Chapter 7 Health Insurance

As my latest favorite crime novel detective* puts it, They all count or none of them do.

I'm not one for the 'single payer,' aka 'socialized medicine' solution to our little insurance quandary.

As bad as HMOs can be, and I've dealt with some turkeys in that area, none of them are an Amtrak or a Post Office.

We're about to swear in a President some adults I know have a sort of Santa Claus-style faith in with regard to health care. Including at least one person with a PhD, which is to say these friends are not idiots even if they're deluded about both the effectiveness of the Federal Government and the actual difference between a Republocrat and a Depublican in the White House.

The same fairy dust George Bush didn't have to stop terrorists and a global financial crisis, Obama doesn't have either. Sorry, that's the breaks.

But this wasn't prompted by the NPR love-bombing of the incoming administration, which I take as par for the course. Along with their fundraising begathons, this is just something that comes with the territory.

It was prompted by a conversation with yet another friend who's only real recourse for medical bills is bankruptcy court.

One friend owes around $100,000 to a county hospital that kept him alive, if barely, with congestive heart failure. He's fully disabled, including a disability to pay a six-figure hospital bill on the pittance he gets for being disabled. Since his condition is not reversible, he'll either die with bill collectors hounding him, or he'll go Chapter 7, the only legal and effective way to make them fuck off.

Another owes a mere twenty grand. But being relatively young and not established in a career, that's something like a year's wages. And these bills come from a congenital condition that is only going to add to the bill pile. The first friend I mentioned could probably declare bankruptcy and live as long as he's likely to with 10-15% heart function without going back into the hole again. The latter friend could 'go out' as the saying goes and likely be at least as deeply in debt before seven years is up.

And do we really want our bankruptcy courts to be health insurance of last resort?

Here's my idea, and it beats a 'single payer' system up one side and down the other. Treat catastrophic health insurance the way we treat liability auto insurance. If you want to participate in the system, you have to buy insurance. No groups, sorry all you UAW members, but your boss cannot be the source of seemingly 'free' insurance anymore. I'm getting screwed pretty hard in this proposal, but bear with me.

This insurance will pay nothing for ordinary checkups or routine followups with specialists. It won't pay for maintenance meds or for cutting edge treatments. It will pay your $54,000 hospital bill when you shockingly drop dead mowing your Mom's lawn at 32. It will cover your annual treadmill if you have an enlarged aorta due to a fluke of genetics. It will cover your congestive heart failure even if that was caused by a few too many rounds of Old Overholt back when you worked construction.

When I say 'participate in the system,' I mean if you want to work or buy stuff. A good way, overall, would be to tie this insurance to a driver's license, though there are some places you can rely on mass transit. If you don't want a handful of New Yorkers to be able to opt out of paying and still receive benefits, I guess you could extend it to state ID's as well. Basically, if you want to be able to get a job, even a menial job, you'd have to prove you had minimal health insurance.

People with means can still buy Cadillac coverage if they like. Such coverage often isn't so much 'insurance' as a payment plan, but whatever. The main thing is to pool the risk of the least common denominator from the biggest threats so someone doesn't start out life permanently behind or end life with impossible burdens.

*Harry (short for Hieronymous) Bosch, central character to a whole slew of Michael Connelly police procedurals/mysteries. I've been listening to a few on my commute, and Connelly isn't just a genre fiction hack: he can write. Up there with Ridley Pearson, Dennis Lehane and Peter Robinson. Check him out.