Thoughts on Health Insurance

No insurance company can survive by simply spreading risk across a pool of members. It must, in addition to the expected value of losses, charge a premium to make it worth its while.

For this simple reason, insurance is always a losing investment in the long term. If the expected value of your loss per year is $1000, your insurance company will charge you premiums that recoup the $1000 and then an additional charge in order to make a profit.

Change "expected value of loss" to "expected value of care" and you begin to see the problems in the concept of healthcare insurance for anything beyond the basics. Yes, to some degree large insurers can negotiate costs with doctors and hospitals in a way that individuals cannot. However, inasmuch as you are covered for things like transplants, extended hospital stays, multiple ER visits and non-generic prescription drugs, you are probably overpaying, if you are a healthy person. You are assessed a basic charge that is equal to what a person with a "normal" risk level is assessed, AND the profit premium on top of that. Assume, then, that the average expected cost of care you have is $500, and that the average cost of care that a normal person has is $1000, and that the insurance company takes a $100 profit premium to make it worth its while. You, the healthy person, are paying $1100 for an expected annual cost of care of $500. Factor in deductables, and you see how quickly you are wasting money.

Now this is not just an observation on healthy people wasting money, and insurance companies making extra off of you. It is this: the healthy subsidise the sick. The hypothetical person above is subsidising the above average sick person to the tune of $500 a year. If healthy people were smart, the would band together and start something like a co-operative and pay only a shoe-string level above their annual expected costs, including copays and deductables, and make arrangement for catastrophic care through different insurance.

As it stands, one of the few things keeping up the health insurance system in this country is employer-provided care. People are provided "benefits" rather than choice--they get more insurance than they need, and subsidize those who need more care.

What's the answer? If those who are healthy leave the system and protect themselves with only catastrophic care insurance, those who are currently being subsidised by the folks who are forced to have health insurance (whether it be through employers or through absolutely absurd laws like those in Massachusetts) will be forced to bear more of the costs of their own healthcare. When they bear these costs, they will realize what a waste they are engaging in. They will take measures to avoid needing care for chronic conditions by taking better care of themselves. And the healthy will have catastrophic care insurance, and everyone will be better off.

Of course, this is an extreme position. Of course, we need to make provisions for those who simply cannot take better care of themselves (chidlren, the mentally infirm, the paralyzed, and so forth), but do we owe a moral duty to take care of those who actively refuse to take care of themselves, and who will not pay for their own care? I say no. It is a perverse system that incentivizes those who need more care than average (and can do things to bring down the level of care they need) to continue in their wretched ways. It is a perverse system that expects, nay forces the healthy to pay more than their own share.

What is my solution? Phase freedom into the healthcare markets. Stop forcing healthcare, and allow the market to work to move to put premium levels in line with expected value of care, and stop the subsidization of the irresponsible by the responsible. Incentivise good health decisions by making good health care expensive, or at least in line with cost. As long as the irresponsible are continually allowed not to bear the full burden of their choices, and the responsible are not allowed to make decisions about their healthcare insurance in a free system, we are talking around the problem of healthcare costs.

Bottom line? There is no right to healthcare if you can pay for it and refuse to do so. This includes being able to afford your premium by taking preventive measures, and taking care of yourself. Let those who make foolish choices bear their own burden.

If you ask me if I love her, I'd lie.

I'm confused as to how to start this post. I haven't written in so long that it feels unnatural. I'm here in Galveston, anyway. The weather is great--mid 80s to mid 90s with a breeze. The sun shines every day, and the humidity is bearable. People tell me the oppressive heat has yet to come, though.

I'm working for Lone Star Legal Aid, which is a largely government-funded law firm for poor folks who can't afford a lawyer, or whose claims are too small for a normal lawyer to take without prepayment. So far, I've drafted to "plaintiff's original petitions," which are basically lawsuits in the lowest level of courts here in Texas, to help folks get their security deposits back from some shady landlords. I'm trying to get some information out of the water department to help an old lady out with an outrageous water bill (5-6 times normal, for a period she wasn't occupying the apartment in question), but that seems to be going nowhere. I also filed a TORA request for information from the Galveston Housing Authority to see whether they are giving folks due process when they file for disaster housing assistance. Yes, we are still in disaster recovery mode down here--and the new hurricane season has just started. Given that there was a 12 foot storm surge, however, the town looks pretty good.

My coworkers are cool, and good people. My original boss was "transferred" to the Houston office, and my new boss has us on a new project that seems a bit ill-defined, but interesting. Starting next week, I'm going to be going around through Brazoria and Matagorta counties (southwest of Harris county, which is where Houston is) to look for "vulnerable" populations who may need special legal help in the event of another hurricane. It feels more like social work than legal work, but what do I care about that. Good barbeque, good burgers, and 55 cents per mile reimbursement for driving along the Gulf Coast doesn't sound that badly to me.

