I’ve been trying to buy health insurance to cover myself as a private contractor. At every step where I deal with the insurance company I am reminded of the movie Sicko. I’m a healthy guy who has never had serious medical problems. I tried signing up for Health net 3 months ago. Part of the 50 page application form was to list every doctor visit in the last 6 years or so. So I put down two visits to the doctor two years ago, both for minor problems that cleared themselves up after a few days. 3 months and half a dozen phone calls later I get back a form letter asking for every imaginable detail of those doctor visits – who I saw, addresses, phone numbers, dates, treatment details, etc. It’s like if you get health insurance, you better not ever use it, because if you do you will never get insurance again. I was fed up so wrote back to them and told them to cancel my application. “I’ve already given you these details. You have authorization to look up my records. I don’t have the time or inclination to do your job for you. If this is how you treat a potential customer trying to give you money, how will you treat me when I actually need care?.”
Initially I was ambivalent about nationalized free health insurance. The free market’s incentives are to maximize profits. When it works, the way to do this is to provide the best service for the lowest possible price to attract and satisfy as many customers as possible. The government’s incentives are to satisfy their own customers, which are generally special interests or the bureaucracy itself. It’s different in every situation, but one doesn’t have to look far to find waste, fraud, or poor service where the government is concerned. Look at the lines at the post office or the DMV. There’s also the argument that when something is free you get unlimited demand. It is true this would result in longer lines and worse service compared to an ideal free market scenario.
However, after thinking this through I think nationalized health service is the correct choice. The free market doesn’t work where you have force or fraud – in theory it is the government’s job to prevent just that (although often the government is the cause of said force or fraud). Cox cable has a monopoly where I live. So when I had my cable modem installed I was forced to use their service. As a result, I had to pay $200 to lease a modem you could buy for $50, and a $300 installation fee for a guy to drop it off at my house, and the service didn’t work for a month and a half.
Does force or fraud exist in the health insurance business? I think force is an inherent part of the equation – a sick or dying person has no choice but to accept the services that are available to them. With Cox I could at least go without or move if I wanted to, but the guy in the movie who had to choose which fingers he wanted reattached had no such option. Unlike a typical business, the insurance company makes money by NOT providing service – turning down sick customers, or denying those who are already sick. So it’s undeniable that there is an incentive to commit fraud. Usually lawsuits work out fraud, but a person who has just undergone a major health problem (and paid for it themselves) usually doesn’t have the time or money to fight the insurance companies. A dead person certainly doesn’t. The only people with the resources to take on the insurance companies, the super-rich, pay for their own services anyway.
The only question that remains is will the waste, lines, and bureaucracy of the government be better than what we have now?