Personally I'd rather pay for the slob down the street than see our health care system privatized, because it helps so many people.
Just FYI, my dad was a 4 pack-a-day smoker and he got throat cancer. I did feel sorry for him even though his smoking may have had something to do with his cancer. I used to smoke and if I get cancer someday, I hope people won't feel that I'm undeserving of sympathy. Not an attack your statement, just thought I'd throw that in there.
However, on to the point.
There are essentially three ways to pay for medical care. The individual pays for all their own, individuals club together into private risk pools that spread the risk between those insured, and government insurance schemes of various kinds in which all citizens who pay taxes pay into the pool. I realize that's oversimplification, but it serves for the purpose of illustration.
When the individual pays for their own care, none dast tell that person how they can live, because it literally has nothing to do with anyone else (disregarding issues like second-hand smoke for the moment). However, few individuals are able to absorb huge costs that can be associated with various illnesses and injuries.
When individuals club together, generally through the auspices of an employer, risks are assumed by a third party, which creates risk pools based on actuarial science that categorize everything they can think of that can be assigned a value in terms of risk and cost. Some things they are not allowed to use as determiners for assigning risk and thus cost, such as sex and race; other things they are allowed to use, such as age, weight, medical history, family history, and so on. These are used to establish the costs which the insured pay, and they change with changing costs, such as rising costs of health care. In many cases, the pool of risk is charged to the club (the employer), which then charges a set fee to the insured (employees). This means that employers have a vested interest in controlling costs (which they generally pay a part of) by trying to move their employees into a lower risk pool as a group. Changes can generally be made only once per calendar year.
If an individual chooses to buy their own health insurance, then they act as the employer would in the paragraph above. They are fit into a risk pool based on their own health, history, and other actuarial factors, and they can change their risk based on modifying their own behavior, or they can change their costs by seeking out other insurers who see their risk differently and can charge less. They can modify the terms of the agreement to pay such that they pay more of their own expenses and the insurer pays less, etc. If they find themselves in a risk pool that they cannot or do not want to be part of, they can quit.
In the third method, government acts as the pool manager instead of the employer. When this happens, all who pay taxes (it must be noted that many in the US do not pay taxes, as they are below the threshold for taxation due to income or exemptions) become members of the pool. None are rated higher or lower due to any circumstances; all pay the same amount. That means that all risk is assumed by all payers. No one pays more or less due to their family history, individual risk factors, etc. The fat and the thin pay the same; the chronically-ill and the marathon runners pay the same, despite the actual risk they run of needing medical services.
There are problems with all of these methods. In all of them, one end of the costs for health insurance is left open; that of the providers themselves. This means that the (usually) for-profit institutions such as the hospitals, doctors, drug companies, and so on are all expenses that must be accounted for in setting health care costs, but which are not controllable by the insurance pool or the individual. We can get fit ourselves, we can encourage employees (or citizens) to get fit, but we can't readily control the costs of a stay in a hospital or a particular drug. Government has that authority in some cases, but not all. Insurers have responded by setting limits on what they will pay for a given procedure or drug, and many providers accept those limits, but some refuse and will bill the remainder to the person who receives the care or drug, or in the case of current government payment schemes, they begin to refuse to accept patients from that group at all;
This is why I tend to see health insurance as a three-ring circus. We've got the individuals who need health care dealing with employers who are trying to lower their end of the costs, working with the care givers and drug companies, and all are trying to get some level of satisfaction; and it just doesn't work all that well. Adding another layer; the government - to the mix in lieu of the employer seems to make things even worse; now everyone has to pay and they are part of risk groups they cannot control in any way; they can't withdraw and they can't make the riskiest people take steps to get fit or become less risky. They also run the risk of having doctors and care givers and drug companies refuse to accept their government-run insurance payments.
I am a conservative. I do not ordinarily believe in the goodness or efficacy of government-run anything. In an ideal world, insurance would be illegal; people would pay for their own health care costs. However, such a world does not exist, nor can it realistically.
I see far too many entangling issues with health care costs; Gordian knots which challenge anyone to fix. I would therefore, reluctantly, tend to come down on the side of the Alexandrian solution. Cut the knot by eliminating the players.
National health care; nationalized industry. All providers, all hospitals, all drug companies nationalized. Everyone insured just by being citizens. No exceptions. All risks covered. That also means 'death panels'. By that I mean that since there are limits to everything, there will be established limits to how much effort and money will be spent on a given person's needed care, based on things like their age. 95 year-old patients are not going to get heart transplants, for example.
There are many problems with this solution; I don't claim it will cure all ills (no pun intended). It damages an issue near and dear to my heart - that of state sovereignty. It runs the risk of people with unforeseen issues being put into classifications that deny them care unfairly - although this happens now too. It can cause doctors to choose to work outside the USA instead of working for the government, it can cause drug companies to choose to relocate too instead of becoming part of the government. Some drugs and care and expertise will necessarily come from outside the USA anyway, we're not the whole enchilada when it comes to those things; and the government will still have to figure out ways to pay for whatever is needed out of taxpayer dollars.
But in the end, I think I prefer an all-or-nothing solution. Either leave health care alone - broken, damaged, and expensive as it is now - or go all the way and nationalize the whole thing. Half-measures cannot do anything for us but make things worse, I believe.
