But then Marcus kind of goes off the rails. She and Paul Krugman, both of whom are hypothetically left of center, are incapable of grasping how the health insurance industry operates and what the flaws are in it that obviate any kind of simple fix, as McCain proposes. By providing disincentives to employers and employees to stay with employer-negotiated health plans, thousands of people will be forced out into health plans they must negotiate themselves. Employers are able to get better benefits for their employees because they have leverage. You and I, on our own facing the big, bad wolf of the healthcare industry, have zero leverage.
Already the leverage of employer-negotiated health plans is showing strain, however. Over the last decade, as we've scrambled for health insurance that meets the extreme needs of our son, we've seen items that used to be considered medically necessary become "optional" riders for employers, as a means of competing for contracts and bringing down costs. These riders, which your employer must agree to, include things like physical therapy, occupational therapy, speech therapy, mental health, prosthetic devices, and durable medical equipment. I was once told that the enteral feeding button, which provides a port into my son's stomach so that I can feed and hydrate him was a prosthetic device, "just like an artificial leg," and my employer had not purchased a rider that would cover that.
So throw "medical necessity" out the window when it comes to what's in your health plan's contract. It doesn't matter if the item would save your life, or even allow you to live, period. If it's not in the contract, you don't get it. You have no legal basis on which to argue that it's "medically necessary."
Marcus and Krugman fail to understand the basic difference between "insurance" and "coverage," which is a contractual matter. We could insure everyone in America with cut-rate, minimal-benefits health insurance pretty easily. It would be cheap. What would not be cheap would be the legions of people left stranded without wheelchairs or artificial legs or physical therapy to regain the ability to walk after a car accident. People with chronic illnesses or disabilities who are told that the drugs they need just aren't covered, and who then are unable to work or function. People who are told that if they need nutrition through a g-tube, they'd better set some money aside to draft their will.
The concept of health "insurance" in America may just be out of date. When you buy insurance, you're deciding how much risk you want to take. Well, when it comes to your health and well-being, you may decide you feel in a gambling mood while the sun shines, but when the booms sweeps across your stern and knocks you flat, you may feel very differently--staring down a gun barrel of bankruptcy and permanent disability (to mix metaphors). Why are we a nation of gamblers when it comes to health? Shouldn't everyone have a chance to recover from illness, accident, and injury, or recover to the extent possible so that he or she can continue to hold a job, pursue dreams, be a contributing member of society?
Both Marcus and Krugman don't understand that if we were to make a shift as radical as McCain's without thinking it through and protecting not only people as consumers, but people as (hello??) human beings, if we make that kind of radical shift assuming that the free market will just solve the problem for us (and oh, how I trust financiers these days), thousands of Americans will suffer, thousands of Americans will die, and thousands of American children will be permanently damaged because the Free Market gods demand blood sacrifice.
So a "few" people don't get good coverage? Ruth Marcus doesn't care. Paul Krugman doesn't care. John McCain doesn't care. They want to blame people for doing what people do with insurance: choosing good plans with good coverage. In their rhetorical calculus, people who don't want to be risk-takers with their health are "over-consuming." Excuse me, I thought it was insurance. If our health care as individuals is going to be left to the game of chance that is "insurance" anyone who can't afford insurance (even with tax breaks, which, by the way, do not benefit low-income earners because they don't owe taxes) or who hopes to have access to the cutting-edge health care the U.S. has available (if he or she should need it) is just going to be thrown to the wolves.
The naivete, even of the left, on matters of healthcare, is stunning. None of these people who tout these plans and these adjustments know anything about injury, illness, or disability. They have never had to face those trials, and their failure of compassion is just stunning.