The law of unintended consequences is a bitch, part II

So this is how it's going to shake out. The new Health Care Reform Act will put the screws to insurance companies, forcing them to stop dropping customers who get sick, making them pay claims for pre-existing conditions (congratulations, smokers--enjoy some free chemo!) and taking away the geographic protections these companies have long enjoyed.

But if you take away the conditions that allow a company to be profitable--and those mentioned above are some pretty big fucking conditions--the company may not only become unprofitable, it may go bust or (at the very least) decide it wants out of the health care niche.

So what happens when private insurance companies see a surge in their cost of doing business? Do we really just think they'll suck it up and keep doing business as usual?

If they want to raise rates but the government tells them they can't, what will happen then? No government can tell you you must stay solvent despite a cataclysm in your industry.

Okay, so maybe that's a little dire. Let's just say the private insurance companies stay in business, but see their margins shrink dramatically. What happens then?

First of all, they will pass their increased cost of doing business onto us in the form of even more intense scrutiny of claims, even more diligent efforts to deny coverage, and even more "lost paperwork" than we have to deal with now.

I don't know if you realize it, but insurance companies use the same business model that rebate-fulfillment vendors use. They make it so fucking hard to collect that you just give up. Or at least they hope you will give up and go away.

Can insurance companies make it even harder on us than they do now? You bet your ass they can. Can you even imagine the next level of hell underneath being treated the way insurance companies treat us now? Does the Dante chart even go down that many levels?

This is where you Fantasy-Island Democrats usually start whinnying about the public option. Well, the public option is being pitched to us as a small, niche operation that would not seek to gather in many of us who are privately insured now. Even the GAO says that initially at least, the Public Option will probably be  a prohibitively expensive choice for most of us now using private insurance.

But if our private insurers go out of business, we will not have to come over to the public option? What other choice will we have?

And if and when this influx of reluctant new customers causes the public option to grow monstrously big, how will this new, ostensibly self-sufficient enterprise succeed and remain solvent when its direct competitors--private firms run by smarter and more successful people--couldn't?

There's only one way.

We'll have to constantly bail it out with more and more public money.

Meanwhile, what level of service do you think you are going to get from a government-run insurance company that has grown way beyond its original projected size, into that realm where it is literally unmanageable?

Visualize, for a moment, your current typical insurance company customer service interaction. Now imagine how it would be if a disinterested, undertrained and underpaid government employee was handling your claim.

Now imagine it's five years hence, and the government program has quintupled in size, and it's running a huge deficit because it's a government program so of COURSE it's running a huge deficit, and panicky administrators are trying like hell to rein in spending; starting, it appears, with your life-or-death kidney transplant.

Look, maybe it'll all work out, and I mean that. I am not rooting for it to fail; I'm rooting for it to succeed.

For one thing, there is no doubt that the insurance companies have been playing us for a long time. They've been unforgivably cynical--and even malicious. It's easy to see why: it is a wildly contradictory thing to simultaneously tell a patient you're going to provide good benefits, yet tell your shareholders you're going to spend the least amount possible on that patient's care, and yet that is what private-sector insurance companies do.

It would be easy to look at these private insurance juggernauts and say, fuck you, I hope you get it in the neck, and root for them to suffer a slow, painful death--like, for example, newspapers, and, one still hopes, cable TV providers.

But given the following choice, which would you choose?

1. Profit-driven private sector customer service rep, trying to do whatever she can to avoid paying your claim; feeding you one bullshit lie after another (i.e., the status quo);

or,

2. Languid, union-protected government employee, yawning noisily as she tries unsuccessfully to find your patient record so she can refer you to an appointment 14 weeks from now with a Caribbean-degreed "specialist."

This is actually the choice we are now being asked to make. Fortunately, there is a third choice: make a shitload of money and pay cash for your care whenever possible.

You'll be able to get fine care and see really good doctors this way, but it'll be extremely expensive.

Don't worry about the assholes who say Obama will prevent doctors from moving to the private sector and providing "elite" care for cash. In this country, nothing is stronger than the profit motive, and our society's elites are not easily dislodged.

We have capitalism in our veins, and it'll prevail. And that means it'll prevail at election-time, too.

Doctors are, and should be, affluent relative to the population at large. They will be able to raise a lot of money for some candidate. Don't worry about doctors. Their biggest obstacle is their own desire to do good for people. But if you really piss them off, they might remember that they have a lot of money and a lot of clout, and they might figure out how to use it.

The law of unintended consequences is a bitch.

Making people buy health insurance is fair in the exact same way that making people buy auto insurance is fair. You use the system, you gotta pay. You gotta pay because the rest of us need protection in case you create a big expense (e.g., cause a crash, go into a coma, etc.).

The only problem with this parallel is, you can always opt not to drive a car.

(But you can't promise to never use the healthcare system and expect the rest of us to think you're actually going to honor your promise when you crash your uninsured car and go into that coma, you poor miserable shiftless fuck).

So then the argument comes down to this: is it ever fair for the government to make you pay for health insurance, even though you're dirt poor and need all available funds to feed your family and buy crystal meth? And the answer to that is, of course, stop asking stupid questions. Fair's got nothing to do with it. You will always have to pay taxes. Some of your taxes will always go to pay for stuff you strongly disagree with. As taxes go (if we define a tax as something the government makes you pay, regardless of whose pocket the money ends up in), mandatory health insurance is one tax I think most of us would willingly pay.

Cranky Libertarians, including some people I really admire (like Boortz and Instapundit Glenn Reynolds) say government has no business forcing us to pay for health care or anything else that isn't on their very short list titled "If I Were In Charge, These Are The Only Things We'd Spend The People's Money On."

1. National Defense
2. Go Fuck Yourself.

But this is where I part company with Libertarians. They just aren't aligned with human nature. To paraphrase Donald Rumsfeld, you don't go through life with the fellow scumbag humans you choose, you go through life with the fellow scumbag humans who also happen to occupy the planet as the same time you do.

People being what they largely are (equal parts irresponsible and opportunistic), you wind up with a whole bunch of uninsured folks, which is the situation we have now.

Many of these are people who could choose to buy insurance instead of spending their discretionary income on things like satellite tv and beer, but as I could not live without these items either, I won't get preachy about that.

Anyway, the result of the equation is indisputable. It's what we have now:

Human Nature + Desire For Pleasure Vs. Self-Sacrifice - The Legal Requirement That Everyone Purchase Health Insurance = Whole Bunches of Uninsured Deadbeats.

And that means we responsible types are put in the uncomfortable position of having to decide if we're going to pay for your care when the rest of youse get sick.

Which would not be such a dilemma save for the fact that often it's your children who need the care, and while I'd gladly say no to you and be, in the immortal words of former Grady CEO Pam Stephenson, "conscience-free," I can't accept the idea of denying health care to any child for any reason, no matter how big a screw-up their parents may be.

And you can't, either.

So either we have to find a way to make at least most of the irresponsible opportunists join the giant risk pool that is health care insurance, or we have to keep paying for their illnesses out of our own money, or we have to let sick children die for want of adequate care. There is no fourth way.

That's why making people buy health care insurance is not only fair but appropriate, and we should have started requiring it long before now.

So what happens to people who ignore the new mandate, and then get sick? Comments, anyone?