I went to an Astros game on Wednesday. We got tickets just walking up for $20, and we had pretty good seats. Comparable seats at Wrigley would have cost double that amount, and would have been less comfortable. MinuteMaid Park is absolutely stunning inside--the TV shots don't do it justice.

I'm starting to feel a bit at home here--which is odd, knowing that I will be leaving in seven weeks. I miss Ithaca and law school friends, but I oddly enough don't miss Chicago. I can see myself living down here for good, listening to country music and wearing seersucker without shame or kitsch value, and just having a good time. I'll be interviewing with some firms in Houston, Austin, and Dallas in August, and hopefully one of them will see fit to hire me--Baker Botts, if you read this, please do.

Anyway, I feel like I am rambling. Just a few things to expect--I will be buying cowboy boots with my next paycheck, which hopefully comes soon, as I've been living meagerly on the small amount of cash I have, and a credit card. I HATE carrying a balance, so I'll pay off what I have had to spend first. Goodnight, y'all. I'm fixin' to sleep.

I'm finally starting to read again--normal stuff that I actually like. I have a stack of half-read books that accumulated in my room over the year (I can't resist bargain-book/remainder sales!) and I'm going to get at some of them in this next week before I start work.

I've been putting off a retrospective on the first year of law school intentionally for a while (as if anyone cares--stop using parentheticals) and I will continue to do so until I get my grades in two weeks. Until then, just wait folks.

Near the start of finals, I went over to a friend's apartment to do some exam review--the class was contracts. It was another friend's birthday. She was sad, because she was spending it studying. And she even cried. Let me tell you, there is nothing that will make me more uncomfortable, more wanting to give comfort than seeing a woman cry--I don't care if that makes me sexist, old-fashioned, or anything else in that vein. Luckily, there was another woman in the room, and I wasn't the one to have to give the hug, and the pat, and the "it'll be alright" speech, that is always sincere but never true. A smile, a wiping away of the tear, and then I make a joke at my own expense to lighten the mood, and get a bit of a laugh. All is better, returned to normalcy, and I offer to send everyone in the room (there are four of us, including me) my exam prep materials. We leave, and one of them compliments my new shoes. I am happy.

Today, I know just how that crying friend feels. Having a birthday filled with work--that really, really stinks. Happy Birthday to me? Heh, not exactly.

When the team comes a-vettin'...

I figure that if I ever get nominated for a judgeship anywhere, or decide to run for one (one of these things will hopefully happen at some point), I'll be vetted, and the beliefs I've held in law school will come out. Might as well establish a few of the more controversial ones in digital record now, to ease the process.

1. Brown v. Board of Education was incorrect in its methods. The Constitution does not countenance the extreme idea that "separate is inherently unequal."

2. The 10th Amendment is the most important we have. It is the only check against an over-reaching Federal government that is at the ready to manage every detail of our lives.

3. Roe v. Wade was also incorrectly decided. There is no right to an abortion in the Constitution, and there is no generalized "right to privacy" that comes from a generalized "penumbra" of rights.

4. In regards to number 2, states rights is a total misnomer. It is not states that have rights--it is the Federal Government. The states do not need "rights" to act as the independent sovereigns that they are. It is the Federal Government that must be authorized by the Constitution to do anything. This is precisely why many didn't believe the Bill of Rights was necessary. For example: because nothing in the Constitution allows Congress to establish religion or abridge free speech, the First Amendment is redundant, and stating the obvious.

5. The Constitution is a process-based framework, intended to protect certain very basic rights to participation in the democratic process. It is not designed to protect wholesale every substantive right that the passing majority believes ought to exist. It is a baseline and a firewall; it says "you may go this low, but no lower."

6. The Dormant Commerce Clause--seriously, what the fuck? We need to radically simplify the way we understand the Constitution. The fact that it was written in an age when most weren't is indicative of the idea that it was supposed to be understandable. It shouldn't take a law professor with a PhD and 40 years of experience to "tell" us what equal protection of the law means, or what due process of law means. These are simple statements, and should be taken as such.

7. End the hegemony of the courts over the legislature. We are a democracy, for better or worse. The people's will is law, insofar as it does not run afoul of the basic agreements made at our founding as embodied in our Constitution. Any group that says a state cannot ban abortion or deny rights to a disfavored minority (both of which in my mind are things that are wrong on policy grounds) whether it be in robes or something else, is fundamentally anti-democratic. The courts are the last line of defense against the intrusion of fundamnetal process rights, but that does not mean we need to continue to arm them with ever-increasing abilities to deny the majority will.