No we’re not going to restore the old republic, because it was based on the notion that every citizen was a freeholder, and employment was a bit of extra cash on the side, we could take it or leave it. That’s a truly free market. Ninety percent of the population today need to “get a job” in order to live. That is not a free market. It is, however, the foundation for Marxism, even though we know that Marxism hasn’t provided a solution. On the other hand, we don’t seem ready to abandon all the material goodies that come from an advanced technology and economy.

So, I’m looking for, how do we build as much individual autonomy as possible back into our big complex economy and government? When it comes to health care, we need lots and lots of options. My employer doesn’t get to pick my plan, although my employer may have to contribute to my plan, even my union doesn’t get to pick my plan, although I was a union shop steward once, and the gummint doesn’t get to limit my options.

First, as some have suggested, I can opt in or opt out. If I opt out, I agree that I am totally responsible for the cost of any emergency care I received, and can be turned down for major surgery — the story of the ant and the grasshopper.

Second, there should be about three different kinds of “public options” which will compete with the private insurance companies. These companies are fighting that tooth and nail, which tells me it could be a good thing. They will be funded by premiums, not tax dollars. They have to sink or swim and pay their own way. They can be coops, mutuals, or gummint-sponsored, but I can choose any of them or any private plan I want.

Third, I get a wide range of choices between total coverage, at high premiums, and catastrophic coverage, at lower premiums, with or without a health savings account.

I’d like to go back to medical care under the old republic, where the doctor was a phone call away, and the hospital had about twenty beds, half of which were often empty. But then, if a complex operation to clean out my arteries could prevent a stroke and extend my life twenty years… either that is only for the very rich, or we set up some way to pay for it. And that requires some gummint involvement, or we’re at the mercy of the corporations.

The real problem is, this makes too much sense for the real gummint to get it right, so I’ll probably be joining you in complaining about whatever we end up with when all the dust settles.

To share costs by pooling risks requires an actuarial limit to the “risks” ie what we consider to be an unforeseen financial shock, something we cannot cover from our usual earnings. Many healthcare costs do not fall into that category, and do not belong in any insurance plan. Catastrophies — unforeseen maladies that severely depredate the value of the asset — is what car or home-owner insurance covers — and that actuarial limit is what we should be discussing here too, if we want to make any sense to each other.

A healthcare “lay-away” payment scheme is already available in the law, but most folks don’t understand that, they’ve never been taught their “rights” (the moral hazard of our school system is another argument for another day) so they do not exercise them.

Ross Douthat I think gave this argument the most visibility in the pages of the New York Times last month:
http://www.nytimes.com/2009/10/19/opinion/19douthat.html?_r=1
To assist our fellow citizens defend their rights, more of us need to start talking about the crooked logic inherent in the debate, rather than just shouting incoherently about “oppression” from “the Other” – WE are the other, we oppress ourselves with our own laws and private conduct. The moral hazard? The ones doing the consumming (myself and John Medaille’s generation) have contracepted or aborted out of existence the ones we need to do the paying. Where is the “just price” of that? You get what you pay for, and the process of price discovery is about to blow us out of the water, fiscally speaking.

THAT is the hyprocrisy I refer to, and that is the hypocrisy the Bishops and any other “common good” evangelists have to answer for when they make claims to do charity in truth, for the ‘veritate’ is sorely lacking in their social justice regime. At least Catholic Georgetown U. has the temerity to take their lamp (faith) from under their bushel basket (endowment) and support the work of those compiling the lists to navigate the morass of injustice of our “rights” based democracy. If I own the title to the ‘right’ to healthcare then how come I have to mortgage it to my employer just to purchase ‘access’ to my own right? Its ludicrously illogical, juridically incoherent and morally corrupt! Let the debate begin, but define your terms please. Insurance cannot possibly mean what most of the folks in the thread take it to mean. To share costs by pooling risks re

http://healthinsuranceinfo.net/getinsured/pennsylvania/individual-health-plans/cobra/

The Hipaa laws were amended to MANDATE a private insurer in each state to accept certain customers who’s COBRA expires so long as three conditions are met (**) each state will be different, I linked to PA for that’s where my hubby and I found the only “free market” company willing to do business with us (ie there’s just no market for folks our age: no company offers any policies that can conform to all the gummint requirements for a price folks can cover from earnings and still meet their other expenses, such as roof and board)

(*) socialism, vs private “group” health coverage from private “employers” IMHO is still moral hazard, since I’m not free to use the remuneration I earned — ie my property — in the wisest way I discern, I’m shackled to the wisdom of my “betters” to do that for me, until they go out of business for all their prudential judgements… and my investment in my health and that of my family is rendered worthless.

