To solve the health care fiasco in the United States, we have to understand actual health care markets and spending; we need to establish foundational principles from which to build health care policies; and, we need to strip health care debates of
Short of paying cash or trading chickens for service, the private health care insurance market has served its customers relatively well. Insurance providers offer medical plans and consumers choose from those plans or not at all. As with all
insurance, medical coverage is based on risk. If you live a healthy lifestyle and do not seem to suffer from a history of illness, you would pay lower premiums for your
coverage. The opposite is true if you have chosen unhealthy behaviors and activities or if you have a history of some illness. This is the way insurance works and it will not work any other way.
What we have now, whether from Republicans or Democrats, is not health
insurance. The private insurance market will cover anyone who can afford it but not
with pre-existing conditions. Covering pre-existing conditions is not insurance; it is
welfare. It is assurance but not insurance. Failure to admit that reality is causing all
sorts of policy problems.
We also should keep in mind the realities about health care consumers. Just one
percent of the population accounts for 20 percent of all personal health care
spending in America. The top five percent of the population accounts for half of all
spending, and the top ten percent accounts for 65 percent of all spending. Half of
America accounts for only three percent of all health care spending. So think of that:
The top ten percent of the population accounts for 65 percent of all health care
spending in America. Our focus should be on that top ten percent responsible for
most of the spending – and only politics keep us from that focus.
We must strip all health care discussions of politics. In other words, all solutions
must be free of partisan politics. We cannot decide for or against any policy just
because the other party or our opponent first thinks of it. We have to set aside such
We also have to come to some sort of societal agreement over the very nature of
health care. For instance, is health care a right – like a human right? If a human right,
medical care becomes an egalitarian ideal and every effort must be made to apply
that right for everyone. In other words, medical care must be universal and its
application covered under any circumstance. But if it is not a human right, what is
Conservatives, like me, see health insurance as a commodity, not a human right. We
see medical care the same way we see food, shelter, and clothing. That said, we do
recognize our moral obligation to those in need. If someone needs medical care, we provide it. If health care is a human right, the answer is universal, single-payer,
coverage – we would socialize coverage, meaning we would place the cost of
everyone on the backs of everyone. At that point, our only concern would be to make
sure that everyone, even the poor, contributed to the most efficient system possible.
But, if not a human right, then we are tasked with the moral obligation to care for
our neighbors. Charity care is the most efficient and wisest use of societal resources
to provide care for those in need. But the reality is that not everyone is moral or
even feels the need to help their neighbors in need – from volunteer providers to
volunteer financial donors – and when we do not step up voluntarily, we can hardly
argue when advocates seek government to step in. In other words, we can hardly
argue when failure to volunteer turns into compulsory means. That’s the way it
works. There are no vacuums in these affairs. Needs will be met one way or another.
So, if you are a conservative, our health care public policy looks like this: First,
ensure a free marketplace for medical coverage; second, emphasize charity care to
provide for our neighbors in need; third, define the proper scope of an effective
public safety net when charity fails or falls short of meeting needs; and fourth, the
hardest part, meet all needs because, for one thing, it is our moral obligation and, for
another thing, if we don’t, politics will enter the picture and we will end up with
what we see going on now in Congress – failure on all counts.