Response to a comment on pre-existing conditions

Here is a response I made to a comment on social media regarding pre-existing conditions in the new healthcare bill, which went so long it forced me to neglect the blog for another evening. For context, the commenter is a friend of mine who, last I knew, identified as a libertarian.

Rant about the Trumpcare bill passed by the House last week.

I keep hearing the quote that, under the new bill, "you cannot be denied insurance as long as you do not have gaps in coverage".

This seems like a suckers bet to me. This is just like a late fee, albeit a very costly one. How many people pay all their bills on time every month for their entire lives? Just one slip up means that you are re-evaluated and may be denied coverage.

What is even more crazy is that so many opponents of the ACA say "I don't want the government telling me I have to buy health care." The new law says the same thing, only now it is private companies that decide the penalty.

Rant over

My response:

Generally you can't make much headway in healthcare debates because it's a conflict of principles. On one side people believe that humans have a fundamental right to healthcare, and the other people believe the have a fundamental right to not have their money taken for the benefit of others.

However there is another way to view the issue that side steps the moral dichotomy, which is to analyze the internal contradictions of the system in place. We must make a distinction between health insurance versus comprehensive healthcare. Insurance inherently implies uncertainty and risk. Comprehensive coverage includes aspects of healthcare where there is little uncertainty. For instance, insurance plans that cover routine checkups have transcended the fundamental role of insurance. Whether one views healthcare in the insurance sense or the comprehensive sense will determine how one criticizes such a plan. Someone who thinks purely in terms of insurance will complain that covering routine visits doesn't really insure against anything. Their counterparts will complain that the healthcare plan is only partially comprehensive.

The same dynamic can be applied on the national scale. People have different criticisms of national healthcare depending on how they view the scope of healthcare (not to mention the larger moral/political debate). As such our policies are a mashup of different intentions and viewpoints sort of lumped together. Because we can't agree on whether healthcare means insurance of comprehensive coverage, and because we don't even make the distinction, what we are left with is an approach that is often at odds with itself and is utterly disappointing to those on both sides of the issue.

You can pretty much tell if someone views healthcare as insurance vs comprehensive coverage by their stance on pre-existing conditions. If a plan covers pre-existing conditions it is definitively not insurance. You wouldn't expect to be able to purchase homeowner's insurance while your house is on fire. The "no-gaps-in-coverage" clause is quite understandable to those with an insurance mindset of healthcare, and in fact it is a necessary requirement in order to run healthcare as an insurance program. Otherwise you can just wait until your house is on fire to buy an insurance plan. Someone with the opposing viewpoint sees the no-gaps clause and assumes it is some deceitful scheme to find loopholes to deprive people of their right to comprehensive healthcare. The issue at hand isn't whether someone misses a bill (and I've never lost insurance over a single late payment). The issue is about avoiding a moral hazard where people are incentivized to delay their purchasing of insurance until it's needed, which destroys the entire point of insurance to begin with.

Last I knew you identified as a libertarian. I have to ask is that still the case? I no longer identify as libertarian but as far as healthcare goes I'm right in line with them. I don't imagine a libertarian could possibly be content with (a) the government forcing its citizens to buy a product, or (b) the government forcing companies to accept customers whom they know will cost them money. Maybe there are arguments to be made for that, but none are libertarian-friendly. Is it so wrong that the private companies decide the penalty? As a motorcycle owner I'm sure you realize that having gaps in coverage does cost you money in the long run. They run their numbers on the expectation that your bike will be garaged during the winter and, if you try to drop coverage just during the winter, they will raise your rates to make the numbers work again, plus a little more out of spite. It might seem contradictory that you are okay with coverage-gap penalties in the automotive sector but not in medical, but it's not. Because you don't view healthcare as insurance, but as comprehensive care, which means effectively adopting the liberal stance on the issue.

It is troubling to me that so many people naturally assume that the answer to the problems in our healthcare sector, largely caused by government interference, should be solved with more government involvement. Look at the issue of healthcare-employment coupling. Most people are troubled that they can lose their health coverage if they lose their job. So they've largely demanded that the government adopt an array of protective measures so that people won't face potentially life-threatening consequences when already suffering the misfortune of losing employment. The solution is to regulate the coupling. But the coupling is completely absurd in itself, and only exists because of government action to begin with. Can you imagine if one lost his homeowner's or auto insurance when they left a job? It doesn't make sense. Yet we're entirely too accustomed to it in the medical sector. Another example is the tendency for health insurance companies to try to wriggle out of their responsibilities, and to vastly outspend plaintiffs on legal representation. The response of the government, seen clearly in Obamacare, is another vast array of regulations dictating what the companies must cover. There is a clear libertarian solution to the problem: force companies to honor their contracts. The whole ethos of libertarianism is that the government primarily exists to protect property rights and to enforce legal contracts. If the government would just satisfy its duty, to ensure customers of insurance are getting what they paid for, then there would be no need at all for the government to delve in to the impossible task of decreeing what constitutes satisfactory health coverage. And what have they changed? If the insurance companies were able to cheat their contracts by finding any available excuse to deny coverage to customers, why would they behave any differently in response to regulation? The solution has been merely to shift the problem around, while giving the government an excuse to bloat its bureaucracy, funding, and regulatory labyrinth.

This is a good example of the reason why many bloggers on the alt-right are fed up with libertarians, because so many are just more principled liberals (oxymoron alert). Perhaps "previously principled" would be a better phrase, at least in this case. This commenter seems to have discarded libertarian principles entirely, but, last I knew anyway, still identifies as a libertarian. Which brings up a couple questions.

1. Is our problem with libertarianism, or just with libertarians?
2. Are most libertarians just liberals who don't want to be called liberals?
3. Is there something innate in libertarianism that drives its acolytes to adopt liberal positions? 

The last question can't be answered with a general yes, since so many on the alt-right were formerly libertarian. And perhaps the first has been answered by many already, who see libertarianism as admirable in theory, but something that requires a certain type of society to be pragmatic.