“De chacun selon ses facultés, à chacun selon ses besoins.”

A quick rant while I try to get my head around some other issues…

My office held an insurance “open enrollment” meeting the other day. I’ll spare you the gory details as to why this particular meeting was held at this particular time. Those are stories to be told over a beer or two, followed by something stronger. Instead, I’d like to briefly discuss the bigger picture, which is just how incredibly absurd the entire health care system in the U.S. has become.

We spent an two hours in the his meeting listening to insurance salesmen go into grave detail describing the merits of the different plans they were offering. It’s really quite surreal listening to scenarios involving your own death, dismemberment or other catastrophic condition reduced to “how much it will cost you to continue living.” If I were to choose plan A, then this type of care would cost more than if I choose plan B, but I would have to pay a greater amount out of every pay check and even then, there are limits and restrictions and caveats and so on.

The dental plan options were the strangest of all; we were told we could choose an expensive plan wherein we could choose our own dentist, but the amount that the insurance would pay for certain services was fixed and would not be adjusted if your dentist charged more. The other option would be to select a less-expensive plan that would also result in lower out of pocket costs, but our choice of dentists would be restricted to a very few “retail” (and yes, that’s the word they used) dentists who were, for all intents and purposes, directly in the employ of the insurance company.

Based on my back-of-the-napkin math, it looks like it will cost about $40,000 U.S. per year to keep me and mine covered under these plans. I’m counting both my contribution and the company’s. That’s a staggering number if accurate. That is how much money it costs to have an insurance plan that will pay part, but not all, of your medical expenses, assuming you go to the right care givers.

TL/DR; We get relatively little for a great deal of cost and enormous complication.

Here’s the fundamental reason I have a problem with the system: A person’s need for health care is unrelated to their ability to pay for it, and there’s no reasonable way of knowing what your health care needs will be in a given year. Some people will inevitably choose a minimum amount of insurance because they’re absurdly healthy and young, but sometimes the dice come up double-zero and you’re done. The salesmen even perversely pointed out that health care costs are the #1 cause of bankruptcy in the U.S.

Give me a single-payer system any ol’ day. The largest risk pool is the most efficient risk pool, regardless of how much those insurance salesmen mocked the concept. It’s more profitable to pare the pool down and charge people based on their likelihood of needing care, but I really could give two flying fucks for their profit margins. At the end of the day, everyone is going to receive some sort of treatment. The cost for protecting the profit margins of insurance companies is greater suffering by the people who can least afford to miss work, greater risk of epidemics since many people don’t get care prior to visiting an emergency room, and vastly greater cost to taxpayers because they’re picking up the people that can’t afford insurance. If you think that protecting a profit model is worth all of that, then I suspect we’re not going to agree on very much.

And don’t talk to me about death panels unless you want the patented Sir Alex Ferguson hairdryer treatment. Right now, private companies are making decisions as to what health care you’re allowed to have, right up to and including whether or not to “pull the plug.” I’m not saying that the government wouldn’t have similar entities, but don’t pretend like we don’t have “death panels” right now.

Anyone that says “Why should I have to pay for Bob’s health care?” should take a course in empathy, and then, maybe, one in economics. Then they should look in the mirror, because it’s been my experience that people who wear those t-shirts expressing those Randian sentiments tend to be exactly the sort who consume far more health care than they pay for.

Honestly, I’m fine with some people using more health care than they pay for. It is literally impossible to know exactly how much health care you’ll need in a given year, so playing those insurance games of trying to guess what your needs will be are just silly. Just cover everyone under a single payer system and be done with it.

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