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To save money, don’t exclude the poor, exclude the sick

To save money, don’t exclude the poor, exclude the sick June 28, 2012

The Republican privilege-principle of Tyler Cowen, Bryan Fischer and Rick Perry isn’t just morally monstrous, it’s also bad economics.

“We need to accept the principle that sometimes poor people will die just because they are poor,” says Cowen.

“There is simply no way to control the cost of health care if hospitals are obligated to provide healthcare to all regardless of their ability to pay,” says Fischer.

But they’re both wrong. Poor people aren’t the source of the runaway cost of health care, and — even though there are so many of them — denying poor people access to health care still wouldn’t save much money.

It’s sick people, not poor people, who are responsible for the high cost of health care. There’s no savings to be had from excluding the poor, but trillions can be saved by excluding the sick.

Insurance companies figured that out a long time ago. That’s what all that “pre-existing condition” stuff was all about.

I appreciate that for people like Cowen and Fischer, kicking sick people when they’re down doesn’t provide quite the same emotional satisfaction as dancing on the backs of the poor, but once they realize the scale of the economic savings at stake here, I think they’ll come around to appreciate the insurers’ position.

They’ll see that, to paraphrase Cowen, “We need to accept the principle that sometimes sick people will die just because they are sick.” And if we’d just allow that to happen without trying to interfere, we’d at last have a real free market in health care.

This shift — rejecting the sick instead of rejecting the poor — could also provide what Cowen and Fischer personally need from a health care system. For Cowen, being healthy, it would reassure him that he is a winner and not a loser. And for Fischer, being healthy, it would reassure him that he is among the righteous and not among the damned.

And when it comes down to it, that’s all either man really needs. The costs and the political wrangling are just a sideshow to what they’re really looking for in health care policy: a sense that their lives have meaning (by which they mean a sense of being better than other people).

OK, enough morbid snark, here’s a more hopeful story as we wait to hear whether or not the Supreme Court has decided that the Constitution requires us to exclude sick people from health care. John Blake of CNN shares the conversion story of a former health insurance executive:

When Wendell Potter first saw them, he froze.

“It felt like touching an electrical fence,” he says. “I remember tearing up and thinking, how could this be real.”

Thousands of them had lined up under a cloudy sky in an open field. Many had camped out the night before. When their turns came, doctors treated them in animal stalls and on gurneys placed on rain-soaked sidewalks.

They were Americans who needed basic medical care. Potter had driven to the Wise County Fairgrounds in Virginia in July 2007 after reading that a group called Remote Area Medical, which flew American doctors to remote Third World villages, was hosting a free outdoor clinic.

Potter, a Cigna health care executive who ate from gold-rimmed silverware in corporate jets, says that morning was his “Road to Damascus” experience.

“It looked like a refugee camp,” Potter says. “It just hit me like a bolt of lightning. What I was doing for a living was making it necessary for people to resort to getting care in animal stalls.”

The U.S. Supreme Court’s decision Thursday on the constitutionality of the Affordable Care Act is a colossal legal and political issue. For Potter, though, the issue became a crisis of faith.


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