I greatly enjoyed reading the diary of my compatriot ignatz uk on his/her experiences of working in Health Insurance and why a single payer option is necessary. I respectfully disagree.
I am soon to be moving to the US from London, and having to get to grips with Health Insurance policies is one of the ugliest frustrations of the move: compared to US tax returns, visas, and finding accommodation - nothing is as irritating as being told that my medical wellbeing depends on the legal gymnastics employed by a corporate entity. For all its faults, I will miss the British NHS more than marmalade and Test Match Cricket.
I agree that single payer might be something of an improvement if you have already accepted that insurance is an acceptable model for delivering general healthcare, but my Anglo-centric view of the world is that universal public healthcare, paid for through progressive general taxation, is simply the only acceptable way to support the health of a population in a civilised country.
Ignatz uk's diary picked out the crucial point for me: Insurance companies (like all companies) are solely accountable to their shareholders, and their job must be to maximise profits. I have no complaint on that score, and don't wish to demonise them for a simple corporate reality. Motor insurance, home insurance, contents insurance all work this way, and it seems a fair and efficient way of mitigating risk, whilst generating reasonable profits.
However, I think the insurance model (higher cost for higher risk) that is perfectly suitable for auto-insurance, is a ridiculous and disastrous model for healthcare. Any insurance model, whether public or private, whether single payer or employer provided, will prejudicially hurt the least healthy and those in economic hardship. That problem is systemic, and will accompany any insurance provided model of healthcare.
There will always be people who are going to be loss-making: their contributions will never match the cost of their healthcare. Any reliance on a profit-making insurance company will always see these people suffer, because there is no way to make the unprosperous chronically ill profitable as customers.
This is my problem: Insurance companies cannot take on those who are too ill to ever be profitable. Ill-health is not a risk, it is a guaranteed outcome in some degree for every citizen at some point. As long as there are people subsisting without health insurance, we guarantee that some of the very sickest and most of the very poorest will rarely get the healthcare they need and that seems, to me, to be the epitome of injustice.
Healthcare should be an investment by a society in its people: by ensuring good general health, it improves productivity and generates more than it costs. Government is happy to invest in infrastructure to support business growth, so why should government not take a role in supporting the health of that most-important of infrastructural assets: the workforce? Government, unlike insurance companies, can afford to make a loss on the poorest and the sickest in society, because that is what government is for.
Government already does invest in the workforce by paying for public education. We accept without question that education should be universal, because it is to the benefit of the whole society to maximise literacy and numeracy.
Even the most fire-breathing Republican would likely have to stop before suggesting that universal Public Education should be abolished and replaced by an insurance scheme covering only 4/5ths of the population. "Pro=business" Republicans would have to acknowledge that without general education, free at the point of use, for all children that the United States would be ill-equipped to compete against other industrialised nations. That infrastructural investment is exactly what general taxation should be used to support, and I see Healthcare as the other side of that coin.
Education and Healthcare are too important to the success of a nation to be left exclusively in the hands of companies who do not and cannot care about general levels of health and education, but are and must be concerned only with their own profits. Healthcare and Education are the foundation for all successes, individual and public, and therefore universality of provision, paid for by the government (albeit with private sector options for those prepared to pay twice) is in my view the basic mark of a civilised society.
I yield to no-one in my fondness and respect for the United States and its people. I am hugely excited to be moving to live on the other side of the pond. But the lack of a universal public option for health care is a chronic and unforgiveable shortcoming for any nation that claims to be truly civilised. I hope my interjection from abroad is not taken to be insulting: it is not intended as such, but I think the debate about healthcare in the United States is far too generous in accepting the idea that an Insurance model is in any way suitable as a way of providing basic human rights.
A public option, universal and free at the point of use, is not an unattainable ideal. It should be the bare minimum of acceptability in a civilised country.
To leave a whole population at the mercy of the insurance industry, and millions without healthcare at all, is little better than barbaric.