Why I Want to Pay for Your Healthcare

As the Democratic party continues to argue in the primary about universal policies like Medicare for all or debt free college a new and disturbing line of argument is emerging. Why should I have to pay for the ultra rich, or illegal immigrants to get healthcare? Why should I have to pay for everyone? This is disturbing to me from a moral perspective, as I think it runs counter to the idea of healthcare as a human right which the party only recently figured out is true. But it’s also just wrong from a policy perspective. It’s pretty tough to get a correction on this in a presidential debate where you only have a minute or so to respond to anything so here’s an explanation.

Don’t want to pay for things associated with people’s lifestyles, like obesity related Illness? Then why aren’t you asking about how the farm bill and poverty interplay to cause obesity? Why not address food deserts too? Obesity is not simply about personal choice. You’re not addressing the problem by trying to avoid paying the costs for healthcare, you’re just making it worse in the end. Paying more as outcomes become worse. Modern industrial medicine will just shift these costs to you. Loss of productivity in the economy also directly affects you in numerous ways.

You are always going to pay, in the end, the real question is what is the best way to pay.

There is little transparency about the costs associated with healthcare and as a result healthcare providers are free to adjust their prices as needed without much consequence. Another reason for this: you don’t get a lot of choices to shop around. Insurance requires you to stay in network in order to save costs, and even when you go to the right hospital, you could still end up with an out of network doctor. It doesn’t even matter if you are unconscious when you arrive at the hospital, insurance companies expect you to inquire about the network status of every doctor who sees you. Don’t forget to ask the anesthesiologist or the physical therapist.

So, no one has choice over pricing. Even insured people can be surprised with out of network bills. And our system which allows uninsured and underinsured people to exist lead to worse healthcare outcomes and increased costs for all users.

I think I would find the argument about allowing people to have a choice about insurance coming from the candidates against medicare for all more persuasive if they spent as much time talking about making reforms to address waste fraud and abuse from hospitals, insurance companies, and drug makers. Their argument is about fear of changing to a new system, rather than a full policy proposal. The only aspect a public option addresses is access. Costs may level as the market stabilizes from the influx of patients, but over time, it’s going to start going up again, and at the same rate it is now, without a lot of other serious regulatory reforms.

So since we’re all paying for it anyway, because that’s just how modern industrialized medicine works, the only way to fix the system is to make healthcare more efficient. And that means removing the profit motive as it’s pretty much antithetical to becoming more efficient for patients instead of shareholders.

But another argument that comes up around this is why should I be paying for ultra rich people’s healthcare? Shouldn’t they be expected to take care of themselves? This is just a diversion based on a false premise: that anyone can or does take care of themselves. It seems reasonable until you realize that no one exists outside of society, that we are interdependent. And when you look at how medicare for all gets paid for, it will always require the ultra rich to subsidize the cost for others. So the taxes I pay into the system may support the healthcare costs of my family, and maybe an additional person or two. But the richest people can be taxed to provide the costs of healthcare for hundreds of thousands without even changing their quality of life.

This system needs massive reforms to fix it without replacing it. Since no one is talking about that you can be sure that their “solutions” won’t actually address the problems which are costing every American. Medicare for all is not only the most moral system, it’s also the most efficient, which is the only way to address the real problems inherent in the system. I’m already paying for your healthcare, I just want to do it in a way that creates better outcomes and costs less.

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