Not much. In fact, in everyday politics, the two are inseparable and mutually benefiting. As with most things, both sides are enjoying wringing their hands about what they seem to want us to think are major differences regarding healthcare. While the Right seems to be very upset about government healthcare, on the one hand, the Left seems to be worked up about corporate healthcare, on the other. It seems to me that we should try to discern the practical difference between the two and see what we are left with to root for, if anything.
Let me begin by dispelling two dangerous myths about this polemic: There is nothing “private” about private insurance and there is nothing “public” about a public option.
1. Against “private” insurance: When people choose their health benefits they are hardly presented with a plethora of options that are simply there for their private well-being. The options available are the result of a bureaucratic web of deliberations between corporations and employer (who, in many cases, are corporate). On the side of the employer, they usually want to find the lowest rate without compromising the quality of coverage, or, on the side of the provider, they want to find the highest rate with plenty of red tape to prevent too much coverage being guaranteed to maximize profits. When the employee makes their choice, this is not a private decision they are making. And, if the next term of negotiations wants to shift “private” options on them, they have no choice but to change.
2. Against the “public” option: This is actually less interesting to me than the previous myth. It is mostly the age-old political trick of invoking a generic public in order to help generate popular sentiment. Truth be told, the negotiations that will take place between the government and insurance providers will not be in the interest of people’s health, but, like the corporate negotiations, they will also be about credit and debits. The option to take the government care will usually be because people have no option and it will hardly be the coverage that the public has deemed best. The rich will continue to get better care wherever they can find it, and for good reason.
These two points assume that people have a job of some kind that offers benefits with premiums they can afford or that such a non-public option even exists for those who lack options. But the point remains that while the rhetoric has been between a so-called “public” and “private” option, the truth is that the healthcare debate is better described as a conflict between the government and corporations.
Given that they are very closely related in many ways, this should be troubling to all sides.
Nonetheless, there are real and serious differences between the two. Most importantly, access to coverage.
While government healthcare may implicate an entire society of taxpayers in decisions of that they find objectionable, it is hardly to say that the same thing doesn’t happen through corporate healthcare. In fact, if we take into consideration the broad structural effects of corporatism, it may be worst (from a certain view that I am not too sure whether I share or not). However, if we can say that both government and corporate healthcare are fundamentally prone to support things we find objectionable—which may even be the fact that either one of them exists at all!—then we must also remind ourselves that they both provide a significant good to society: care for the health of our bodies.
What we are left with is this: the government can provide this good to everyone and a corporation cannot, or at least refuses not to (I suppose it could if it wanted to). Here, the choice is simple; and I would make the converse choice if it were true. In other words, if a corporation offered universal insurance and the government resisted, I’d hold my nose and take the corporate side.
So, while we should not celebrate either the government or corporate healthcare, we must admit that the good they provide in their own tragically imperfect ways is best provided to all and not to a select few. There is nothing private or public about it. There is nothing innocent about it. It may be financially difficult. But, all things considered, the difference between government and corporate healthcare is that one can be universal and the other, as it currently stands, cannot.
Both government and corporate healthcare are troubling to me, but, for now, the government gets my vote. If a corporation offers a universal plan with better terms and conditions, then, I would change my mind for the exact same reasons.
the government can provide this good to everyone and a corporation cannot
I disagree. Rather, I would say that the government can provide the illusion of providing this good to everyone, whereas a corporation does not. The illusion, but not the reality.
Accountability is the issue, and the difference.
I would agree that accountability is the big difference here, but I suspect that we disagree on how that shakes out in practice. With government the only means of accountability is through voting. One might as well try to control the behavior of a private insurer by buying a share or two of its stock.
In the case of private businesses, by contrast, accountability comes from being able to decline to deal with the entity (either by choosing to give your business to a competitor or by going without).
I think that accountability through “exit” is more powerful and exerts a greater control on corporate behavior than accountability through “voice” exerts on government behavior.
