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Tuesday, December 09, 2008

Nationalize It?

Good old Sid posted on my Kate's Law post:

Examples like this make one-payer, cover-everything national health insurance look less evil all the time.


It's a fair cop. but seriously, dude. Look at things we've nationalized. Amtrak, for instance, amounts to nationalizing the (passenger) railroads to save them. Last time I inquired about ticket prices, not only was it the least flexible form of travel I can imagine (incredibly few departure times coupled with almost random possible destinations) but it cost more than flying.

And this option that cost more than flying receives Federal subsidies. How much? A lot. I remember seeing, some twenty years ago, a claim that it would be cheaper for the Federal government to buy you an airplane ticket and pay for your rental car at your destination than to subsidize Amtrak the way it does.

That may have been bullshit, 64% of all statistics are made up right on the spot, but it's probably closer to true than most of what you hear on CNN, NPR and FOX.

Oh, look, here I found a more current analysis. And it still doesn't inspire me to think the train is worth saving. If you want romance, ride the Train to Nowhere, which, unlike the Bridge to Nowhere, is inexpensive, educational, fun, and not entirely pointless.

But aside from the railroad: the Post Office. This is an institution we nationalized as we became a nation, and it sucks. It sucks hard. Over time, it's service levels have diminished while its costs have soared. 42¢ to mail a letter? What's their response? Raise prices or cut out Saturday deliveries, because they still can't get it done.

So while private health insurance sucks, the Federal government taking it over sucks harder. It can't help it.

Here's my proposal. Instead of national coverage, let's get away from the model of employer provided health benefits. I have them, but I'll give them up. So will the UAW, and if the Big Three stop making cars that suck like postal service, maybe they can survive.

What if your (required by law) liability health insurance was tied to your job? Get fired and you might not be able to drive to your next job interview.

No, you can risk-pool the problem cases just like we do with people who have almost enough points to revoke their driver's license, and you can require everyone to carry minimal coverage. This would be your catastrophic and chronic stuff. Diabetes, heart attacks, autistic children, cancer, etc. If you fail to carry coverage, you can't participate in the economy. In most places, making a driver's license conditional on carrying basic health insurance would work. In a few places, New York City, for instance, you'd have to come up with something else. Maybe say it's a condition of a DL or a Metro Card. A very few ultra-wealthy might ride around in chauffeured cars and avoid it, but those few could certainly pay for their own medical bills and would be a statistical zero overall.

Likewise, weirdos who want to live off the grid in a shack in Montana could opt out if they're willing to act Amish and not drive cars.

If you can't afford it, there could be an option just like there is with housing and a lot of other stuff where you could get the bare minimum provided if you can prove you're destitute.

But private companies would still write the insurance. Don't make it another useless Federal program, it's too important for that.

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