Many readers seem to believe there is no difference between equality of opportunity and equality of outcomes. I favor the former, not the latter unless it's a result of the former. It staggers me to realize that so many do not even grasp the difference. But the critique of private sector healthcare rationing is real and worth airing:
I'm one of the 40+ million Americas that the market has efficiently removed from health care rolls. I was laid off from a corporate job and make ends meet with freelance work while I job hunt in this rather difficult job market.
I bought a private policy -- because COBRA was twice as expensive -- a year or so ago from the company that held my employer-sponsored plan (rhymes with Clue Loss / Rue Field). I figured this would make continuity of prescriptions and care pretty straightforward, and instead found, when I went to the pharmacy, that those carry-over prescriptions were no longer covered, because my seasonal allergies were now a pre-existing condition. Yes, it's true that leaving health care in private hands reduces political corruption, but there's one thing that I've seen happen with long term political corruption: indictments. You don't see that too much with corporate corruption, do you?
As for me, I'm in this 18 month window where I can't get health insurance, because the forms all ask for medications that have been prescribed over the last 18 months. I've come to believe that America's official health care policy is "Don't get sick," and I'm sure as hell hoping not to in the meantime.
As for the "innovation at the top end" that you cite in our current arrangement, that's a really exciting piece of the puzzle for those of us who can't see a doctor unless things have gotten really bad. And I'm a single, healthy person. God knows what happens when there are kids in the mix, or if, for instance, I had a long term chronic condition like, say, HIV. That would really suck -- whatever the joys of innovation at the top end might be for those lucky enough to access it.
Here's the truth Andrew: our system is already rationed. Our government already provides health insurance to large numbers of Americans eligible because of age, civil service, military service, or disability. Since the market has efficiently excluded so many working Americans, I vote that the market face some competition. If its offerings really are superior, then I'll have ghetto government insurance until I'm eligible for these supposedly better products, but we all know it's better than nothing. And people with families to think about -- my God, there's a reason that in other countries they call these things safety nets. It's dangerous to be without insurance, and frankly, my views of the "free market" are pretty dim by 2009. And I don't think I'm alone.