28 July 2010

Better Than Insurance

I have a great idea.

Are you tired of trying to figure out your medical insurance, overly-managed care, privacy policies, Medicaid, Medicare, and all that? As an alternative to patronizing commercial insurance (for as long as Congress allows it to function), and especially to frustrate government control of your body mass index and your bedtime, how about this:

A large number of people would voluntarily contribute some money each month to a fund of their choice – the money they might otherwise spend for insurance premiums. The fund would want to be endowed with enough money from its participants that it can maintain a cash flow sufficient to cover its purposes. And its chief purpose would be to cover the cost of its members’ medical expenses as they occur. Maybe the people who contribute to a certain fund would have a common interest – it could be they belong to the same church or maybe they’re all farmers – or maybe their fund invites anyone to join.

Each fund would be managed according to rules that the contributors mutually determine. Maybe one fund encourages healing by unconventional approaches such as meditation and acupuncture and would cover these services at 100% of charges but would offer little or no coverage for prescriptions or surgery. Maybe another fund caters to members who have risky pastimes and who expect to undergo more frequent orthopedic intervention. Skydivers and people who race motorcycles would be attracted to this group, which would have complete coverage for fractures and lacerations but might not cover healing-by-meditation at all.

People who see no health benefit from inhaling smoke could choose a fund that has a low level of coverage for lung cancer and which might also provide no coverage for smoke-as-therapy (cannabis).

So – this being America and citizens having the unfettered right to associate with whomever they choose – the idea, so far, raises no issues. On the face of it, it does not even qualify for any notice by the government. People pool their money in lots of ways and distribute it as they see fit. Lawyers, for instance, send astonishing amounts of money to private organizations such as the American Bar Association, in exchange for a list of promised benefits, and that’s not regulated by the government.

Under this funding idea of mine, for a medical office visit, the patient would either pay the total cost at the time of the visit or else would wait for a bill from the doctor, which the patient would then submit for payment or reimbursement. Or maybe the doctor or clinic or hospital would agree to send the bill directly to the fund. The patient would ultimately be responsible for the expenses incurred if the fund is not organized to cover the incurred expense. The fund would not be dictating the medical care, as happens with insurance and government.

Now, I fiercely defend anyone, individual or corporation, who has found a way to make a ridiculous profit from a business, provided there are customers willing to pay too much for a product or service in order to support that ridiculous profit. In America, it’s a private matter.* While I defend anyone’s right to become absurdly wealthy, I don’t personally volunteer to help make someone absurdly wealthy unless I think they deserve it. Each of us can probably think of a product that is so good we’re willing to pay far more than it costs to make and distribute it. Some people feel that way about Post-Its, for example. It also happens when a new product comes along and everyone has to have it no matter the cost – Cabbage Patch dolls, iPods, Avatar. You get the picture. Sometimes a guy simply deserves to capitalize in a grand way on a terrific idea. I don’t begrudge Bill Gates one cent of his fortune, even though his product, Windows, is full of flaws and has lousy, over-priced service. Had I been around a hundred years ago, I would not have begrudged Henry Ford all the money he could make from me.

I don’t feel that way about health insurance. No individual leader in the insurance industry inspires my gratitude or admiration as does Bill Gates or Henry Ford. They didn’t invent the product, and there is nothing so special about any particular company that makes me want to cheer and recommend it to my neighbors over the “competition.” (In fact, insurance is so regulated that, like banks, they essentially have an enforced monopoly.)

If I could, I would buy my coverage from a not-for-profit cooperative, much as I can choose to do my banking at a credit union. You see, there is nothing about health insurance that is so new or unique or hard-to-manage that anyone can possibly earn millions a year heading it up.**

I fail to comprehend how it improves the service I receive from my insurance company, or how it reduces my cost of insurance, when there are stockholders who must be paid, executives who must be pampered, and buyout deals that must be propped up, all at my cost as the payer of the premiums. That’s why I would like to participate in a not-for-profit fund beyond the interest of the government. (Beyond these wastes, my premiums also support the waste of compliance with government interference, such as privacy notice mailings, and the scandal of cost-shifting.)

Insurance-for-profit is not a pretty industry. It’s all about people being paid to push money around. The people being paid the most to manipulate my money under an insurance policy are accountants and lawyers. When we let Congress get its nose into things, it passes acts to create more government agencies – the unconstitutional fourth branch of government – to create more jobs for accountants and lawyers, who become the high priests of more inscrutable rules.

The only alternative proposed, so far, to commercial insurance is a government program. This needs to be abjured by a citizen outcry simply because it places more of our business into the hands of an incompetent government. It is not corruption in the ranks of benefits administrators that is insidious. It is corruption in the manner in which Congress conducts its business and abdicates its responsibility to a lawyering class of its own creation. There is nothing so complicated about insuring people that more than a handful lawyers nationwide should find themselves employed in its concern.***

Ergo, I seek a way of insuring the unexpected costs of maintaining my own health by circumventing commercial insurance and government narcissism. I realize that I will be taxed unto death and beyond to support those who have come to expect their free stuff from government, but I seek an alternative to the many thousands a year I will otherwise have to cough up soon for Medicare and all its parts and supplements.