On accountability: I disagree with both, as I find that both corporate and governmental power are structurally unaccountable in any significant way.
The corporation is accountable to its stockholders. The government (of a republic) to its citizens. Its not rocket science.
Kurt: If it were so simple, then, why isn’t that the case so often? I mean, in theory that may indeed be the case (makes sense to me), but corporate and governmental power is not simply the product of deliberation from stockholders or citizens, it sets out in-advance to manufacture an image and perception via many things (marketing and propaganda come to mind). This complex web of things seems to largely conclude in them getting to do what they want while the people they are accountable to have little to no idea what is happening and for what reasons.
This a false dichotomy. Why not allow individuals to purchase their own health insurance…like they purchase car and home owners insurance. Take away the employer tax deduction for health insurance and this will happen. Then let’s change it back into insurance…only paying for catastrophic costs. Throw in a tax deductible Health Savings Account or something similar and suddenly insurance premiums go down while decision making is given back to the individual and his/her doctor. And then our health care system will provide quality, affordable care and it will be sustainable in the long run.
Dan: We purchase car and home owners insurance very differently than we purchase health insurance. If we could do it that way, I may be congenial to your suggestion. But here is a big problem: I don’t NEED to own a car or a home, but I am stuck owning a body. The care that follows, is also quite different, to be sure.
Don’t get me wrong — I’m not suggesting that the u.s. government (or very many nation-states for that matter) is accountable to its citizens in a way that is all that serious. To me, it’s a matter of degree.
I don’t NEED to own a car or a home, but I am stuck owning a body.
I don’t think it is a good idea to thing about this is binary terms (either you need something or you don’t). Having health insurance is more or less important to different people at different times, as is owning a house or a car. Indeed, there are lots of people for whom owning a car or house is more important than having health insurance.
Sam,
I agree that we purchase car and home owners insurance much differently then we purchase health insurance. The point is that car and home owners insurance are every bit as complex as health insurance and yet the vast majority of people purchase are capable of purchasing individual policies.
And I understand that while not everyone owns a car or a home, but we all own bodies. But there is a difference between health care and health insurance. Uninsured people can get health care at many emergency rooms and other clinics regardless of their ability to pay. But I don’t think this impacts the issue of an individual being capable of purchasing their own health insurance.
Also, Care of the body is quite different than care of a home or car. But I would expect the average individual to understand far more about the care of their own body than about the care of a car or home.
On Dan’s point:
In a nutshell, it could not be more wrong! We need to make the distinction between actuarial insurance (you pay based on your own individual risk, just like in car insurance) and social insurance (you pay in common to help those in need today, on the understanding that you will be helped out in need). The latter embraces solidarity and is more Catholic; the former embraces individualism and is more Calvinist.
Aside from the moral issue, there are good economic reasons why social insurance works. It’s about pooling risk, getting lots of healthy people in the pot, which lowers costs. You also save on administrative efficiency grounds (this by the way, is a key reasons why single-payer systems are much better at containing cost).
What happens if you go the individual route? Well, young and healthy people will do really well. They’ll get great deals. But then all the people who need care the most are pushed into the fringes, and because the pool is smaller and costlier, healthcare for this group becomes unaffordable. They get left behind.
The experts note that this individualist approach based on HSAs would make things worse. Jonathan Gruber from MIT has argued that such a plan (HSAs and high-deductible policies funded by tax credits) would increase the number of uninsured and increase budgetary costs. Not good.
I hate to say it, MM, but I’m afraid you’ve fallen victim to Econ 101 thinking!
All the evidence indicates that adverse selection isn’t a big problem for health insurance, and the experience of Singapore (which utilizes HSA plus catastrophic coverage and spends half per capita what Canada does on health care) suggests that Mr. Gruber’s concerns are off base.
I don’t think it is a good idea to thing about this is binary terms (either you need something or you don’t).
Just like you capitalists to want to confuse the absolutely clear distinction between wants and needs!
