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Looking at the title of this article again, it seems a little strange. Surely it goes without saying that having a company insure your health is a good thing? How can it not be good? Surely people who are insured have better health and live longer? One of the more interesting things about the so-called scientific method is that everyone knows how it is supposed to work. You have to start with a hypothesis. In this case, it would be: people with health plans enjoy better health. You then devise an experiment involving a statistically significant number of people. One group, drawn randomly from the population have health plans. The other group (the control group) do not have health plans. Researchers then monitor their health for, say, ten years. Data is collected and analyzed. Results are published in a peer reviewed journal. Human knowledge is increased. Except, the US has been running this experiment for decades. Millions of people across the age range and with differing levels of health are uninsured. Millions more pay for private coverage. The remainder have plans provided by their employers. The data over the years shows that uninsured people have a lower life expectancy. In fact, the poor on average die seven years earlier than the rich. By a coincidence, many of those without insurance are poor. Now that is bad news for this research. There are many factors contributing to death. They are directly related to the social class and lifestyles of the individuals involved. In this, lack of access to medical care is not a major contributing factor. Put another way: there has never been any research to answer the question posed in the title to this article.

We need to consider two contradictory statements: when they fall sick, the poor go to an emergency room and, if they are lucky, receive treatment that keeps them alive; when they are insured, the rich receive care that gives them better health. Except the international statistics show the US has higher mortality rates than most of the other developed countries. To help you understand, we need a comparison with Europe where there is a completely socialized healthcare service and better life expectancy. Both at a European and individual state level, there are panels of experts who decide what treatments and which drugs represent good value for money. States will only pay for treatment proven effective and safe, and will not pay drug companies the retail price they claim. Instead, the states will only pay for approved drugs at prices agreed in negotiations. In the US, insurance companies happily pay for a battery of medical tests and procedures even though there is no evidence any of this work is effective. This adds to the irony. Sometimes the rich die young even though they have received multiple treatments. This is because their expensive treatments are ineffective. Read the rest of this entry »

Let’s leave the politics of healthcare reform to one side and focus on a proposal to change the law to allow free market competition between insurers in different states. A policy consistently mentioned by the Republican party is to break the state monopolies in the insurance market. Since the 1800’s, the individual states have claimed the sole right to regulate the sale of insurance within their own borders. Each state has asserted the right to license insurance companies and to set the terms on which they can conduct business. This has led to a patchwork of different sets of regulations with each state creating unique laws. In turn, this forces an insurance company to set up separate subsidiaries to trade in each state. No licensed company can sell a policy to someone who has a residence in another state. There was a brief moment in 1944 when a decision of the Supreme Court allowed the possibility of federal supervision. But the lawmakers in Washington immediately changed the law to retain state control. Why is this a bad thing? The national insurance companies have divided up the states between them and choose not to compete against each other. This keeps the number of insurance companies in each state artificially low and, because there is no real competition, premium rates are higher than they should be for weak policy terms.

You are reading this article on the internet. When online, you can buy more or less any product or service across state or national boundaries. Although there are some restrictions, e.g. some states limit your right to import drugs from foreign countries, there is an almost free market where you can search for the cheapest price and buy whatever you need. There is no possible economic justification for retaining this historical privilege for insurance companies. All it does is preserve their ability to maximize their profits at your expense. For example, in Minnesota three insurance companies dominate 80% of the market for health plans. There is no doubt that, if more companies entered the market, the premium rates would fall. During his run for President, Senator John McCain was in favor of free markets for health plans. President Obama supports it and the proposal is in both versions of the healthcare reform bills currently stalled in Washington. But because the Republican party’s only policy is to oppose everything the Democrats propose, it seems even this simple change in the law may be lost. What will the result be? The anticompetitive behavior of the insurance industry will continue and you, the consumer, will suffer. Read the rest of this entry »

The world of politics is never supposed to make any real sense. After all, once you pit people’s cherished beliefs against each other, passions are roused and the arguments soon become bitter. It would be better if everyone was just allowed to do what they wanted. But, when it comes to organising medical care for the population, it takes a government to put the right kind of infrastructure in place. People have to be trained as care givers. This takes years and costs a small fortune. Hospitals and clinics have to be built. And then we come to all the support staff who drive the ambulances, keep the places clean and keep the accounts. Ah, yes, the money. All of this work over years has to be paid for. So the $64,000 question is who should foot the bill? It’s at this point that emotions get in the way of common sense.

Talk to one side of the argument and they will tell you people who want access to medical care should carry private insurance. Talk to the other side and they will tell you the state should pay for the service out of the tax revenue. It’s never really clear why people disagree. Only people who are in work pay tax. Only people who earn can afford to pay the premiums on insurance. It’s the same money. The only difference is the way it’s collected – one as tax and the other as premiums paid to an insurance company. But wait! There is a difference! If the state collects in the money, it can use it more efficiently because, unlike the insurance industry, it does not intend to make a profit. So the only reason to support the current system is to allow the insurance industry to continue making an ever larger profit.

As the Senate is currently set up, forty-one senators can stop any reform. That’s forty Republicans plus one other. Yet when you look at the number of people these Republican senators represent, it’s only 36% of the US population. This is somewhat unfair. The party with the majority of representatives was voted in by 64% of the population. The Democratic platform could not have been more clear. It was to be reform of healthcare provision. Yet when you look at the media, all you see reported is the opposition to reform. The “tea party” movement captures all the headlines. But in all this, there is one really big irony that gets very little coverage. Read the rest of this entry »