When it comes to health care, the topic of money is often seen as a distasteful matter to bring up. If you want to discuss costs, it seems to imply that you prioritize finances ahead of personal health.
And yet, when we talk about health systems, the financing should always be at the heart of the debate. If you don't talk about how to finance it, but only focus on the moral need to look after everybody's health, you end up with something like the mess that is Obamacare.
The idea that everybody should get health care is hard to argue against. But, there should always be pressure on the individual patient to strike the best deal. The quality of services should have to meet good minimum standards. Within that, though, there will be plenty of versatility and patients can look around to get the best offer.
Many patients can find help by looking outside the health system itself. Those trying to cure themselves of an addiction, for instance, know there is more to their treatment than simply 'stopping' (trying to do so can cause other, even more serious, problems such as speeding up the heart rate, for instance, or bringing on headaches or seizures).
A regulated medicine-assisted withdrawal course, on the other hand, would do wonders, and can be obtained without necessarily having to put pressure on a 'universal' health system.
It's by allowing for plenty of choice, and giving patients and potential-patients an incentive to look around and uncover the best deal, that you keep the system affordable.
This concept started to become frayed with the move to an insurance-led system. As a result, patients were under little pressure to find the best price. The suppliers of the medical services knew they didn't need to push down costs either, since the insurance would cover it.In practice, you had escalating prices as patients and suppliers agreed not to worry about costs. But, of course, those higher costs did have to be paid and they were paid by the taxpayers, who were now being asked to pay more for insurance.
Obamacare takes this flawed concept and stretches it to a ridiculous level. In most public systems, the typical person takes more out of the system than they put back in. Even if they make a contribution, this contribution will often be too small to offset the cost of the services they use.
But, in any properly worked out system, you need plenty of people making a significant net contribution, which obviously becomes more difficult to achieve as the system itself becomes more expensive.
Older people tend to have more health problems and, therefore, act as a drain on the health system in the majority of cases. So, in practice, it comes down to young people, many of whom are healthy and so make few demands on the system itself, to pay for the costs.
Yet, who will actually pay under Obamacare?
Those under 26 will be able to use their parents' plans, meaning that they make no contribution to costs, but may still use the facilities from time to time. Looking at those who are over 26, but young enough to probably still be healthy, many of them won't receive enough of a salary to be eligible to pay for the system. Again, though, they'll be able to use the facilities, and so will probably end up costing the system money.
The system relies on affluent youngsters. But of those, a good number will be young women who may well want some sort of maternity care, meaning that they will often end up costing the system money as well. In fact, the only group of people who are likely to make a significant contribution are affluent young men.
However, if those young men want, they can opt to pay a penalty. This will amount to a meager one percent of income, which often won't be much of a penalty compared to the cost of health insurance.
In practice, many people will make a few calculations. If they think they'll be better off by just taking the penalty, they'll opt out. But, if they think they might have a significant need for health care, or they'll have to make a very small contribution, they'll opt in.
The system essentially deters those who should be making the most significant contributions and attracts those who'll be the biggest drains. Will it work? No. Will it cost huge amounts of money, and then yet more to put right? Undoubtedly.
There is a place for welfare, but when it removes all traces of logic and practical consideration, the result is a catastrophic mess that, in the long term, helps nobody.