Is there anyone out there interested in joining me in creating a fund, managed by ourselves, from which we may each draw for certain pre-arranged and mostly unexpected medical needs?

Wait a moment… I have just been informed that my idea is not new. In fact, that is how commercial insurance came into existence in the first place. And I’ve just been shown that government became interested in it because money was changing hands without passing the sieve of government extortion. And to attempt such a cooperative on such a simplistic level now thwarts the purpose of insurance regulation, which is to create jobs for business school and law school graduates, salaries for CEOs, and revenue for government.

I’ve missed something, I guess. Strike those phrases above about freedom to associate, it’s my money, et cetera. (There once was such an America. I swear it. I grew up in it, but that was many years ago. Sorry to trouble you, everyone…)

*If I could make great-smelling soap, for instance, and market it for $28 a bar under some fancy name and millions of people would buy it and give me $26 profit on each bar, why, that’s between my customers and me (and the IRS – I don’t propose cheating on taxes**).

**It’s not the stockholders’ profits that are hard to swallow – in fact I’m starving for a little stockholder profit myself these days. And the obscene CEO salaries leave me only a mildly bitter taste; I try not to invest in companies that treat their executives like royalty. The hidden game that I most despise is the corporate buyout. Companies of all sorts are being bought and sold all the time, and that is what really hurts us all. As soon as Prince Hotshot becomes CEO of Neighborly Mechanical Chicken Separator, Inc., he expects to make a name for himself through cost-cutting, then expects to sell the company within a year or two so that he and those closest to him – whether on the Board or in the ranks of management – can each make a huge personal gain. I do not suggest that this should be illegal! I suggest only that rational investors would protest this culture of greed by putting their money into companies that have a different culture. It so happens that we little investors, who could have effective influence if we all understood what we are supporting, have made the self-enrichment of the executive class the prevailing culture by failing to examine closely enough – and thereby accepting – what goes on at levels we think are beyond our reach.

***What I DO propose is 100% turnover each time we send people to Congress until the ones who are sworn in every other January get the message that the IRS needs to be abolished and that the federal government needs to be funded by a simple flat tax that everyone pays at the same rate, such as a consumption (sales) tax. The “rich” might spend more and thus contribute more revenue, but the “poor” would contribute something in rough proportion to their overall wealth. Such a tax scheme would remove redistribution by reverse taxation, and those truly in need would receive assistance through welfare schemes separate from the tax process.

26 July 2010

Biker Rules

As we sometimes do when waiting in line among complete strangers, I complimented a T-shirt worn by someone queued ahead of me. Bright and well-designed, the shirt commemorated a bikers’ rally somewhere. The rather elderly woman wearing it asked me: “Do you ride?” I told her I did not – that I have trouble enough staying upright when I’m merely walking. (Well, when crossing a trout stream on slippery stones, for instance, but that’s not pertinent here.)

A rambling conversation about motorcycles followed, which quickly came around to helmets for bikers. I told this presumably-veteran biker about a woman I knew, passenger with her husband out for a casual ride, who was killed recently for lack of a helmet when their bike rear-ended a stopped car.

This biker lady told me that my dead friend was probably safer without the helmet, because what’s the first thing that happens at an accident? Good Samaritans try to pull the helmet off, and that will either kill you or paralyze you. “Let those who ride decide,” she said, in the manner of quoting a rule or proverb. Then she asked whether I knew the eleventh commandment, (I did not): “Thou shalt not stick thy nose in thy neighbor’s business.”

Hardly had she said this when the lady with the shirt was called to the front, ending her wait in line, and stealing my opportunity to respond effectively. So, for her, and for all the rest of you bikers out there, here’s my take on the bikers’ proverb and the 11th commandment.

If bikers were the only ones affected by their helmet decision, then I would have no interest in the subject. But those who ride without basic protection do affect me no matter how their medical care is covered. Those with commercial insurance are members of my medical insurance pool. Sure, they pay premiums (or an employer does), if they have a commercial insurance plan, but my premiums are affected by the insurer’s “experience rating.” The experience rating includes the costs of treating catastrophic trauma and of heroic interventions to save lives. An employer's cost of such benefits is passed on to me in the price of a product, so it affects me there as well.

Those without commercial insurance are dependent on my “voluntary” payment of income taxes for their government coverage such as Medicaid, or, if totally uninsured, they are dependent on charity care at the facilities that treat their medical issues, which then affects me because the cost of providing charity care is shifted to my commercial insurer and raises the premiums I must pay.

So if I am going to let those who ride decide, then let those who ride live with my rule which is “Let those who pay say ‘Nay.’” And my eleventh commandment is, “Thou shalt not stick thy hand into thy neighbor’s pocket.”

Of course, my rules have already been trampled by the audacious stampede of the acquisitive masses under the joke of "representative" government. The have-nots can vote themselves largesse from the public treasury, which is funded by those who pay the bulk of the taxes but who are overwhelmed at the voting booth. But if those of us who pay were to organize ourselves as well as a few (I stress: a few) bikers and others have done who have their hands in our pockets, perhaps those who pay could say “Nay” and make it stick. Then I’d be happy to let those who ride decide.