...Unfortunately, this leaves us with something of a problem. Reciprocal altruism is fine if all you need is for Mom to sit with you and brew you some herbal tea. But in a modern society, you need to procure health care from strangers -- which is to say, through the transactional system of market exchange. Nationalizing the health care system does not fix this fundamental disconnect between our evolved instincts and the inevitable necessities of a modern economy.
National health care systems, in other words, must make exactly the same sort of decisions that private insurers and individuals do: what is worth paying for and how much to pay....
...Before the internet, most people had no way of knowing whether there were other treatments than the ones their doctors recommended, so as long as doctors only prescribed treatments that were approved, the government could maintain the fiction that there was no calculation going on.
America has never really had that comfort, because most doctors take a lot of different kind of insurance, and they don’t know what will be covered until after they’ve discussed treatment options. So Americans could hear about a treatment, find out it wasn’t covered, get outraged, and call their congressman. This may be one reason that our system is so expensive....
...A true national health care system, along the lines of Britain or Canada, would have advantages and disadvantages over what we have now. But one advantage that it doesn’t offer is to free us from the need to think about our health care in the cold logic of dollars and cents, rather than warm and fuzzy altruistic ideals. Health care cannot be a right, full stop; it has to stop before we run out of wallet. Which means that no matter how much it horrifies, we have to stop hoping for a system that will make those hard decisions and unhappy trade-offs go away.
Why Luxury TVs Are Affordable when Basic Health Care Is Not
The Return of the Obamacare Death Spiral
Earlier this week, Aetna, which covers about 900,000 people through the health exchanges created under Obamacare, announced that it would dramatically reduce its presence those exchanges. Instead of expanding into five new states this year, as the insurer had previously planned, the company said that it would drop out of 11 of the 15 states in which it currently sells under the law.
Aetna's decision follows similar moves from other insurers: UnitedHealth announced in April that it would cease selling plans on most exchanges. Shortly after, Humana pulled out of two states, Virginia and Alabama. More than a dozen of the nonprofit health insurance cooperatives set up under the law—health insurance carriers created using government-back loans in order to spur competition—have failed entirely. While some insurers are entering the exchanges, even more are leaving.
What this means is that in several states, and even more counties, there will be only one insurer available through Obamacare. In at least one county—Pinal County, Arizona—it is likely that there will be no insurer available on the exchange at all.
This slow exodus of insurers from the health law's marketplaces represents a serious threat to the continued stability and existence of its exchanges. Obamacare is perched on the edge of a death spiral....
