No Free Lunch

Before we look at the future of healthcare, let’s take a look back at how we got to where we are today. Let’s also begin with what should be obvious, but no longer is, and that is that healthcare is not a right. Period. One rough definition of a right is that it cannot be something with a monetary value, and that certainly doesn’t apply here.

When we speak of healthcare in this context, what we are really talking about is healthcare insurance. Mixed in with that is the question of who pays for healthcare. In the end, someone has to pay, so the real question is this: Should the person who receives the benefit pay for the benefit, or is someone else to be burdened with that cost?

Why does our health care in America cost so much? There are several reasons, but a big one is that we demand nothing but the best, with little regard for what it will cost – a direct result of an insurance system that gives the individual no incentive to make the kind of normal cost/benefit decisions that are made with every other transaction in normal life. If “someone else” is paying the bill, then there is 1) no incentive to comparison shop, 2) no incentive to defer treatment that might not be necessary, and 3) no incentive to live a healthy life style. Pharmaceuticals can be incredibly expensive, but we like to ignore the expensive testing that is required before any new medicine becomes available for use. TANSTAAFL (“There Ain’t No Such Thing As A Free Lunch”) applies.

Medical insurance long ago stopped being insurance – it became a form of pre-paid medical care paid for by someone else (typically an employer). Real insurance is a risk-sharing plan where people essentially pool their money to take care of those relatively rare cases where one faces a medical issue that is 1) unexpected, and 2) beyond any reasonable ability for an individual to pay without financial ruin. Insurance is not for the normal medical care that any reasonable person should expect and anticipate and budget for.

If we treated auto insurance the way we treat medical insurance, we would demand that our auto insurance pay for new tires, oil changes and lube, worn CV joints, and other normal repairs that are just an expected cost of ownership. No one should expect that 1) they will not need medical care, or that 2) someone else should pay for it if they do.

With that background in mind, let’s look at the big picture of what government policy should be regarding health care.

Let’s hit the big question first: Should government be in the business of providing health care? No. That was easy. Is it politically attractive? Yes, it is a winner to the mob. Everyone who is OK with having someone else pay their bills is all for government-run healthcare. Sadly, the majority of people today have become so enthralled with the Leftist idea of entitlement and “soak the rich” that politicians flock to the idea. It gets votes. It gets votes because people are so short-sighted that they don’t care who pays for it or when, as long as it isn’t them and now. That is the thinking that has saddled future generations with the debt of previous spending (i.e., vote buying). “Future generations?” – the future is now for today’s youth. That kind of deferred indebtedness is what my generation – the Baby Boomers – is widely, and rightly, criticized for, yet I still see calls for this same “let someone else pay for it” from younger generations. Nothing changes.

So, if government-run, or even government-involved healthcare is a really bad idea, then what is the solution? To quote Thomas Sowell, “Much of the social history of the Western world over the past three decades has involved replacing what worked with what sounded good.” Healthcare is a perfect example.

One of the primary functions of fraternal organizations used to be to provide a form of health insurance to their members [ source: http://www.freenation.org/a/f12l3.html ]. These fraternal organizations each shared a common bond among their members, whether by race, creed, religion, or other commonality. They could accept or deny based on their own criteria. As closed and private organizations, they were able to closely monitor the claims of their members to assure that the system was not being abused. There was a powerful incentive to keep it efficient and eliminate abusers, while the common bond of the members provided a powerful incentive to offer compassion even when the price tag was high. Compare that to a system administered by faceless bureaucrats with no personal funds at stake.

Up until I turned 65, and was required by law to be in the Medicare system, I was part of a Christian medical cost-sharing program. There are several of them, but the one I used was Medi-Share. My wife is still part of that program and will continue until she turns 65. Having had my own business for the past 24 years, employer-funded medical insurance was not an option.

As a private organization, they have every right to set their own criteria, and those criteria are aimed at providing incentives to assure that members lead a healthy lifestyle and thus keep the costs down. Some examples:

• Must be a professing Christian, subject to verification by the minister of the local church.
• Must not abuse alcohol or tobacco or other drugs.
• Physical exam required, and there are financial penalties for being overweight, high blood sugar, or other conditions that can be corrected by lifestyle changes. Meeting those goals through lifestyle changes removes those penalties.
• No coverage for treatment linked to alcohol or tobacco or drugs.
• No coverage for injuries sustained in a vehicle accident in which you are the driver or passenger in a vehicle where the driver had been drinking.
• No coverage for abortion or complications from abortion.
• No coverage for injuries while riding a motorcycle without a helmet.
• No coverage for injuries when participating in activities reasonably known to be high risk.
• No coverage for pregnancy outside of marriage.

Each of these requirements involves a conscious choice by the member – a major factor that is missing in “regular” medical insurance today, and certainly in any government program. Every similar program has their own set of criteria, so each person can find the one that best suits their needs. Is the criteria tough and exclusionary? Yes, of course it is. That’s the way it is supposed to be. It sets a high standard so that the members have low cost coverage by encouraging a healthy lifestyle and not having to subsidize the bad choices of others.

What about Preexisting Conditions? The way that Medi-Share handles it is that Preexisting conditions are not covered at all during the first seven years, but then an increasing percentage of coverage begins until the point when all preexisting conditions are covered. Is it “fair” to deny coverage to someone with a preexisting condition? Or to ask it another way, is it fair to those already in the program to have to pay for someone who just joined knowing they were going to be a drain on the system right from the start? There is an incentive to join early and contribute to the fund before the need arises – not always possible, of course, but it’s still a valid issue and it goes back to the whole question of who is responsible for paying for an individual’s medical care.

One can come up with a long list of “But what about” cases, and the Left excels at such tactics. If you’re looking for a solution that is “fair” in every case and accounts for every possible situation, then you’re not going to find it. The best option for healthcare is really just an extension of Freedom of Association. Credibility and consistency demand that we advocate for such a system rather than pander to those who believe the socialist lie.

TANSTAAFL – There Ain’t No Such Thing As A Free Lunch