Sunday, August 2, 2009

Health Care - Finding the Line

Prompted by the above exchange on Facebook -- just a passing instance of an immensely rich genre of political banter in the USA -- I want to find the straight line of the argument behind the right-wing opposition to paying for health care through taxation. I do not mean to imply that either of us were striving for thoroughgoing analytical rigor here; I take this merely as a prompt.

On one hand, there is a revulsion to "free" health care as an instance of overgenerous social safety protections that create moral hazards -- i.e., people will go running to the nearest provider of medical care the next time they get sick or injured, without regard to their ability to pay its true cost.

On the other hand, there is a claim -- not in the comment cited above, but easy enough to find -- that the costs of such generosity will sink the nation as a whole -- all those profligate, layabout, ne'er-do-well medical-care-seekers and the good, honest, abstemious, tax-paying folk alike -- into a state of profound, ruinous want.

X will be too cheap; X will be too expensive. Am I wrong to see a slight tension between these claims?

I wish to clarify my particular confusion (so to speak) in the light of my recent attempt to destroy a concrete curb with my face. Part of the ensuing medical treatment was a CAT scan, for which I received an invoice declaring the true cost to be $550, but for which I was charged a co-payment of only $15. Note that this was all under the auspices of the private sector -- I am not a public sector employee, nor is my health insurance plan publicly provided.

Under the ethical terms of the right-wing critique of tax-funded health care, what are we to say about this? Specifically, what is to be concluded about the $15 direct expense, the $535 gap between true cost and out-of-pocket, and the total of $550? What would a right-winger with a deep ethical allergy toward giving or receiving subsidies say, and more interestingly, what do such people do?

  • Should I insist on paying the $535 to the insurer?
  • Should I take pains to ensure that the $535 is paid to the other premium-payers covered under the same insurer -- e.g., throw a first-come, first-serve pizza party and invite them all?
  • Should I do some fancy actuarial math to calculate whether the premiums I've paid up to now, including the premiums my employer has paid on my behalf, equal or exceed the $535, and insist on paying the difference?
  • If I do the latter, and it turns out the insurer is "ahead" in the final accounting -- a distinct possibility -- should I demand a refund?
  • Should I take the earliest possible opportunity to drop this insurance coverage and insist on paying true cost for all medical services hereafter?
I repeat the larger questions: what say the right-wingers? And more interestingly, what do they do in circumstances such as these? I would be genuinely surprised -- no, shocked -- if I learned that right-wing opponents of subsidization drop out of private insurance plans. I can cite names of people who have not done so.

I think it goes without saying that I continue to wonder at the magical thinking whereby subsidization among premiums-payers is morally superior to subsidization among tax-payers. I am not convinced by claims that government holds a unique kind of power over people, not here anyway. We're free to emigrate from the USA any time, for any reason we like or no reason at all, and it wouldn't bother me if right-wingers did some of that. I wish them well in their pure, unadulterated, subsidy-free utopia located ... somewhere? Wherever this magical land is, I wish them all the best there.


ab said...

Is it wrong to have a “safety net”? From what I’ve personally experienced, life is capable of shitting on you whether or not you’re properly insured.

Dale said...

Trust me, ab, I find the "thinking" highlighted here as baffling as you do. I can recite the arguments faithfully (not to say I've done complete justice to them here).

I find the arguments laughable, and it puzzles me how apparently serious adults see it otherwise.

Let's be clear, and begin at the beginning: they *really don't like* paying taxes. They apparently spend many a sleepless night tormented with the thought that money they pay in taxes is going to parties who do not, according to some very pinched understanding of desserts, deserve it. Much flows from here.