Saturday, February 19, 2005

A Philosopher’s Suggestion

In response to my challenge for concrete suggestions on redesigning the health care system, the following comes in from daughter Eleanor. Eleanor teaches Philosophy at the University of the Pacific in Stockton, California. She also served a term on the Water Board of Half Moon Bay, California and was for a time its President.

I think we as a society need to answer two pretty basic questions; 1) Are we going to hold individuals ultimately responsible for their own health or illness? Or is there a floor below which we just won't let people sink. (e.g., are we willing to let people die of infections or injuries that could easily be treated because they can't afford/choose not to purchase insurance? Or do we hold the view that decent people make sure everyone gets some basic level of medical care?)
2) If we decide we are not willing to just let people die because they are poor or irresponsible, then we have to address a trickier question: how much care? and how do we pay for it. (ex hypothesi, the poor and irresponsible are not going to bear the brunt of the cost - if they could or would they wouldn't be poor and irresponsible.)

It has always seemed to me that if our answer to the first question is that we are not really a very cold hearted people, then the natural approach to the question of insurance is that we all mutually insure. On the theory that none of us know who is going to get sick or injured, we should make sure we all chip in enough that everyone who needs gets taken care of. That is my theory of how health insurance ought to work.

This business of making insurance a for-profit enterprise has only one thing to recommend it: in theory it tends to drive prices down. The downside is that in practice it tends to drive sick people out, and so defeat its purpose.

Here is my suggestion: make health insurance a public utility with an elected board of directors. State, County, City, who can tell which size will work best. This form of organization tends to keep costs low (lowering rates is always popular with taxpayers!) includes everyone, (you get covered according to where you live) is sensitive to local needs, and can balance local expectations and standards with ability to pay. The folks in charge ONLY have an incentive to keep costs low while keeping services high.

They also have an incentive to partner up with local folks who can do something about public health and preventive care. Water districts do more to encourage water conservation here in California than anyone else. Kind of odd if you are in the business of selling water to help people buy less, but that's the fact.

I know it is not very PC these days to suggest that government might do something well, but think about it: wouldn't you like to take your insurance coverage for granted in the same way you do your water service?

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