Why I Favor a Single Payer System

What is Insurance

Let me define insurance for you, from dictionary.com. “The act, system, or business of insuring property, life, one’s person, etc., against loss or harm arising in specified contingencies, as fire, accident, death, disablement, or the like, in consideration of a payment proportionate to the risk involved.” Now in English: “Paying some money now, when you’re not sick, so that if you have a major accident, the person to whom you paid the small amount foots the bill.” To simplify it even further, it’s a person or a company looking at you and saying, “I’ll bet you $60 a month that you don’t get sick to the point that it costs you $60 a month. If I’m wrong, I’ll pay for the cost of your sickness.”

Insurance is basically a bunch of people gambling on your health and then redistributing the money they get FROM the healthy people (who don’t end up costing $60 a month) to the sickly people (who DO end up costing more than their monthly premium). You, the customer, then get to say, “I think it’s worth $60 a month to have someone pay for my cancer treatments, should that occur down the line.” Or “I don’t think it’s worth that. I’ll forego the insurance and take the RISK of paying for my cancer treatment myself, should that occur.”

The insurance company makes money by covering enough people who don’t get sick that they take in more money than they give out covering the people who do get sick. They look at each person and make a risk assessment. The more they offer to cover, the more they’ll charge you each month.

The three points to notice that MAKE insurance what it is: (1) It is a voluntary agreement by both parties. (2) It is individually based on risk. (3) It is meant to cover “specific contingencies” (according to the definition) not overall health and upkeep.

Without these three things, what you are talking about is not health insurance; it’s health care (or it’s enslavement or theft if number 1 is missing). Health care is something everyone ends up doing… caring for their health. You pay for your health care in many ways. Eating every day is a form of health care (you die if you don’t do it) and you PAY for that health care with money (that’s what the business called “grocery stores” is all about). Sleep is a form of health care and you PAY for that health care with time. Exercise is a form of health care and you PAY for that health care with time and energy.

Some forms of health care are goods and services provided by a separate individual from yourself (e.g. a doctor providing his opinion or expertise with a scalpel) and some forms of health care are goods and services provided by you for you (e.g. sleep).

But, there is ALWAYS a COST to health care. Someone always has to pay something.

A Single Payer System

Given these realities, how do we best live in this world? What system best suits the reality in which we live?

I think the best system of health care (not health insurance) is what I call a “Single Payer System.” But, this might surprise and shock you: that “single payer” is the person who uses the health care service.

WHAAAAAA? Crazy, right? Someone pay for the goods and services they use? Perish the thought!

I know everyone reading this just changed their opinion about the post. If you liked it before that paragraph, you hate it now, and vice-versa. Before I start addressing your opinions directly, I have three points to make.

1) The Actual Costs of Health Care Services

The cost of professional health care services is actually much lower than the current “out-of-pocket” price. The cause of this is third-party payment (i.e. insurance is paying for everything nowadays). An average ACL tear gets billed for about $25,000-$30,000, but the actual cost to run an MRI machine, and the medical professionals to perform the 2 hour surgery and help through recovery, is much lower than this number that appears on the bill. (I’ll explain why in a minute). But for now, grant me that I’m right and the true total cost of these goods/services is closer to about $5,000.

2) The Goals of a Health Care System

We must establish the goals of a health care system. For any good or service in an economy there are three basic goals: (1) Wide availability (2) High quality, (3) Low cost. The best system is the one that achieves all three to a high degree of success. It’d be great if all three could be achieved perfectly, but that’s not going to happen. This basic economic truth applies in health care. How can we make the best quality of care at the lowest cost possible available to the most people? My answer is this: promote competition. Give health care service providers (medical professionals) the freedom to compete for your patronage. If Dr. A is charging $25,000 for an ACL repair, and he says “I’ve repaired over 1,000 ACL’s successfully,” and Dr. B is charging $4,000 for an ACL repair and he says, “I’ve repaired over 100 ACL’s successfully, and one unsuccessfully,” but you the consumer are paying for it all, you get to decide which one you want to buy.

Personally, I’ll go for Dr. B. (And I’ll bet you that most people will too!) Pretty soon, Dr. A has no customers and says, “Fine I’ll do it for $5,000!” and suddenly people think, “The added experience is worth an extra $1,000. I’m going to Dr. A.” And by this time, Dr. B has successfully performed another 800 ACL repairs. So, the same services at an increased overall quality end up at a lower overall price.

This is a simplified example, but it communicates the point. Competition for customers is how you produce the highest possible quality, at the lowest possible price, available to the largest number of people.

3) Health Care is Not a Human Right

We must not believe the lie that health care is a human right. It simply is not. Particularly, the external services someone else provides are not a right. You are not entitled to someone else’s goods, services, time, or money. You’re not even entitled to the basic health care service like food! You have to pay for it with your labor if nothing else. Health care is not a human right; it’s a human responsibility.

