Let's change the framing. The fight over the nation's health has two-parts: 1. The actual therapies applied to medical problems, and 2. Who pays for these therapies? If the present debate was limited to the first issue we would just call in all the best doctors and let them work up a set of guidelines. Obviously, that is not what this debate is about.
This debate is about who pays. Here there are two major players: 1. Insurance companies that want people to hire them to pay, and 2. A gaggle of people coming from all directions who want another alternative. They want another alternative because the first alternative is bankrupting the country and has been unwilling to sacrifice profits when the quality of patient care was at issue. Insurance companies are not evil. They are just doing what all companies are tasked to do, return the most profits to investors. The insurance industry, therefore, wants to preserve the status quo because that is where their cash cow is and they do not want competition from outside the industry because that will reduce their profit margin. They want to preserve the system whereby; if you want to pool your money with other persons to pick up the tab on your medical costs, should you incur such; you can only pool money with other policy holders of an insurance companies. As the Church Lady used to say, "How conveeenient."
The second group - those folks looking for an alternative - are asking why they cannot pool their money as taxpayers, in other words, what's to keep taxpayers from self-insuring? Does this violate some principle of democracy that taxpayers have to use insurance companies to pay their medical bills? We didn't depend on them before WWII. Why are they indispensable now? Is this some violation of the tenets of capitalism that taxpayers cannot seek out the best deal for their buck if it means insurance companies have to give up their exclusive market in health insurance contracts?
Mind you, nobody is calling for insurance companies to be outlawed. The President has made it perfectly clear that he is not interested in destroying the healthcare insurance industry but only in giving the American people an alternative in an market where insurance companies have no non-industry competition. The President believes in competition. It seems his detractors believe in competition only when they get to make the rules that tilts the market to their advantage.
What I am suggesting is that one of the tools in our arsenal of talking points should be this concept of taxpayer self-insurance. Wealthy individuals self-insure by saving for that rainy day; corporations do it by setting aside a medical contingency fund; and workers are doing it, in part, through Medicare. The only people blocked from self-insuring are all the rest of the citizens of this country, particularly the one-in-six Americans who, for whatever reason, who are un or inadequately insured. What we are saying, through our policies, is that if you are not a wealthy individual, corporation, or worker, you have no right to self-insure. If you cannot chin up to the bar some private insurance company sets, or have really deep pockets you are doomed to personal bankruptcy if you get seriously sick. Why should that be?
America is supposed to be the world's most free country. The whole world is supposed to look to us for how democracy is done. Every person in the world needs a Constitution like ours and laws like ours. Isn’t that what our politicians tell us? So, where is it written in our Constitution that taxpayers have no right to self-insure? By my reading, there is none.
There is, of course, this irrational fear of "the gov’ment taking over medicine." I can understand people being afraid of something that is somewhat new, though Medicare has been around for longer than a large percentage of Americans have been alive. What I cannot understand is how people are more fearful of people they elect than the CEOs of billion-dollar corporations they don’t elect. How does this not call into question the basic premise of democracy: that the people are smart enough to do what is right for themselves? If we cannot trust our elected officials maybe we ought to just scrap this whole idea of democracy. Maybe King George was right back in 1776: the people cannot do for themselves what is best. Maybe democracy is really a fatally flawed concept. I don’t believe this but some witness to this, it seems, if only by their fears.
In conclusion: Taxpayer self-insurance has not been an option in the past, not because it’s impractical, financially unworkable or unlawful, but as a consequence of pure political expediency driven by an alliance between the insurance industry protecting their cash cow and members of Congress invested more in perpetuating their political career than in extending to the taxpayers of America the right to pay for their own healthcare without a private insurance company charging 25% more for the same or lesser benefits.
From this perspective, this debate is over whether this alliance is maintained to the detriment of the solvency of the American economy and the well being of our fellow Americans or it is broken and Congress does what it was elected to do: serve the best interests of the American people, with one of those best interests being the right to self-insure. Let's all work to break the alliance.