Health Care Versus Health Insurance

Interesting post from Dana Goldstein:

An interesting question raised at the Ed in '08 conference: The idea of universal pre-school (in other words, affordable for everyone) isn't very controversial, unlike the idea of universal health care. But should pre-school be mandated? In other words, should we be requiring that all three and four-year-olds be enrolled in some kind of education program, even if it's "home schooling?"

On requiring, probably not. What I think this analogy does is highlight the distortions on our thinking forced by the health policy community's determination to find a way of reforming the health care system that involves appeasing the insurance companies rather than destroying them. In a rational and humane universe, health insurance wouldn't be universal. It'd be kinda rare. Something very rich people or the idiosyncratically risk averse paid for out of pocket. What would be universal would be health care. And as with universal preschool, the existence of universal health care wouldn't imply that at any given time every single person was actually receiving health care. Nor would it quite guarantee that everyone was actually receiving all the health care they need -- ornery people might just not go to the doctor.

Rather, the promise of universal health care would be that, as with the promise of universal preschool, the care would be provided to anyone who wanted it at a price that everyone could afford.

But if you want to keep the insurance companies in business, then you're looking at a different picture. Barack Obama has a plan to make health insurance affordable for every American. But many analysts think that a program like that is fundamentally unworkable unless you require that everybody buy health insurance. The problem is that there's a difference between only showing up to get your health care when you find yourself in need of care (that's normal!) and only showing up to get your health insurance when you find yourself in need of care (that's against the whole concept of insurance). Then, of course, once you decide on a mandate your problem because enforcement. But this mostly serves to underscore the fact that the compromises being made in terms of trying to create a realistic legislative package for 2009 are very real compromises, major steps away from ideal circumstances that introduce unnecessary complications into the system.

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