Obamacare will make the problems worse

None of what you write supports the case that Obama’s proposal will make things worse.

Nobody has suggested that regulation eliminates greed; at best it is viewed as a necessary evil which helps to “temper, harness, channel, and control greed”.

Perhaps some of your confusion stems from the assumption that insurance companies care primarily about “market share”. Businesses care about profits, not market share. In the US, insurance companies make money by only insuring healthy people—people who pay premiums but don’t make claims. There is no incentive to insure people with pre-existing conditions, and there is a strong incentive to cancel the policy of anyone who becomes ill. The original notion behind insurance is to spread the risk of medical expenses widely, but because insurance companies can pick and choose who they insure and when this doesn’t work.

You also seem to misunderstand the plan that has been proposed. It is *not* a single-payer system like the one in the UK (with which, I should point out, the Brits are very satisfied). The idea is to introduce a low-end insurance plan comparable to, and in competition with, the low-end plans offered by private insurers. This has been proposed as a way of avoiding the need for heavy-handed regulation of the insurance industry. By providing a basic plan, Americans actually have a choice of providers, and they know that at least one provider won’t cancel their coverage (no matter what). It’s hard to see how this can be seen as “reducing competition”.

The government is also offering low-income people a subsidy to help them buy insurance, but this subsidy can be used to buy any plan—either a private plan or the government’s low-end plan.

Frankly, I find the argument that Americans shouldn’t be entitled to basic health care, whether they have money or not, completely archaic. The majority of Americans live in constant danger of losing their health coverage because in the US if you lose your job you lose your insurance. It’s painful to hear, but the US is one of the *worst* countries in the world in terms of health care structure.

a) The rhetoric has focused on the greed of insurance companies because Americans are only now realizing that insurance companies are *not* looking out for their best interests. In fact, they are knowingly killing people and if nothing is done it will continue.

b) You can’t seem to decide whether you’re for regulation or competition. Regulation is slow, inefficient, and politically fraught. Competition in the form of a public option eliminates some of the need for regulation in a market-oriented way. I would have thought conservative/libertarian ideals would favor the latter, not the former.

c) Saying that any health reform leads to single-payer is like saying that any right to bear arms leads to personal nuclear weapons—it’s disingenuous nonsense. If you don’t support the current proposal be honest enough to argue about that, not about some imagined policy that you’ll have sufficient opportunity to object to when and if it were ever introduced.

And please don’t invent quotes from Obama. He certainly has *not* said that he intends to transition the US to a single-payer system. That’s Republican propoganda.

d) I suggest you actually learn about the health care systems in other countries before declaring them disasters. In survey after survey the British public is much much more satisfied with their system than the American public is with theirs. The same goes for the Canadians, the Dutch, the Germans, the Swiss, and many many others. Americans don’t seem to realize just how much worse they have it than others around the world.

e) The options available vary hugely by locality, and in many markets the vast majority of the population is covered by just one company. More to the point, buying your own insurance is far more expensive than getting it through your employer, mainly because the government has distorted the market with tax breaks that go to employers and not to individuals.

f) “Entitled to basic health care” presupposes an agreement among the citizens of the country that we will all bear some fixed cost to ensure that whoever is unlucky enough to need health care will get it. And I hate to tell you, but it’s already happening: everybody who turns up in the ER has a right to be treated. And then a right to declare bankruptcy as a result of the costs. Which means everybody else has to pay for that person’s health care. Care that would have been orders of magnitude cheaper if it had been addressed by real insurance before it became an emergency. We are already living in the worst possible version of your scenario.

The pure libertarian ideal seems to miss the point that contracts involving all members of a community are entirely legitimate. If the citizens of the country decide that the price of living in the US is paying an income tax, then that is their right, and those who disagree with that decision are free to leave. Of course, there are many checks and balances to ensure that the majority does not exploit the minority, and that certain fundamental aspects of the contract will never be violated: this is called constitutional and governmental design.

The functioning of a modern society is, I’m afraid, an inherently complicated thing.

a) The lack of a unified regulatory framework creates massive inefficiencies as well as unnecessary market segmentation, both of which are anathema to free market principles. This is in addition to eliminating any real possibility for portable health insurance, which is needed for a population as mobile as the US.

b) If the government can do health insurance well enough that people actually prefer it and choose it—despite the fact that the same subsidies are available to private insurers—then private insurance deserves to go out of business. Economists don’t think this is going to happen.

c) I suggest you actually read the things you link to. On every occasion Obama has been very clear that he does *not* think imposing a single-payer system on the US would be a good idea. And he said this to crowds of single-payer supporters.

d) Citing Fox News polls quoted in insurance-industry press releases only undermines your arguments. I find it unlikely that a greater percentage of people rate their insurance as good or excellent than the percentage of people who actually have insurance. If you’re looking for a Fox News story, how about this: http://www.foxnews.com/story/0,2933,136990,00.html The WHO and other international bodies regularly compare health care and satisfaction; the US consistently comes out among the bottom of the OECD countries.

You may be surprised to learn that less than 10% of the German population has private health insurance. The other 90% are covered by a government social insurance scheme. And, of course, insurance is federally mandated and strictly regulated—far more so than Obama’s proposal.

Again, I suggest you actually learn something about how health care is managed around the world before assuming that *anyone* else follows the US model.

e) The monopoly-level control of markets by the largest insurers is well-known, heavily-documented, and difficult to refute; I suggest you do some research instead of making assumptions to support your worldview. The AMA’s report, for example (http://www.ama-assn.org/ama1/pub/upload/mm/368/compstudy_52006.pdf) shows that in 98 percent of markets at least one insurer controls 30 percent or more of the market. In 64 percent of markets one insurer controls 50 percent or more. in 37 percent or markets one controls 70 percent or more. And in 16 percent of all markets—that’s one in eleven markets in the US—a single insurer controls 90—90!—percent of the market. If you think there’s real competition in the insurance industry you’re willfully ignoring the facts.

f) Entitlement to social services is *always* a social agreement.

Dostojevski was making a point: people value their lives more than any abstract notion of rights, because a dead man has no rights. When you see a loved one die because an insurance company found a way to deny them coverage, you may wonder whether an abstract fear that any reform may take us an inch closer to socialism was really worth the price.