Politics has a dearth of engineering ability. This should come as no shock to anyone who realizes that the majority of politicians are lawyers. As a consequence of their lack of engineers, our politicians lack problem solving skills. The mathematician George Pólya once said that it is better to solve 1 problem 5 ways than it is to solve 5 problems 1 way. In general, it’s typically important to realize that there are multiple ways to solve the same problem. Congress rarely seems to understand this.
One example of poor problem solving is how we have forced health insurers to provide insurance coverage to people with pre-existing conditions.
Now before you get all red in the face and scream at me for being a greedy, heartless, silly Republican (and I’m no Republican), re-read that last sentence carefully. Please observe that being insured DOES NOT equal healthcare. Due to political rhetoric, we have an inclination to believe this falsehood, but the abstractions are certainly different. You can have healthcare without health insurance (consider going to the doctor and paying for healthcare). You can also have health insurance without healthcare (consider being paid a large lump sum by insurance if you’re diagnosed with cancer, but not receive treatment for your cancer). They are simply not equivalent. In other words, we can still give people with pre-existing conditions healthcare without providing them health insurance (and we certainly should!!!). Simply put, giving people with pre-existing conditions health insurance just isn’t correct by any sensible definition of what “insurance” and “pre-existing conditions” mean.
First, let’s start with some definitions. Any engineer has to use definitions to solve problems. I’ve copy/pasted these from merriam webster:
Insurance – coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril
Pre-existing – existing at an earlier time
So, insurance protects us against a loss. For example, if I buy home fire insurance, and then lose my house to a fire, the insurance will “guarantee” me some “contingency or peril” (by definition), meaning I will be reimbursed for the loss of my home.
Typically, we say X Insurance protects us against loss of X. Car insurance protects me against the loss of my car. Home insurance protects me against the loss of my home. Life insurance protects me against the loss of my life. Naturally, health insurance protects me against the loss of my health.
Pre-existing conditions, on the other hand, are medical conditions that a person has before they bought insurance. In other words, they have already lost their good health. But wait just a minute. How can insurance protect me against something that I don’t have to lose because I’ve already lost it? I thought the definition of insurance was to protect me against loss? If my health is already lost, how can I possibly buy insurance against loss of health?
Do we allow people to buy fire insurance after their homes have burned down? Do we allow people to buy car insurance after they crash their vehicle? No! We don’t! By definition, we can’t. If someone buys home fire insurance after their home burns down, this is a contradiction. I don’t know what they bought, but it sure wasn’t fire insurance.
As you can see, it is just plain wrong to give health insurance to people with pre-existing conditions. It simply isn’t correct. It breaks the abstraction of insurance in such a way that we can no longer even call it insurance. So, in essence, no one has health insurance, because we’ve ruined what health insurance even means. If you offer a product to cover an existing ailment, it can’t possibly be insurance by definition. We are starting to see a sharp rise in premiums due to the fact that insurance “has to make up for” people with pre-existing conditions. This is absolute nonsense! What a mess we’ve put ourselves in.
There are several steps to solving a problem. Typically the first one is to identify the problem. What are we trying to solve? What are we trying to fix? The next is to figure out solutions to the problem (yes, there is usually more than one). After we come up with some set of solutions. Each solution will have pros and cons. List them out, and make an informed decision on which is “optimal” (admittedly optimal is a weasel word, since what is optimal for me may not be optimal for you).
In short, the problem is that we want universal health care. Even if you don’t believe we should implement universal healthcare, you can’t admit you don’t want it. In solving that problem, our politicians found precisely one solution (incompetence, much?) and decided to ram health insurance down everyone’s throat. Yikes. What a bad way to solve the problem. Where were the other solutions? Where was the single payer solution? Where was the free market solution? No other solution was seriously discussed. And let’s not forget that this vote was extremely one sided, meaning that the solution was not a compromise. Additionally, it’s clear there are logistical problems with this solution, like the fact that it forces you to break the abstraction of insurance by offering health insurance to folks with pre-existing conditions. There’s also the problem of forcing people to buy insurance, which is a private good. Forcing everyone to buy a private good makes for another ripe contradiction, again, by definitions, but I’ll spare you another definitions lecture. This is left as an exercise to the reader ;).
I think that there are many good ways to solve the universal healthcare problem. Personally, I’m in favor of a single payer system, but I’m willing to recognize that there are other good, viable, solutions. In particular, there’s a free market solution. Cutting costs of healthcare (by eliminating some malpractice constraints, forcing upfront/transparent pricing, having the consumer deal with insurance companies and not the hospital networks, etc), subsidizing poor people, and having health insurance be true insurance is another way of solving the universal healthcare problem. Either of these would be better than the inconsistent, malformed, illogical healthcare system we currently have.
However, I am not in a position to decide what is “optimal” (remember the weasel word?) for the American people with respects to healthcare. That is what a politician is supposed to do. They are the ones who are responsible for defining optimal, and they sure have done a poor job with their definition when it comes to healthcare. So what I think about what’s “optimal” for the American people is totally irrelevant.
What I can tell you is that our current solution isn’t even close to “optimal” for anyone, except maybe insurance companies (which is an abomination). I can also safely assert we should have a solution that doesn’t fundamentally break abstractions (like insurance) and doesn’t have conflicting, incoherent definitions (like insuring people with pre-existing conditions). You can’t expect a system to be good, reasonable, and useful if it isn’t even close to being logically sound. Our healthcare system is no exception.
Nice work here. BTW… I think you missed a QED in there (somewhere) 😉
You base a lot of this on the definition of “insurance”, because that’s what we call this product. The problem is that health insurance isn’t really insurance. Ignoring the pre-existing conditions aspect, it already provides services beyond that definition. Things like covering routine check-ups, anything preventative, or savings accounts already breaks this definition. Therefore, I feel that to strictly use a name to setup your argument’s premise immediately falls apart (from a proof standpoint).
“Health insurance” is a misnamed variable. The responsibilities of this object have evolved overtime and no-one ever went back and refactored it for a new name (something like “health care cost sharing plan”).
What’s my point? I believe you’ve addressed a problem for a product that is not what actually exists by assuming words mean things (and we all that with politicians, they don’t).
I’ll also nit-pick one more thing, I think you need to define “universal health care”. Because what this would really be is a single payment vehicle that would replace insurance. I feel like you risking conflating the “insurance != health care” argument from early. Saying single payer as an option for “universal health care” immediately couples the concept of payment vehicle with health care. The lines gets blurry IMO.
That’s entirely the point. Health insurance isn’t insurance, I completely agree. It’s more than just a misnamed variable, though. We act like it is insurance, even though it’s true semantics don’t have much to do with insurance, and that causes problems. You can only buy the product through insurance companies, for example. You pay a premium. You have a deductible. These are insurance specific terms. I find it a bit absurd that you think the premise falls apart because I’ve appealed to the definitions of what words actually mean. Words have definitions and semantics, and these attributes of words matter. We can quickly see that we go into absurd, incorrect, and contradictory states if words have no meaning (I want to hippo the lion’s laptop! Please if yes.). If words don’t mean things, and we can’t agree on that, then there isn’t much more to say. I do fully assume words mean things…as I think reasonable people should.
You are correct in stating that a payment system doesn’t define what a healthcare system should be. But insurance is currently the payment vehicle into the system, not its totality. So I figured it would be apropos to talk about the payment systems in particular.