What’s more, you don’t always get what you want, and, contrary to the philosophy of The Rolling Stones, you don’t always get what you need. (People still die, even when they get the best possible health care humanity can provide. This is why the Gospel of Jesus Christ, that you can beat death if you believe that Jesus is the Christ the son of God and, by believing, have life in his name. But if you don’t want to believe that, we can argue it some other time.)

This is where conservatives often get accused of being heartless. No, they’re simply being realistic. They recognize the cold hard fact that everyone will die and everything costs something, so they operate within those bounds (or as some people call it: reality). It is not loving or kind to pretend that services have no cost (be it monetary or otherwise), it is not loving or kind to pretend that sickness and death will cease to be (they won’t until the second coming of Christ), and it is not loving or kind to pretend that pain excuses all behavior, or gives you the right to take someone else’s stuff. Theft (of goods or services, even at the hands of the government) is wrong. Period. Even if you’re starving, and you steal food to survive, it is still wrong to do. Someone’s circumstances do not change the moral nature of theft. This is also where conservatives get accused of heartlessness, because they forget to speak up for personal charity. Just because conservatives think the starving thief is still a thief, it doesn’t mean they want him to stay starving… they just don’t think legalizing theft is the best way to fix the starvation.

Most conservatives are quite generous on a personal level. They want to give, and do give, a lot of their own time, energy, and money to help alleviate societal woes like poverty and sickness. They form charities that help the needy and volunteer at churches and other altruistic organizations to give people food, and the conservatives go so far as to pay for it themselves, all so that the starving person won’t stay starving but resort to theft either. True conservatives believe in unbelievable generosity on a personal level, but believe in basic moral principles on a policy level.

Your Objections

So if you still hate me because I favor people paying for the health care they use, let me answer some of the objections I’m sure you’re thinking:

  • What about those who just can’t afford it?

What about the single mother with a minimum-wage job, who is just trying to make ends meet and then trips and tears her ACL? How is she supposed to pay for a $2,000 MRI and a $20,000 surgery? How can you be so heartless?

Here’s where I explain why that surgery doesn’t actually cost 25k. The reason is that health insurance has tried to become health care. Look on any insurance claim and you’ll see an amount billed, an amount negotiated by insurance to be paid, the amount paid by insurance, and the amount paid by you. Don’t gloss over that negotiation part. It’s usually labeled “Negotiated Savings” on your medical bill.

There are two parts to this economic truth: 1st the cost rises, and 2nd the cost is negotiated down. Let’s deal with them separately.

Why do costs rise when insurance gets involved: It goes like this, the doctor says to you, “That surgery will cost $5,000 total.” You say, “What? I can only afford $3,000!” Then the insurance company says, “We’ll cover the difference. Just perform the surgery.” The Doctor says, “Oh, did I say $5,000… I meant $10,000.” The insurance company says, “Okay. Like we said, we’ll cover the difference. Just bill us. We’re taking care of our patient!” Doctor: “I’m sorry, there’s an echo in here. I wanted to be sure you heard correctly the cost is $15,000.” When a third party gets involved as a money-bag and a secondary provider, and the actual provider knows he can charge more without the threat of losing the customer, he charges more.

Why do they get negotiated down: The insurance company says, “Look, you and I both know it doesn’t cost that much. Yes we’re going to use the service no matter what, but if you gouge us too much on price we’re gonna sue you for more than your profit margin, and we’ll win.” The Doctor says, “Okay, okay, well, just match the patient’s costs. Make it $6,000 total.” That way, the doctor still makes more than if he just worked directly with you, the customer, but he doesn’t get sued. What does the insurance company then do? They turn to you and say, “Your risk has gone up, so your monthly bill will go up to reflect that.”

You put these two realities together, add in regulation after regulation saying insurance companies have to charge this, and can’t charge for that, Have to cover this and can’t cover that, and you can’t go to this doctor or across state lines to increase competition, and doctors have to provide this, and can’t provide that, and we have to pay people to enforce these regulations, and the doctors lose money by providing one service that isn’t needed and has to make it up somewhere else, and you have to pay the insurance people, and the government people, and the doctors, and the nurses… and finally you get to where we’ve gotten.

Again, yes, this is over-simplified, but the example is roughly what’s happened. The end result? An ACL surgery “costs” 5 times more than it actually costs and you’re stuck paying ridiculous premiums for services you don’t want because the government regulations say you “need” them.

Whereas, if you were allowed to maintain your position of control as a consumer and say to a doctor who tries to gouge you, “No, I’m not going to use this service. Some other doctor will take my business and charge me a fair price,” then costs would go down and insurance companies would be doing what they were always supposed to do: insure against specific contingencies.

This is where the single mother who doesn’t have insurance (her choice) comes back in… In the system I am proposing, she would be required to pay the actual cost of the service (about $5,000 give or take) and if she can’t afford it, she has two recourses: (1) be at the mercy of the personal charity of others (i.e. call her rich friend from church, or appeal to local charities to give her money to pay for the surgery… which quite often will exceed all needs raised). This is often viewed as an insufficient answer because of the uncertainty. There’s no big brother there guaranteeing that she will have her surgery paid for. Correct, there is not. She is definitely at the mercy of charity, and sometimes, charity doesn’t come through, but that is a small minority of the time, and I would argue that a guaranteed free but crappy service is not any better than no service at all. Or, (2) not use the service and become one of the marginal few for whom the system does not work at all.

