The case for universal (non)coverage

Massachussetts recently rolled out a new plan to mandate health insurance coverage for everyone in the state. Health care coverage is a topic I've mulled over repeatedly because I think our system is very, very broken.

Let me start by stating the obvious: health care costs are rising because we don't pay the bill. We don't even pay the premiums, really: we look to the employers to do that. So when we get a bill for a ridiculous amount for a trivial procedure, we don't get upset; we just shell out the co-pay and forget about it. Inefficient just doesn't seem like a strong enough word. Stupid. Stupid comes close to covering. Insane might be going to far . . . but not by much.

Of course, I learned this lesson because -- guess what -- I pay for my health care out of pocket. I have a Health Savings Account, in which I set aside money tax-free to cover health care expenses. I went this route because I ran the numbers and concluded that one of us would have to either have a baby or cut off an arm to come even remotely close to having enough medical expenses to justify the premiums.

Now that we pay the bill ourselves, we ask a lot more questions that we never dreamed of asking before. Questions that, in retrospect, seem obvious, like: "What's this going to cost?" or "Is there something cheaper?" or, most astoundingly, "Is this really necessary?" To think: we never asked these questions before. And people wonder why health care costs are rising? They keep rising because there is nobody standing there to say, "That's too much."

And, not surprisingly, the cornerstone of the Massachussetts plan is high-deductible, low-premium insurance plans, in which most treatments are paid for out-of-pocket. Ironically, everyone gets the coverage they need when they start paying for healthcare themselves.