In an attack directed at George Bush, an outraged Al
Gore stated that Texas ranked at the bottom for states who's population
is covered by health insurance. He also lamented the fact that there are
millions of children in Texas who are uninsured.
Apparently, lack of insurance is yet another newly discovered form of child
abuse. I think this is a very telling statement, not about Texas, or George
Bush, but about the attitude of the liberals and other collectivists towards
insurance. It seems as if Al Gore is equating lack of insurance with lack
of medical care, as if having one without the other is unthinkable, or
at any rate unacceptable. If he is correct, then the collectivists have
scored a victory in one of the most important arenas, that of our lives
and health. Some relevant questions might be asked. Has insurance improved
health care? Must you have insurance today in order to get health care,
and if so, why? Would we be better off with government health care?
Insurance has two unfortunate effects, both of which
are widely seen throughout the health care industry. The first concerns
the destruction, or at any rate the impairment, of the marketplace. The
second is the acceptance of a central, non medical, authority exercising
judgment and control over our health care. In addition to this, the insurance
companies must take a piece of the moneys collected to cover their overhead,
and generate profit. In this way, the insurance companies act as a sort
of a middle man. The use of a middle man in the delivery of any good or
service, always results in an increase in price. Medical care, along with
any other product, costs less when we buy it direct. In addition to the
increase in cost, there is a decrease in quallity, and even in availability
when insurance becomes the primary provider. There are a couple of reasons
for this, not the least of which is avarice on the part of the companies.
In a free market, a doctor may let his customers determine his rates; In
an overinsured marketplace, the insurance companies become the market.
This will create an environment which encourages cookbook medicine, and
where cost cutting, and shortcuts become the normal and accepted practice,
rather than one option among many. This is why a five to ten minute visit
with a doctor often requires an hour or more, as the doctor maneuvers from
patient to patient, in an effort to run the maximum number of bodies per
hour through his facility. His pay is based entirely on his numbers; quality
of care plays no part except as determined by the dedication of the individual
doctor. There is no incentive for improved quality of treatment,
since all treatment, and all providers, are paid for at the same rate.
A doctor may be influenced in his choices by what
is covered, and the amount that insurance is willing to pay. In the past,
tests were ordered, and treatment prescribed, according to the perceived
needs of the patient. In today's overinsured market, tests and treatment
are often dictated according to a set of standards put forth by insurance
companies. These standards have more to do with the health of the company
than the health of the patient. Doctors put up with this because there
is money to be made, and because it is a very secure arrangement. Insurance
companies always pay their bills. If a doctor can set up his practice to
run enough bodies through the office every day, payment is assured. This
also diminishes the need to compete in the marketplace. An insured patient
will have no place else to go, except to other doctors honoring the same
policy. These other doctors are likely to operate their business in the
same way. Even if a patient is disatisfied enough to change to another
doctor, the treatment is unlikely to improve. All doctors who participate
in the same insurance plan would be bound by the same restrictions. Required
treatment which would not be recommended by one doctor would, under the
same plan, not be recommended by any other doctor. You are in essence being
treated by the insurance company, rather than the doctor. The price of
this inferior care rises because there is no marketplace to drive efficiencies.
Insurance has brought us to a place where we have to justify the decisions
we make regarding the care of our own bodies. It has also brought us to
a place where we no longer decide how much we should pay for this care,
or of what quality it is to be.
The unfortunate effects of insurance have pervaded
more than just our health care. In many states, it is not legal to drive
without it. You will not get a mortgage without home insurance. Life insurance,
rather than investment, and savings, is being advanced as a guaranty of
our family's security, and our funeral costs, should we pass away prematurely.
In every one of these cases, as in the case of health care, the results
are the same; an increase in costs, and a decrease in service and quality.
The reasons for this are plain and obvious once you consider what insurance
is and what it does to the marketplace. The consequences of letting insurance
intrude more forcefully into more areas of our lives may be gauged by looking
at it's analogous form of government --- socialism. This may seem like
a real stretch of logic, and may make the reader reassess the credibility
of the author, but please bear with me for a bit. Socialism, in it's pure
form, is the destruction of the marketplace. It is centralized control
of goods, services, resources, production, and consumption, or rather,
it is the attempt to centralize these things. A socialist economy pools
all wealth, and distributes it according to the dictates of a central authority.
How does this differ from insurance? It is interesting to contrast the
effects of medical insurance with the effects of socialist economic systems.
Both are known to produce shortages, reduce choice, impair quality, and
in general set up a system which is not accountable to those who are claimed
to be served by it. In short, there is little, if any, contrast between
the two systems, particularly when insurance is compelled upon us either
by legal or economic means.
The original need for insurance was for commercial
ventures where the investors did not wish to risk penury if a disaster
should occur. The initial users were men in the shipping business who could
be ruined by the loss of a ship or spoilage of a cargo, but soon the idea
spread to other businesses. On the less commercial side were friendship
organizations. These had been in existence for generations, and were fraternal
as well as practical associations. One of the main benefits was that dues
paying members would be provided with burial expenses upon their death,
sparing the family this expense at a time when it could least afford it.
Private coverage of property as well as of life was soon offered to individuals
as a sort of a cross between the two organizations. These grew from agreements
made between men, into professionally run corporations designed to turn
a profit. As an option for business men, insurance may not seem like a
bad thing, but as a source of security for the individual, it is unnecessary,
and exerts too great an influence over the course of one's life. The free
market is driven by the desire to sell goods. Improved quallity, and reduced
cost ensues where competition motivates providors to entice customers away
from each other. In an insurance driven economy, the money has already
been, paid and it becomes a matter of trying to increase profits by providing
the lowest possible quallity and quantity of sevice for the money already
I would be curious to know what Al Gore's take,
as a lawyer, would be on having legal insurance set up along the same lines
as medical insurance. If this would do to lawyers, and to the legal system,
what the pervasive influence of medical insurance has done to doctors and
medical treatment, I am all for it. Imagine long lines of litigants sitting
around in outer offices, waiting to sue each other. Harried lawyers with
huge case loads, spending only a few minutes with each client, before telling
them that they have no case, or that the insurance board won't approve
this kind of suit. Imagine people who commit horrendous crimes being told
that their policy won't cover this, and they will have to go to prison.
This is actually one instance in which the poor, collective structure of
insurance might actually do the country good, It would certainly benefit
us all as individuals. Unfortunately, this is unlikely to occur because,
unlike our lives, health, and property, litigation is considered too important
by lawmakers to be entrusted to insurance companies.