One of the clear policy differences between Barack Obama and Hillary Clinton (and between Obama and John Edwards) is related to their plans for universal health care. Although both Democratic candidates for president have promised to make universal health care a reality if they are elected, they disagree philosophically on whether or not health insurance is something that should be mandatory -- a nice way of saying "forced" -- or not. Obama wants to correct the flaws in the present system which lead to people being unable to get insurance because of the high cost of premiums or because no health insurance company is willing to offer them insurance. From Obama's perspective, health insurance is something almost everyone wants, but it is also something which not everyone is currently being allowed access to. Thus, Obama thinks that government's role in health care reform should be to tear down the barriers which are preventing people from getting insurance. People who can't afford health insurance will be subsidized; people denied insurance from private companies will have access to a national health care plan, like everyone else. Obama draws a line at having government force people to have health insurance, although he does insist that all children be insured. Clinton and Edwards don't draw that line; in fact, they believe it would be wrong to let anyone go without health insurance, even if certain people don't want to have insurance.
I think the pivotal question here is whether or not people have the right to make decisions that might be wrong or dangerous to themselves and costly to society. As individuals, most people would undoubtedly prefer to have as many choices open to them as possible because they trust themselves to make good choices and don't want the government to tell them how to live their lives. As members of society, people tend to fear what other people who think differently than them might do, so it becomes more appealing from that perspective to limit other people's choices. Yet when we limit other people's choices through government intervention we also end up limiting our own choices as well. Anything that supposedly makes society better through the limitation of individual choice also makes our country less free. That doesn't mean we should never limit an individual's ability to make choices, of course, but I do think we should at least think about how taking choices away will affect the individual whenever we make policy decisions that will limit freedom.
Is there ever a legitimate reason to not want health care? I tend to think a fair number of people who would be insured by Clinton and Edwards probably won't be insured under Obama, but I also think the number of uninsured will fall dramatically. The continuing numbers of the uninsured will likely include wealthy Americans who aren't worried about the costs of health care, Americans who can afford health insurance but for whom it would be a significant and recurring cost they'd rather not take on, poor Americans who fall through the cracks of the system and don't get insured even though their insurance would be subsidized, and Americans whose beliefs and opinions prevent them from seeking either health insurance or health care of any kind. Each of these groups brings a set of problems to the table. The wealthy and other people who opt not to buy health insurance don't pool their funds to help pay for the health care of others. Taxes, though, will insure that this group does still pay something. The poor who don't get insured will be victims of bureaucracy, denied by government inefficiency what they were previously denied in the name of corporate efficiency. From a civil liberties perspective, it is the fringe group of people who don't want health insurance because of their beliefs or opinions who are most in danger of having their rights trampled on. Personally, I'm not too fond of hospitals, but that wouldn't stop me from going to one if I really needed help, and I do think most people who work in hospitals are trying to do the best they can to save lives and restore health. I also think health insurance is a good thing and I'm glad to have it. Still, I cringe at the thought of telling someone that they are wrong for distrusting doctors and hospitals or for having beliefs that discourage the use of modern medicine. Health care, after all, isn't just sweetness and light. People do die and suffer because of ill-treatment and incompetence in health care institutions, the insured and the uninsured alike. While I think health insurance and health care providers are the cause of much, much more good than they are of evil, I can't say that it is invalid or wrong or crazy to take the opposite view and not want to have health insurance as a result. Similarly, if you don't want to buy into a health insurance industry that has, by most accounts, not done a very good job of allowing access to health care for everyone, I cannot fault you for that. The reason people are clamoring for universal health care is because private insurance failed to deliver it to meet the needs of all; the leading Democrats seem to think government and private insurance can work together to make health care work, but I could understand why anyone might be skeptical of that notion. Thus, it seems to me that there are legitimate (although sometimes selfish and sometimes odd) reasons to not want health insurance. However, it is worth noting that while people may willingly opt out of having health insurance they may not be so willing to opt out of receiving health care (they may even be so injured that they can no longer make such a choice at all); in those cases, the cost of providing health care to a "free rider" will sometimes have to be born collectively by society as a result of an individual's choice.
All things considered, I do like Obama's approach towards health care reform better than the approaches of his Democratic rivals. I think he is right that most people do want health insurance and would choose to have it if it is truly available to all. I don't think it is government's responsibility to put a gun to people's heads and say, "Get insured!" Instead, I prefer government to be an advocate and an enabler rather than a tyrant. Simply making health insurance available to everyone who wants it will be a serious funding and bureaucratic challenge; why further complicate things by also forcing health insurance on people who don't want it? This would be a partial rather than a complete solution, however, because there will still be people who remain uninsured. In an imperfect world where people do not think or believe the same things, perhaps a partial solution is the best we can have.
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I have worked in the health insurance industry for more than two decades and have mostly voted republican but have now come to the conclusion that some form of national health insurance is needed if we want to prevent health care costs from bankrupting individuals and employers. Competition between private plan offerings will not contain costs over time as well as the government can. I agree with Mr. Obama that it's the cost of health insurance that prevents all citizens from having universal coverage and not a lack of desire or availability to get coverage. As health care costs rise the private insurers will pass along more of the cost to individuals via higher premiums, higher copays and coinsurance, and reduced coverage. The situation will only become worse if all citizens are mandated to have coverage and be forced into paying for higher costs.
Short of a full national health program though I wonder if a hybrid national and private program would work. It would resemble the old private insurer model where you could get a basic health policy and then pay additionally if you wanted major medical coverage. In this scenario the federal government would provide coverage to all citizens to receive primary and preventive health services. The private insurance industry via employers or pooled individual policies will offer the major medical or catastrophic coverage. People who desire the additional coverage would choose among these plans much like Medicare beneficiaries choose between Medigap policies.
The primary and preventive care piece would be cheaper for the government to finance than all health care costs. This hybrid approach would ensure universal coverage but still provide some choice.
I think the alternative will eventually be a national health program that covers all services, a scenario that involves the government overseeing new construction and use of medical facilities, use of medical equipment, and the use of treatments. I think we should take the intermediate step of trying the aforementioned hybrid system first before going to the final alternative.
Check out peoplepowergranny.blogspot.com and read how I understand each candidate's position on health care reform in the USA. Would love your opinion and invite you to vote in my poll.
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