So the blunt, harsh, reality-based answer to your actual question is: they might not get what they need. It’s still better than the alternative. There is a possibility in this system that your leg, or her leg, doesn’t get fixed! And yes, I still view this as a much better system than any other out there. How can I say such a thing? How is this better than the government controlling your health care? Whic leads to the next objection…

  • Why is a few people not getting health care better than everyone getting health care?

2 reasons: (1) Freedom is preserved. Freedom is at the heart of the philosophy of Western Civilization and this country. Americans should have the freedom to choose between two alternatives and accept the consequences and responsibilities of each choice. I think preserving freedom is worth many costs, up to and including my life. (2) Life isn’t fair. Operating a system that pretends like it is fair would be cruel and wrong, and this system doesn’t pretend as if life is fair. The simple reality is that the world isn’t perfect or fair, so some people are going to lose. When this reality is accepted, the question then becomes, “How many people, and how are they losing?” I contend for a few people losing a lot (very few people who just never get any health care) instead of everybody losing a lot (everyone in society getting extremely low-quality or high-cost care). This answer usually yields the next objection I hear, which is…

  • How can you be so heartless?

I don’t think I am being heartless, I think I’m recognizing and working within the bounds of reality. Denying reality for the sake of someone’s feelings is not loving or kind. Denying reality would be heartless. Pretending like everything is free, or pretending like life is fair when it’s not is incredibly cruel. Recognizing reality and trying to do what is best (as I’ve defined above… I think “what’s best” is contending for the system that provides the highest quality possible at the lowest cost possible to the most people possible) is the opposite of heartless. I learned a long time ago that communicating to people the harsh reality of the world in as clear a way as possible, instead of lying to them to spare their feelings or make them like me more, was actually the loving and heart-full thing to do. So I do it. I’m okay being perceived as the bad guy if it means the truth was spoken. Perception is not reality. The real question is, “Was the truth spoken?”

As an addendum, I don’t want to be unnecessarily harsh for the sake of harshness. Simply being mean is not my goal; getting the truth stated as clearly as possible is.

As a second addendum, the following scenario has happened to me enough times to bring me to this conclusion of “being okay being the bad guy.” The scenario: I say something true in a clear, but admittedly offensive way (but necessarily so). Someone reads my words and communicates to me in no uncertain terms that they think I am human scum and wish my death would come about in horrifying and brutal ways. This person exits my life for maybe a week, maybe a month, I’ve had it happen once that it took a year, but eventually that person comes back to me and says something along the lines of, “I was so offended by what you said, but you know what? It stuck in my mind and forced me to think about it. I eventually came to the conclusion that you were right. I needed it said that way to make it stick I guess…” This has happened to me enough times that I have concluded that it is best for me to just say what is true, and if people think I’m heartless because of it, then I accept that reality and continue on. I’ve learned to trust the opinion of a few people who are close to me, who know me well, to tell me when I’ve gone too far. The rest of the opinions I take with a salt shaker (because a grain usually isn’t enough.) Reading my post “About the Blogger and the Blog” might further explain my reasoning behind what and how I write. If nothing else, it lets you know that I am aware of how I am often perceived and it is an intentional philosophy… even if you disagree with my approach.

  • Why not have a Single Payer System (the way Bernie Sanders means it)?

Simply put, that system will not provide the highest quality care at the lowest cost to the most people. It is concerned only with the last metric, “the most people,” but ignores the product it is producing. A single payer system ignores the first two qualifiers, “highest quality and lowest cost.” I freely admit that socialized medicine provides health care to more people than a free-market system. But there are a lot of adjectives I would attach to the words “health care” in that last sentence, none of which could be confused with the words “quality” or “good.” Socialized health care provides all the people with either a much lower quality of care or the same quality of care at a much higher cost. It boils down to, I think it’s better to have a cheap but quality system that does miss a small portion of the population (one in which freedom of choice is preserved) than to have a poor quality, medium-to-high cost system, that misses no one in the population (and in which freedom of choice is removed). The total “cost” (both monetary and philosophical) is much greater for the Bernie Sanders Single Payer System than it is for a free-market system.

Conclusion

This post is getting rather lengthy, but I’m not really sorry about it. I get passionate about things that matter. I like talking about things that are true. I want to see general society think through the reality of health care, and health insurance, and understand what they’re actually asking for when they ask uncle Bernie to give them free medicine. I want them to see what the actual cost is. Nothing is free except the free gift of God. What they’re actually asking for is slavery. Little by little, we give up our freedom for the promise of protection, and one day we wake up and realize we no longer have freedom or protection. That is the eventuality I want to prevent.

At least I’ll have guns to ward off my tyrannical government when they come. Don’t know what you leftists are going to do, though. 😉

 

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