I’ve been thinking about medical care. As we all know, it is expensive, and either you pay directly, or else if you had the money and the foresight, and were fortunate enough not to have any pre-existing conditions that the insurance company has decided render you uninsurable, you paid in advance in the form of insurance. Or else you pay as you go, or you go into debt, or you just plain suffer or die. Unless… your job pays your insurance.

And it was while contemplating this idea, the “job” paying for your insurance, that my thoughts came to a screeching halt. Now, it only takes a little insight to follow this line of thinking. So work with me here.

First of all, let us imagine for a moment that Fred works for the utility company. You know, gas, electricity, water. Just so we can point a finger. Now, let us further imagine that the utility company provides Fred with medical insurance; in the end, this is the same as providing him with medical care, I think we can agree. Now, to the extent that he’s not paying or co-paying for that insurance, that’s what I mean by the “job provides.” Otherwise, he would be providing, and that’s not what I’m concerned with here.

Now, the money that the utility company is paying for that insurance policy with is coming from where? From the utility company customers. Just your average person. Let’s say that is Joe. Average Joe. Now, Joe has to pay for his utilities. Otherwise he freezes or swelters, can’t run his refrigerator, flush his toilet, etc. I think most people would agree with me when I assert that paying his utility bill isn’t really an “option.”

And of course, the cost of Fred’s insurance, that is, the insurance that the utility company provides to utility worker Fred, is built into Joe’s utility bill. Because that’s where all the utility’s income is derived from — just your average Joe.

So it is clear that in fact, Joe must pay for Fred’s insurance. The policy of having Fred’s insurance built into Joe’s bill isn’t something he can control. It’s there, if he doesn’t pay it, he doesn’t get utilities. So it’s a done deal in every sense of the phrase.

Unfortunately, this means that the opportunity for Joe to get medical insurance is reduced by his having to pay for Fred’s insurance first. There’s no way for him to opt out of paying for Fred’s insurance and just pay the costs of Fred’s labor.

Now, some might say, “but there are many utility company customers and only a few employees by comparison, so it’s really not that much.” This is true. However, Joe is also paying for the insurance of the gasoline vendor’s employees, the phone company’s, his Internet service provider’s, the city’s employees, the county’s employees, the state’s employees, the federal employees… you get the idea. Any job that has insurance provided “by the company” or “the city” or “the feds” is really a job that Joe pays his share of the insurance for. For any cost he cannot avoid, such as utilities, or fuel required to get to work, he must pay other people’s insurance. It is only after paying all these things that he can even begin to consider paying for things in his own life that are optional — like insurance.

I guess it is no wonder that Joe… your average Joe… can’t afford medical insurance. He has to buy everyone else’s, first. Being on the bottom of the economic totem pole means you pay for others before you pay for yourself. Isn’t that… poorly thought out?

This is one of the reasons I’m for pooling our medical costs and paying for everyone out of the pool. I despise the idea that someone could be ill and not get the care they need, or be damaged financially as a consequence of illness. I don’t like the idea that the poor have to suffer more, either; doesn’t sit well with me. It seems to me that like education, the health of the citizens in general are a foundation element of maintaining a strong society, and we should just buckle down and get it done. I know this is an unusual tack for someone who leans as libertarian as I do, but I’ve thought about it a lot, and this is where I always end up.

Insurance companies are, I think, a uniformly bad idea. They’re the very embodiment of the term “conflict of interest.” On the one hand, they want to offer consumers protection from something, in this case, medical problems. In order to do that, they figure the odds and charge everyone in the pool enough to cover what the odds predict will happen to the pool, plus enough to have a cushion and pay the company employees.

But on the other hand, these are for-profit companies, and they have an obligation to maximize profitability… and in every case, they do that by “cleaning” the pool, that is, removing those people who are most at risk. Because the fewer high-risk individuals in the pool, the better the odds get, and the more money they make. Unfortunately, the people removed are the ones most likely to need care; which is why one tries to have insurance in the first place.

I know a woman who has had breast cancer and is a diabetic. She’s uninsurable. I’m not saying she can’t afford premiums — I’m saying the insurance companies refuse to cover her. She’s obviously someone who is very likely to need care. So they don’t want her in the pool.

This is precisely what I mean by conflict of interest. Insurance companies don’t work very well, especially for people who really need coverage. So I say let’s get rid of them, everyone pool our funds based on the current year’s medical costs for everyone, and in this way, everyone will have care.

Yes, there will be people who use unusually large amounts of resources; but there will also be people who are healthy all of their lives. That’s the whole point of pooling. We don’t know what will happen to us, so let’s arrange things so that no matter what does, or who it happens to, we know we’ll do our best for them. In the end, we’ll be better off.