America has one of the best health care systems in the world. Not everyone, however, has equal access to it. It is not governed by the free market. Some want universal health care which is another name for socialized medicine. We’ve seen how well socialized medicine works in Canada and the UK. That is to say, not. Indian health care and military health care is socialized, as is Medicare and Medicaid. Health insurance sucks. The problem started many decades ago.

My ex said their were two kinds of health insurance, low cost – high crap and high cost – low crap. That is to say the more you pay for your health coverage the less bureacratic crap you have to deal with to get insurance to pay. The question is should a serious illness push a middle class family into poverty? I could say that having crappy health insurance is better than no insurance, but that’s not the solution.

After World War II, employers wanting to hire new workers could not offer higher saleries. To compensate they could offer things like health insurance and other fringe benefits. By doing that it insulated the employee from the true cost of health care. I’m working towards a proposal here. Health is a personal, a familial, and a social issue. And there is a stigma to certain illnesses, not just AIDS. People try to make sense of why some get sick. They think it’s divine retribution, that you are unclean. Leprosy and the Black Death have shown us how people react. The fear and stigma of illness is very deeply rooted in our psyche. It’s part of our survival instinct.

We have to overcome the irrational fear associated with some illnesses. There are geniune fears to deal with like “Bird Flu”. But what if someone breaks a leg. Well that’s a personal issue but a social one as well. If we treat the person’s broken leg and take care of them, we are creating a social contract. Once the person is better they will be a productive member of society again and in turn if someone else breaks a leg they will help tend to that person. Not everyone breaks a leg. So why should they participate?

There is such a thing as economies of scale. We should be able to set aside a small amount of our incoming to create a huge pool to take care of people who get sick. The problem comes when the number of sick and injured becomes greater than the pool of resources available to take care of them. That’s where triage comes in. An unpleasant fact of war is that when a large number of casualties come in the medics have to decide who is savable. Some they know are just going to die, so they devote no resources except maybe some morphine to ease their passing. And sometimes they have to save the morphine for the living those who are going to make it.

The situation is not nearly so grim for our civilian world. Can we create a pool of resources for the poor and middle class that will not push a family into abject poverty when a serious illness or injury occurs? Some type of catastrophic coverage? There are other issues to discuss as well such as prescription drugs and the over prescription of anti-biotics. Obesity, diet, and exercise all play a role here as well.

If we were going to let the free market rule, then we’d have to eliminate all health insurance, private and governmental. We’d have to get rid of medicare and medicaid payments to doctors. It’s interesting to note that specialists get paid more for the same procedure than a non-specialist. Hence we’ve had more specialists since the 60’s. Doctors, nurses, and health care providers should be allowed to make a decent living and considering how much education a doctor has to have they should be able to earn quite a bit. How would a free market system work for someone dying of cancer, AIDS, or multiple sclerosis? Not very well I think.

If someone has a stroke and are almost completely paralyzed, they could live for many, many years as long as they are cared for. They could never be a productive member of society again. They would be a burden on their family and the health care system. We shouldn’t let them die unless they wanted to. And there may be treatments developed to help them live better.  As long as we don’t have to triage and there are enough productive members of society contributing to the resource pool, they shouldn’t be a financial burden on anyone.  It does involve a redistribution of wealth, but I’m not suggesting we have socialized medicine.