(**) ie that corporatist-socialism some adamantly want to call the “free market” — fuggedaboutit — we have never had free markets in healthcare, we’ve just had the most expensive socialized care in the world. That’s the searing hypocrisy we hear all round, ‘cos as a Nation we’ve not been able to afford it for some years now and have borrowed from our creditors just to cover fixed costs. There is no “disposable income” left to debate over, any more spending and our creditors could come down hard and cut us off pronto. They’re just busy redesigning a new reserve currency behind closed doors so that their “common good” economies will still able to conduct business. Us? We’ll be left with worthless green paper and our peculiar flavor of “the common good” — a bankrupt geriatric nanny state.

Now for me, I’d like a low premium, high-deductible policy, and pay some money into a Health Savings Account. I’m not going to empty the account every year, so I can roll it over, and save a bundle on premiums. But, I’m good at math, my mother trained me to keep good track of money, I am capable of writing long letters to recalcitrant bureaucrats and regulatory agencies and sit tight waiting for them to blink first — it may not be for everyone.

If there is a huge monopolistic private sector, selling something we cannot live our lives without in the modern world, like medical coverage, the gummint has to do something, as our representative, to keep them in some sort of bounds. I’d like to see every proposal from Nancy Pelosi’s to Paul Ryan’s bound up into one big omnibus bill, giving each of us the CHOICE of any of the above options.

I guess it is the same people who continue to run up credit card debt and don’t really think about ever paying it off. Or get crazy car and house loans, etc.

And though I bought a house last year, I am eligible for the $6000 tax credit if I wanted to buy a house this year. Crazy. Who makes up this stuff, and why do folks keep electing them?

It is similar to what we paid before, and much less than we paid if you count what the employer subsidized. I worked at a 200 person company. My friends at smaller companies, who don’t have their insurance subsidized by the employer, pay around $600/month, and one of them went to private insurance on his own because it was cheaper than what his company could get.

I did just look up rates for a relative, who will likely be getting private insurance next year, and due to her living in NH, her rates will be double what they would be if she lived in PA. I have no idea why that discrepancy exists, unless it is local monopolies.

“Unless you have a health insurance plan through your employer you cannot protect yourself from financial ruin should you have a troubled pregnancy (which is highly likely, you just don’t hear about it because people prefer to keep that kind of trouble private). The trouble is, especially in your twenties, your employment situation is incredibly unstable. Thus the current system discourages young people from starting families during their optimal child-bearing years. ”

Where are you getting your information from?

While I tend to agree that the government is not likely to be a very good health care provider, the free market has demonstrated they definitely are not good health care providers. I love the idea of co-ops and think the bishops would do us all a lot more good if they spent their time facilitating more of that instead of holding press conferences on their refusal to be forced to do abortions. As I understand it, the problem with these co-ops is that the pools are thus far so small they cannot cover catatstrophic illness – which nowadays includes having a baby.

As for socialism – crying “socialist” at every proposal offered may be emotionally satisfying to some but it is at best obstructionist when it isn’t completely inaccurate. Government is an effort on the part of a people to organize themselves to promote their welfare. So in that sense every co-operative effort becomes “socialism”. Americans once prided themselves on their pragmatism – so let’s get down to pragmatic solutions to health care and pass on the ideological blinders.

And yeah – let’s rein in military spending – cause if we don’t start re-ordering our priorities we may find we have spent all that money on a military that has nothing left to defend.

On a more serious note, I don’t think it is right to force people to give to charity against their will. When it comes down to it, that’s what taxing people to pay for other folks’ health care is, and it kills charity, creates justified class resentment, fosters dependency on the state instead of on family, friends, neighbors, and closer communities.

I would tend towards Caleb’s sentiments, except for the fact that Christian charity and compassion compel me to not merely be apathetic but righteously indignant towards the situation and culture in which I may one day raise children. I am extremely blessed with the job that I have, and I want everyone to enjoy even a sliver of the benefits that I have been graciously given. Right now we’re left battling the political machine for a partial ban on abortion and left scratching our heads about conscience protection.

Finally, I wouldn’t feel completely vindicated (emotionally satisfied?) if my rant doesn’t somewhat find in my sights the generation a step removed from us, the baby boomers, who hang out around here especially. We could use some help, and I hope this place of cyber-meetings turns into a springboard for “real-world” action.

And why do we have a sewage system? Primarily it is for public health reasons. I pay my taxes responsibly, and I am no fan of big government. But I would gladly redirect my portion of my income taxes to socialized health care system and reign in the military. Some forms of wealth don’t translate well into the abstraction of money, and health care is one of them. Caleb is right, life is nasty, brutish, and short, but there is no reason we cannot be civilized about it.