reeks of evil. It should not be tolerated in the civilized world, not in the supposed “city on a hill.” Opposing universal health care is not just a political position, it is a moral one; it is taking a stand against life, against hope, against goodness. It is an evil act and those people who claim to be on the side of liberation but who deny the possibility of UHC — the Clintons, the Feinsteins, the Bad Dems — are moral monsters.
We wouldn’t tolerate this kind of thing when it came to food. We wouldn’t tolerate Water Insurance, or Mugging Insurance. Why do we allow capitalists to play games with our health care for profit? Because it’s always been this way? Not good enough. Obamacare is teetering. Many exchanges are emptying out because, as it turns out, it’s not profitable to provide health care to sick people, and if you take away insurance companies’ ability to gouge and deny care that spoils all the fun. Obamacare will collapse, not because it was a stupidly designed system, but because it was based on a fundamentally flawed premise: that the insurance model can be somehow wrangled to work in the consumer’s favor, that the profit motive and the public health can both be served without one receiving short shrift. Hopefully, what emerges from the ruins is a true modern universal health care system, and we can join the 21st century.