Our healthcare dilemma in the USA

Two rational options

The two rational options for healthcare in the U.S. are:

A) A free market system that denies care to those that can't afford it.

B) A socialist system built to provide universal care.

Our current state of affairs

The patchwork of private insurance corporations we have now is failing us. Your insurance gets billed directly by your healthcare provider without you knowing the costs ahead of time. Hospitals provide care whether or not a patient has insurance and must try to make up for losses. One of the only options to do this is to bill as much as possible for every single item, procedure, test, to those who are insured.

Healthcare has (unintentionally) become a protection racket

In addition to being inefficient, this patchwork of private insurance and private providers and individually negotiated maximums, has given birth to what is essentially a protection racket of "in network" providers. You have to be "in network" to get the benefits of pricing that the insurance and providers have negotiated ahead of time. If your Doctor or hospital is not in the right network, even if you could afford paying for their services out of pocket, you wouldn't get fair pricing. For example, once I had an emergency room visit that lasted about three hours. The bill I received from the hospital, not including the doctor's services, was around $5,000.  After it was sent to my insurance, it magically became $800. Insurance hadn't paid a dime at that point because I hadn't yet met my deductible. Just the fact that the provider was "in network" made the price difference.

So how much should that visit actually cost? Was it a $5,000 visit or an $800 visit? Those are not similar numbers.

While frustrating, I don't believe that this somehow comes from malicious intent. I believe this is the natural outcome of regular people doing regular day jobs that happen to work in a broken system. The system is fundamentally broken because we, as a society, hold two competing ideals that are irreconcilable and we haven't seriously examined them. It's uncomfortable to confront two competing ideals. It's cognitive dissonance.

Our irreconcilable ideals

1) It's immoral for hospitals to turn away someone who needs medical help if they can help them.

2) If you can't afford it you shouldn't buy it.

Pretending like these two thoughts can somehow both work in the context of healthcare is why we're in the current mess we're in.

The free market approach to the complex healthcare situation would probably work, but it would require that hospitals not provide care to those that can't afford it. That's option A.

Or we could acknowledge that, as a society, we actually already believe in universal healthcare and then create a socialized system that fits that belief. Option B.

I'm a capitalist when it comes to most markets and transactions but not health care.

Health care contains too many inelastic costs, decisions that are life and death, to which bankruptcy pales in comparison. It's not a good fit for the advantages free markets provide.


I choose Option B.

Money should not be a deciding factor for providing care. We need a system that lives up to that ideal. Universal healthcare in the U.S. is not an easy problem to solve, but the first step is to look at what the problem actually is: We hold two competing and irreconcilable ideals.

I appreciate what John Green has to say on this issue, this video is worth the watch.