Pensieri di un lunatico minore

Health-care

Of late, there has been on both my mind and my reading list, the recurring thoughts of health-care in the United States. I work for a small (approximately 20 person) technology start-up in the Washington, DC area, and am fortunate to have excellent insurance coverage. In talking with our CEO the other day, we were discussing insurance and specifically the concept of single-payer systems and “nationalized health-care.”

Now, it is important to understand that my boss is both a Marine and a died-in-the-wool Republican, but his instinctive reaction is that as a small-business owner—it’s his money on the line as much as any venture capitalist—the nature of his company puts him in the worst of all possible worlds. This comes as a shock, but is completely logical from a conservative and free-market perspective.

In order to attract the talent that we need, something we have been very successful at, we have to offer good pay and good benefits. In addition, we generally pursue a more mature workforce than many companies have: the average employee in the company is late 30s, early 40s, and has a spouse and kids. They represent the substantial intellectual resource that the company needs.

Unfortunately, this workforce also represents the most expensive to insure. As a small company, we are thrown into a risk pool that is not as diluted as many at a large company might be experienced with, further increasing the premiums that we have to shell out for. This represents a double disadvantage for a small company. We are fortunate that we do not compete in our space against any “large companies.”

So, the argument goes with my boss and I, that a single-payer, nationalized system for health insurance—at least as a core benefit, if not the full benefit—would level the playing field between companies large and small, and reduce the disadvantage that start-ups face in competing. In addition, it would open up the employment pool more by reducing the penalty that employees face in changing jobs between companies.

The current system, codified in the war-focused 1940s, is built on premises that no longer apply. People no longer work for the same company for their entire life—which are now much longer than they were before. Start-ups now spring up and compete much faster, but also may not have the staying-power that traditional big companies have demonstrated. Neither of these are “bad things” for the dynamism of the market. Continuing to cling to outmoded thinking is holding us back as a Nation.

What we both agreed on, though in minor ways we differ, is that the United States desperately needs a nationalized system, paid for by the Federal government, without intermediaries like insurance companies who sole goal is to make a profit, not to demonstrate value and manage long-term care requirements. More tax-breaks are laughable, and will only further enlarge the deficit and reduce our future options.

We already spend $1.9 trillion dollars on healthcare, or approximately 16% of our GDP (_The Economist_, 28 January 2006) between public and private funding, with over half of it funded through the public side. This is more than any other wealthy nation, by a substantial amount and is more than adequate to fund a new system without any new taxes. What is needed is not money, but the political spine to see this happen.

Ever since Mrs. Clinton’s doomed initiative—a piss-poor half-effort—politicians have feared to tackle the enormous pink elephant in the room and instead have salved our collective wounds with tax breaks and homilies about how America has the “greatest health-care system in the world,” something that is only true if you are both insured and wealthy enough to exploit its available resources.

The President is expected to discuss health-care as his vision for the future. While this is an admirable thing to bring into focus, my fear is that it will be done with the same political mendacity that all of his initiatives demonstrate. A proposal beholden to tax-break driven mania and special interests is potentially the only thing worse than our current disaster, and we all must hope that true leadership is demonstrated, rather than the parroting of palliative missives and lobbyist talking points.