Having health insurance is more or less important to different people at different times, as is owning a house or a car. Indeed, there are lots of people for whom owning a car or house is more important than having health insurance.
Subjective feelings of “importance” do not signal “needs.” Health insurance is indeed more or less “important” at different times, but it remains a need always.
Health insurance is indeed more or less “important” at different times, but it remains a need always.
That can’t be true, not in the same sense that food and water and shelter are “needs” (these things have been around for hundreds of thousands of years, whereas almost all generations of humanity managed to live without “insurance” of any kind).
S.B. – Surely you’re brighter than that. In a society in which insurance is needed to be guaranteed health care, insurance is a need.
Just like you capitalists to want to confuse the absolutely clear distinction between wants and needs!
It’s a funny thing: most people tend to think that the distinction between wants and needs is absolutely clear, yet they differ greatly as to what counts as a want and what counts as a need. Such differences are often obscured by the use of amorphous terms (e.g. “living wage,” “basic health care” etc.), but they are nonetheless real.
It’s a funny thing: most people tend to think that the distinction between wants and needs is absolutely clear, yet they differ greatly as to what counts as a want and what counts as a need.
The fact that people disagree about where to draw the line between wants and needs does not mean that the distinction does not exist, as you implied.
USA = only Western country with no universal healthcare. But biggest military on the planet and most people in prison (ratio). Any questions ?
The main scandal is that in the USA health insurance is tied to the job and that one frequently has to start from scratch, incl. the sad “pre-existing condition” joke. Having to switch doctors is just icing on the cake, Limit on sick leave is also sweet. (my Dad had a hip replacement this year, 3 months sick leave (paid), including spa retreat for 3 weeks.
The lack of fully paid maternity leave (4 months in Austria) is just one of the reasons the US would be barred from joining the EU.
Humans cannot survive without the things they need – like air, food, water, sleep, etc. Humans have survived without health care – “health care” as we know it didn’t exist until pretty much the 20th century. Therefore, health care is not a need because humans have survived without it.
Health care is a want – people want to be liberated from physical pain and from death. They seek this in health care. I am not saying the desire for health care or for physical health is wrong. But it might be wrong to be obsessed with our physical health and freedom from death.
Humans cannot survive without the things they need – like air, food, water, sleep, etc. Humans have survived without health care – “health care” as we know it didn’t exist until pretty much the 20th century. Therefore, health care is not a need because humans have survived without it.
Sloppy logic, I think. People cannot survive without their health. Health care obviously has taken different forms, but the fact that “health care as we know it” didn’t exist until recently does not change that people need health care. By your logic, food is not a necessity, because food “as we know it” hasn’t existed until recently.
Health care is a want…
How do you square this with the church’s view that health care is a human right? Does the church often demand that mere “wants” are a matter of human rights?
But it might be wrong to be obsessed with our physical health and freedom from death.
That’s easy for a relatively health person in the First World to say.
Even ridding ourselves of corporate subsidies for employee health insurance, there are reasons to believe that a private market would fail without significant oversight, equivalent to or greater than what we have today. While there are some that attempt to maintain that insurance economics is the same as commodity economics, that is a pretty fringe viewpoint. Insurance has some things that are unique to it. Additionally, home insurance and auto insurance markets are heavily, heavily regulated. Life insurance markets are heavily regulated. At least the well functioning ones are. Even in auto insurance, many states have high risk pools that are forced upon carriers in order to satisfy universal availability requirements.
As to Sam’s point on accountability, it seems to parallel MacIntyre, and hence, introduces some of my issues with him. It is one thing to argue that our functional influence as shareholder or voter approaches zero. It is another thing to argue that it is zero. The latter in my mind is functional nihilism. If I can organize 200 people in my congregational district, I can get a meeting with my congressman and likely influence him. That my voice might not receive as much reception if I simply call his office doesn’t speak to his lack of accountability to me. It takes significant inertia to move large bureaucracies. I’m not sure having our government be reactionary is all that desirable.
