Then there is Jack the Tenth. He drinks, a lot. He insists on riding his big Howard Davidson motorcycle without wearing a helmet. When he goes down the road there is more smoke that comes from his cigarette than from his bike. Sometimes he smokes some weed that he buys in the Kingdom of Colorado. He says it makes his rides prettier. The kingdom just bought its first ambulance, just in case.
As a benevolent sovereign I want to make sure that my subjects are well cared for, so I'm going to provide what the Kingdom of C calls Universal health care. My kingdom isn't rich--we are still making payments on that ambulance--so I have to figure out a way to pay for it.
My Royal Accountant tells me that we could easily cover eight of our citizens for $10/month. If they all pay. If we knew for sure that Sarah the Matriarch would die in her sleep at home, we could do the same for her, but, there is that nursing home. Then there is Jack the 10th.
"I'm consulting with Count Adrenaline of the Kingdom of Chaos, to come up with an estimate for him. It ain't gonna be cheap or pretty, though."
Bob, one of the young husbands in my kingdom is a sharp lad. He approached me the other day. He
"Him? . . . wouldn't touch him with a ten-foot pencil, no matter how sharp."
OK, my fairy-tale has gone far enough. In the real world not only are the numbers of citizens far greater, the complexity of issues is exponentially greater. Having said that, though, can't we just admit that there are several elephants in the room.
- Some people are a far greater risk than others. Much of that divide lines up with the divide of old and young.
- If everyone is going to be insured, the healthy, at least for a time, are going to have to put more in the system, probably much more, than they take out.
- If there is a government mandate--that means the government can punish you if you don't participate--then those who choose a healthy lifestyle are forced to subsidize those who live foolishfully, or dare I say it, "evil-ly."
- For an insurance company to say I can insure these healthy, young people for $X, but if I include these unhealthy old people it will cost $X x Y, is not necessarily cruel or a sign of callousness. It is reality.
- If there is a blanket mandate that anyone can sign up for insurance at anytime without consideration for pre-existing conditions, how is that different than allowing someone to buy a car insurance policy ten minutes after the wreck?
Compassion and common sense have to have an intelligent conversation on this one.
- Whether the coverage is single-payer, or as it used to be called "socialized medicine," or provided by businesses, the reality is, it is still a form of insurance. Somehow sufficient money must be collected to pay for what is spent for the care people need. Deciding whether government or business can do it best is a conversation that needs to take place.
- There is a limit to how much we can squeeze health-care providers. If fixing plumbing in bathrooms pays better than fixing the plumbing in our chests, guess which career the best and brightest will choose.
Our new President has already begun to "dismantle" the Affordable Care Act. The rhetoric is about to get deeper than the pile of bills one gets after a major surgery. It's important not only that we play nice, but that our conversation be governed by clear thinking.