Pondering Health Care Imponderables

I suppose that the mutable number of health care uninsureds includes various categories who choose not to be covered for equally various reasons. I doubt the Amish are interested in any health care program, public or private. There are some religious groups whos members do not choose to avail themselves of modern medicine for reasons which are reasonable in their way of being in the world but not of it. There are some people who prefer folk remedies or the contemporary equivalents thereof and do not intend to consort with the practicioners of scientific medicine at any level. There are cost-benefit analysts, mainly younger people who are healthy and do not see much benefit in paying some thousands of dollars annually in health insurance when they probably won't spend a hundred on health until later in their lives. There are some substantial number who likewise make choices as to whether health insurance or some other thing of value to them is their better buy, given slim resources. There are also children whose parents are uninsured, but who are, themselves eligible for government medical assistance, though they may not know it. And there are also a number of people, possibly the largest of any category, who are in this country illegally, who certainly do not see health insurance as a spending option because they intend to send most of their earnings home, or are earning money illegally, or have no fixed domicile, or are sufficiently wise latinos or latinas to recognize that buying health insurance doesn't get you anything you won't get in the ER. or other reasons which might include linguistic and cultural factors, not only theirs, but ours, since we have some number of citizens who feel that we owe it to the downtrodden illegals to take care of them with taxes paid by everyone, including those whose jobs were lost to illegals who can be paid less then the minimum wage, worked overtime, and maybe "taxed" through withholdings that are withheld both from the illegal employee and the government.

The semantics of the "uninsured" definition also enters in. Are VA- eligible veterans who do not choose to seek any other health care insurance insured, or uninsured? I suppose it depends on who is compiling the list, and what their agenda is for developing the statistics they will advance.

Not to make to fine a point yet, but a good many of the 30,000,000 or whatever number you might cherry pick from available sources, who are uninsured don't want to be insured, and a good many have a reasonable argument that forcing them to be covered or pay a penalty for not being covered means that they are being taxed (or fined) for a religious principle that they hold, and have consistently held for decades or centuries. The children who merit coverage but don't have it because their parents haven't enrolled them may technically be without coverage, but they are eligible, and would be covered if some reasonably simple steps were taken at the local level to promote the programs in each state through the school system, welfare, food stamp and other programs. (The government is its own enemy sometimes because these programs to aid the poor and almost poor are so compartmentalized that its not that one hand doesn't know what the other is doing, but rather that any finger on either hand doesn't know what the fingers on either side of it are doing, let alone what the hand, the other hand, or any finger but one are doing).

In the Massachusetts plan, the government takes a default position, requiring that anyone who is not covered pay a specific sum annually for making that choice. The proceeds, oversimplifying the plan somewhat, go to paying for the cost of care for the uninsured as a general cost category.

The problem, of course, is that the illegals, probably the largest group of uninsured, are here illegally, so how is the government going to collect this sum which these people, as uninsured, are supposed to pay? Likewise the little kids.

And what about the conscientious objectors of the medical spectrum who do not approve of much that scientific medicine does and would not use the system under any circumstances, and object quite vehemently when the scientific medicine system captures one of their own through well-intentioned social legislation that ignored, when it was passed (probably unread) all but those within a single standard deviation of the norm.

The insured, however you define that, pay for the uninsured already, in many respects. The bills for the insured who are hospitalized are inflated greatly to make up for the cost of indigent care. Doctors still do some pro bono work. Medical practicioners and institutions absorb substantial costs as the result of bankruptcies where medical bills are a factor, but not necessarily the only factor. The losses the current medical system accrues because of uninsured or underinsured users are offset by costs born by those who pay, or by the state and federal governments.

The argument that taxing or fining the uninsured some amount will create a pool that fixes the medical care system by reducing costs all around falls flat, in my estimation. That conceptual approach would only tax/fine, practically speaking, the younger and early middle aged people who assume, correctly in most cases, that they don't need much from the medical system anyway. It will get little from the conscientious objectors who don't use the medical system, and never will, because they will file and win class action suits that will exclude them from whatever program is developed (unless the constitution is trashed), and the little kids can't pay, nor can some other individuals, as a practical matter. Nor will some taxing or fining program work on the illegal population. The government can't collect from people it can't find or refuses to notice.

Pick any figure for the number of people who are not covered by some sort of medical insurance in the United States and then factor in the uncovered who will ultimately prove uncoverable, and also the number who are technically uncovered but need not be, whose medical costs are just absorbed by the present system, and it will strike you as more than likely that this currently proposed revision of medical care payment is not going to do any better than "to rearrange the deck chairs on the Titanic."

During campaigns, candidates are all mouth and the solutions they propose are ever so simple. (All you have to do is just..., the greed of the ...is the root of the problem). Sometimes they are just blowing smoke, sometimes they believe the inadequately evaluated ideas they wistfully espouse.

The thesis that there is nothing stronger than an idea whose time has come perhaps has as its antithesis that there is nothing weaker than an idea whose time has not yet come. There is certainly, with respect to the medical care cost situation, a synthesis, or there could be a synthesis, but it is not going to arise out of the ridiculous congressional spectacle of recent months (years, eons?) where the art of compromise has compromised intellegence and integrity.