I listened to a Soho Forum Debate podcast this week titled: Should The US Have A Public Insurance Plan?
In theory, I’m a big proponent of a public healthcare option. The idea of free or low cost Medicare For All sounds like a great idea to me. Having employer sponsored health insurance (and later Medicare) saved my family from the financial devastation that would have resulted from my wife’s extensive medical needs.
However, my wife’s health care was still expensive and navigating medical insurance was nightmarish. Coinsurance, deductibles, fighting insurance for coverage, negotiating / appealing for procedures, finding doctors & providers, dealing with annual changes to plans and offerings, and much more were just some of the “costs” associated with managing her health insurance and by extension, my wife’s health care.
Getting cost estimates for services and procedures was frequently impossible. Delays for scheduling procedures and care were the norm. Bureaucratic red tape, after the fact arguing over bills and payment issues that spanned years were all part of the experience for us. I’d estimate we spent between 10-40 hours per month managing health insurance issues for 20+ years.
Which makes me wonder – how could I imagine a public option would be better given my previous experiences?
As I’ve said before, if you think the government is going to solve your problems, just consider any government service you’ve been exposed to and how dealing with them has been. If your experiences are like mine at the DMV, registering a vehicle, getting a building permit, appealing a tax assessment, etc. then you know it’s probably going to suck.
The argument from the podcast episode against the private option was best summarized in the line paraphrased below:
“Tweaking around the edges the US Health Insurance System isn’t going to work. We need an entirely different system that has actual market incentives and competition.”
The debater’s argument against a public option is that nearly every other service that is subject to free market forces has gotten better, more efficient and less expensive over the past 50 years due to competition, technology and consumer driven pricing. Healthcare services, products and costs, including insurance, has not. The entire healthcare & insurance system has moved in the opposite direction – worse outcomes, higher costs, abysmal service and terrible customer experiences.
I can’t argue with that.
If I could design a health care insurance program, I think I’d lean toward something that provided coverage for catastrophic events that would result in someone’s death, disability or financial ruin. Basic healthcare services would be priced and sold like every other product and service we buy with transparent prices provided by competitive businesses. People would pay for everyday services like routine checkups, vaccinations and basic care out of pocket.
Health insurance would be more like life insurance or homeowners insurance. It would cover the big ticket items but not be used to subsidize everything.
When I hear people from otherWestern countries talk about their health insurance and medical systems, I’m jealous. Their costs are significantly lower. They don’t worry about going bankrupt, losing coverage or being denied due to profit incentives.
I wish we had a system like that. But we don’t and I cannot imagine we’ll ever get it together to do something like that. I’m a pragmatist. Our population is 5 to 20 times larger than most other Western Countries that offer universal coverage. We also don’t care about other people’s health. Clearly it’s not a priority for us or for our government. The pandemic taught me this lesson. If Covid didn’t provide the incentive for the US to fix our health care system, what else would?
Nothing I suspect.
And so I rant.
But I can’t conclude this post with “we should…” or “we deserve…” or just my whining.
Here’s what I’m doing for myself.
Through unexpected circumstances, I have low cost basic health insurance this year and possibly through 2026. After that, it looks like Trump and Congress’s BBB changes will eliminate that for me.
After that, I won’t pay for an ACA plan that will cost me $24K a year before it covers anything. No thanks. Been there. Done that.
I’ll take my chances and go without insurance. If something is too expensive, I’ll do without it.
After all – what’s the worst thing that could happen?
