I was writing a comment to Karen Novak’s excellent blog on her health “Hello and Fit the First” and I’ll echo J.D. Black’s comment – Karen you are one of the cool kids. Julie Delio’s comment really hit a nerve. She pointed out how even with insurance, serious illness can wipe out a family’s finances, and I was riffing on the difference between “universal coverage” and “universal care” and realized that it was going to be a very long comment, so I thought I’d take it elsewhere, like here.
I work as an independent contractor, i.e. no benefits of any kind, but happily I am paid enough that I can afford to buy my own health insurance (I realize this is by no means the norm). Like every policy I’ve ever had, it has a lifetime limit – in this case $1M. There was a time when this was a lot of money and would buy a lot of medical care. There was also a time when Red Auerbach coached the Boston Celtics. I think that these were contemporaneous. A million dollars just isn’t what it used to be and one serious illness will eat it up, burp, and ask for dessert.
All the posturing about “Universal Coverage” by the candidates for the Democratic nomination just won’t fill that particular maw. Clinton’s plan is more to my liking than Obama’s, but they both rely on private insurers to provide coverage and the limit will still be there. The only way around this is to provide for “Universal Care”, i.e. you get sick, you get the care you need, no screwing around, no limits. You may not get the procedures you want, those collagen injections will need to come out of your own pocket unless they're somehow reconstructive, but you won't need to worry about how you'll pay for it when your doctor starts musing about that "funny little smudge" on your chest X-ray.
I think that expanding the single-payer plan that many of us will be counting on in the future, Medicare, will best do this. I’m not positing a new freebie, but instead of paying private health insurance, we pay into Medicare. Their overhead is 10% of the private insurance companies and the amount paid could be based on taxable income, where one pays an increasing percentage as one makes more money. No caps on income and no opting out. If a person still wants to pay for private insurance for gilt-edged care, great, but Medicare still gets it’s dues, and everyone gets the care they need.
Yeah, some “lazy, undeserving wretch” will probably get free care without paying in, say hair implants or bigger boobs. But you know, I’d rather buy that than buy the CEO of The Hartford a bigger boat.