Why do Republicans want federal health insurance?

I’ve been reading that most of the hardcore Republican governors are refusing to set up state level insurance exchanges like MNSure. You can find a list here.

This seems like a dumb move to me.

The insurance exchanges are going to happen. The Affordable Care Act specifies that if states don’t set up something on their own, their residents will use the federal-level exchange. So basically, they are saying, “You have to get your insurance somewhere else, because we aren’t going to help.”

So Joe Schmo from a red state (mostly) says, OK, I have to do this… Hey, this is cheaper than I thought… And then he finds out that his neighbor, who had been uninsurable due to a long resolved but potentially chronic issue, can now get insurance. And his nephew, who would have forgone insurance because he’s young and healthy, gets an antibiotic-resistant infection from a cut while fixing his motorcycle and instead of being bankrupted, winds up getting more pain from the cut than from the bill.

And after a few years of this, he begins to wonder what all the fuss was about. And a few years after that, the thought of cutting off an insurance patient because they got sick will seem outrageous. (This is now practiced, will be banned)

And eventually, Joe Schmo will wonder why exactly his state and it’s elected officials were so vehemently against this.

Now I’ll try to think why there is such opposition. Politically it might be due to a lot of pure Obama-haters. But there are philosophical reasons that can at least be stated and defended, even though I disagree with them.

  1. It’s a huge expansion of government, and we don’t like government programs in general.
  2. The free market is doing its job.
  3. The insurance-or-penalty requirement is a coercion or a tax.

Item 2 is pretty clearly not the case. If it was, insurance and health provider profits would be a lot smaller. Basic economics (Ec 11, which I took 30 years ago) says that a truly efficient market has extensive choice, informed buyers, fierce competition that drives prices lower and minimizes profits. I don’t think so.

Item 3, which is a key part of making the financial side work, was also part of the plan as developed by the conservative think-tank Heritage Foundation ( who now vehemently deny it.)

So that leaves Item 1, the real issue.

If the free market was doing its job adequately, maybe this program would not be necessary.

And if the conservatives truly believed that the free market can do a better job than any government program, take this dare: what if the government were to buy up some hospitals and run them in competition with the for-profit private sector?
Compare the VA health system, which gets pretty good ratings.

One more note: I just got an itemized statement from my veterinarian about what it will cost to do a couple minor procedures on my cat, Sandy. When was the last time you saw a comprehensible, binding, pre-service cost estimate for human health care? Should doctors work like auto mechanics, where estimates can be made in advance and the profit comes from known markup and (maybe) working more efficiently than the estimate suggested?


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