As to how this applies in real life, consider that an act of Congress was passed in an attempt to save Schiavo’s life. Just one person. That has to count somewhere on the accountable scale. There are stories of corporations reversing decisions based on media coverage. That is also evidence of accountability. Granted, it helps to be white and beautiful to get the media’s attention, but that’s beside the point.
Here’s a novel idea. How about individuals pay for their own health care and quit expecting others to pay for them, whether it’s the government, or a corporation?
American health insurance is not insurance, it’s nothing more than a pre-payment plan. If you compare health insurance to auto insurance, the differences are astounding.
The problem with health care is the insurance companies and pharmaceutical companies control the entire industry. Many doctors are now opting out of accepting any type of health insurance. This way they can charge less and give better service to their patients.
Personally, I believe the main difference is found in the little things. For example, minor adjustments can be made by corporations who have constant restructuring on their health care which saves them money and can increase workers coverage.
“Therefore, health care is not a need because humans have survived without it.”
Is that from the GOP platform ?
The USA is the only Western country without universal healthcare, this discussion would not be had anywhere else. The main problem is that “insurance” is not tied to the person but to the job, resulting in frequent changes in providers, doctors and the lovely “pre-existing conditions” (for all people who weren’t “born yesterday”). This is a relic from World War II.
As far as differences are concerned ? My wife had to apply to a dozen different companies/agencies as a provider, rather than to one agency. Many insurance co. won’t take new doctors to begin with. Billing all these behemoths makes one need therapy oneself. MediCare, for example, has taken 8 months to go through the motions and still isn’t done. The best, as in: paying on time, has been TriCare, which handles military personnel. There’s plenty of PTSD to go around. Government is viewed as welfare, and government facilities therefore feel like that. In Europe, there’s a stronger sense of pride in public institutions, and a sense of solidarity.
In Vienna, there’s a central city-run agency that accredits doctors, administers care etc., the public hospitals are excellent. Sick leave lasts for as long as you’re sick (novel concept, I know). Health care doesn’t vanish with your job. There are many Catholic hospitals, they are part of the city’s health system. I’ve noticed that Austrian patients get to stay in the hospital a lot longer than in the US. For those who want a little extra (such as bringing a doctor of your choice to any hospital, having a private room etc.) there are private insurance options to add on to the universal insurance.
Sloppy logic, I think. People cannot survive without their health. Health care obviously has taken different forms, but the fact that “health care as we know it” didn’t exist until recently does not change that people need health care. By your logic, food is not a necessity, because food “as we know it” hasn’t existed until recently.
Not true at all. Food has always existed in the forms of meat, vegetables, nuts, and fruit. Modern healthcare — down to vaccinations, antibiotics, most forms of surgery, and certainly any sort of electronic tests — simply didn’t exist at all prior to the past 100 years or so. It’s not that the people of 1500 had more primitive antibiotics or heart surgery; they had almost nothing that we would call “healthcare” at all. Let alone health “insurance.”
In a society in which insurance is needed to be guaranteed health care, insurance is a need.
This would have to be heavily amended to be true, so heavily that it wouldn’t do the work that you intend. To wit: “In a society where people are guaranteed access only to emergency health care, and wherein people lower than middle class need insurance to have slightly more ready access to routine health care, albeit mostly consisting of treatments that didn’t exist at all prior to the last few decades, insurance is a ‘need.’”
On Zach’s point: Catholic social teaching recognizes that the common good depends on the circumstances of society. In modern society, supporting the common good and the right to health care means universal health insurance.
Gerald – you seem to have missed the point entirely.
MM – I do not think it means universal health insurance. And there’s nothing in Catholic Social Teaching that says I am wrong. Catholic Social Teaching is more about ends than it is about means.
I do not believe universal insurance is possible. I’m also not even sure it would be desirable. I think that the pedagogical effect of instituting health care as a right given to us by the government will have bad consequences for not only our health care but also our politics. I think it would be foolish to put something as important as our health under democratic control.