The problem in the debate is based on the foundations of the arguments. As you have stated, “healthcare isn’t like other products” and “panels of politicians… can’t do worse than the private system we have now.” That is where we have to agree to disagree. Most on the right do not believe the government can do anything efficiently or effectively because they are induced by certain groups of constituents, not the people most affected by the legislation. And most on the left believe that corporations only have profits in mind and that economic incentives are not conducive to providing healthcare en masse. Starting from those premises, we will never come to the same conclusion.

And as far as my health coverage goes, I was uninsured for years as a graduate student, but ended up okay. Under the health bill as it currently stands, I would have been forced to pay over a thousand dollars I did not have to pay for healthcare I really did not need. And if I did not buy coverage, I would be taxed a penalty I could not pay. I took a risk that I thought was worth a few thousand dollars, and it paid off. Currently, I have a wonderful employer who provides excellent coverage for a cheap rate. In fact, I chose a health savings account, where I have a high deductible, but my employer contributes to the fund that I can use for anything from doctor visits and surgery to aspirin and band-aids. Because I pay out of pocket, and because the employer contributions can eventually be rolled over into a retirement account, this type of plan makes me responsible for my healthcare costs (I only go to the doctor when necessary, I don’t seek prescriptions I don’t need, and I’m more conscious about keeping myself healthy to avoid unnecessary costs). And under the new health bill, I am very afraid that this will be deemed a “Cadillac” plan, which will be taxed at a very unfavorable rate, thereby reducing my employer contributions, increasing my costs, and making my HSA unaffordable. As a self-interested party, I am probably less concerned with the people without healthcare (many of whom still qualify for medicare and medicaid), and more concerned with losing the coverage my employer is so graciously willing to provide.

Second, I do believe the government is better at making a judgment call about my health than an insurance company that stands to reap more profit by denying my claim, yes. And that’s precisely the situation many Americans face now. We hear stories all the time about private insurers denying coverage or payment. On Medicare, however, we always heart that the nation is going to go bankrupt because we cover everything under the sun. Is that a problem? You bet. But because *healthcare isn’t like other products,* people would much rather cover too much and worry about the cost later, rather than go without treatment because it’s financially prudent– I mean, wouldn’t you?

When government rations healthcare, it does so based on policy set by a panel somewhere, yes, that might not always have your best interest in mind– but the private healthcare market *never* acts with your best interests in mind; it acts in the *other party’s* interests, which is to maximize economic gain. When that means Ford sells somebody else Cadillac I can’t afford, that’s fine; but when it means the insurer denies me chemotherapy drugs and offers them to someone more well-off, it doesn’t pass the smell test of what America is about. Panels of politicians have been deciding policy for everyone in America since the settlers of Jamestown 400 years ago, and contrary to what Sarah Palin seems to think, they’ve done pretty well so far. I think they can do the job here, too. At the very least, they can’t do worse than the private system we have now.

The whole idea of interstate insurance purchases would be to avoid the costly regulations and mandates of your own state’s insurance laws and to obtain the benefits of another state’s laws that make your premiums cheaper, usually at the expense of fewer benefits. Ultimately, I think what would happen is that most states would contract and expand their benefits until each state had reached a sort of equilibrium price point that reflected the best available coverage and options according to what consumers want. In other words, as close to a traditional market economy as you can get with such a regulated industry.

Secondly, do you believe the government is better at making a judgment call about your health than you are?

Lastly, you say we have rationed care doled out by the private market. Well the truth is… everything in the private market is rationed. The difference between private rationing and government rationing is that when the government rations, it does so based on an arbitrary policy or by a panel or committee of politicians who do not necessarily have your best interest in mind. When the private market rations something, it is done so by price. (See any Hayek references here). So resources are allocated where the person who needs it most and is willing to pay for it is going to get it.

Second, I’d also like more transparency into my medical costs so I can make better medical decisions– right until I remember that I’m not a doctor. Healthcare is not like other products consumers purchase. Often you have no time at all to weigh costs and decisions (urgent or emergency care), and when you do, often you lack the judgment to make proper choices.

I’m well aware of the implications of my beliefs– that we’ll end up with a single-payer system that provides healthcare to all at considerable cost, and we’ll either need to raise taxes or ration care. But we already have high costs and rationed care doled out by the private market, just more expensively and to fewer people. I don’t presume to argue that my vision is a *good* plan; it’s simply the worst plan their is, except for all the others. Including the system we have now, which is awful.

First of all, philosophically, you should be opposed to a public option pushing out private insurers. While you say it is cost-effective, that is likely because you do not see the hidden costs that come from higher taxes and a rising national debt that eventually needs to be addressed. Also, don’t forget the decreases in innovation and efficiency that accompanies government run programs.

Second, we don’t know whether FedEx or UPS can match the USPS delivery of letters because there is a law making it a crime to deliver first class mail if you are not the USPS. Even William Henderson, a former postmaster general, suggested the privatization of the USPS as a feasible alternative to the current system.

Lastly, I do agree that more should be done in reforming the health insurance industry, but I do not think that includes taking the ability to insure people out of the hands of the private sector. In fact, we have to make sure that reforms to the health insurance industry are really de facto reforms to health care in general. Personally, I would like to see the ability to purchase insurance across state lines, more in the way of health savings accounts that can roll over into IRA’s or 401k’s upon retirement, and the ability for the public to choose their own doctor and see the costs before they commit to a medical decision since I think the indirect payor status blurs the lines of responsibility for rising medical costs.

Earlier on this blog, someone compared this debate to the public option for mail delivery, the US Postal Service. I’d say that’s an excellent analogy. The US Postal Service exists to provide mail service to all citizens, and offers an excellent product: delivery of any letter from one address to another usually within three days, for $0.42. The private sector can’t match that performance, so private delivery services like FedEx or UPS offer higher-end services, charging $7.95 to delivery any package anywhere overnight, with tracking ability.

Likewise, a public option will ultimately provide the fundamental safety net our social compact (the U.S. Constitution) supposedly provides (‘to promote the general welfare’). Will other private insurers be able to keep pace with it? Personally, I suspect they will– but even if they don’t, they can focus on offering more sophisticated services for the higher price. And we still achieve the overall goal, of giving more citizens better access to care, so we don’t end up devoting all our economic activity simply to paying for insurance– which is what we’re sliding towards now.

Sure, we need more doctors and hospitals– but take that up with the medical schools, who are too exclusive in admissions, or with investment funds, pouring their piles of money into other investments. Those are separate issues. The primary problem we have now is that by leaving access to insurance in the hands of the private sector, we are slowly warping our natural economic activity towards keeping ourselves insured, rather than creating *more* economic activity– which is the whole point of capitalism, or so I thought.

I don’t know what the right answer is, but I know it’s not a public option.

The purpose of a public-option plan is to provide health insurance to citizens the private market would otherwise ignore: the unemployed, the poor, the seriously ill. This isn’t just a question of whether these groups can afford insurance– it’s a question of *how to give them insurance when the market does not wish to provide it to them.*

The conservative argument ignores this point completely, or just doesn’t understand the true plight of the uninsured in this country; I’m not sure which. But until you find some way to address it, your solutions are talking past the real problem.