Big = Good, Except When It’s Not

The various proposals for health care reform in Washington have people talking here in Oklahoma. Even though a single-payer system is apparently not an alternative Congress is considering, some Oklahomans are convinced it is a highly likely outcome. Many Oklahomans seem to feel that a government that is powerful enough to provide health care for everyone is, well, just too powerful. Governments should have limited power–enough to start and conduct wars, manage nuclear weapons, put people in prison–little things like that, but not the amount of power necessary to provide health care. That would be overstepping the bounds of a safe and manageable government.

The puzzling thing is Oklahomans (and many other Americans too) seem to believe that government of bathtub-drowning proportions is ideal while insurance company proportions can be gargantuan with no ill effect. Insurance companies can refuse to sell insurance to people who are likely to need care, drop people who become ill, make mysterious impossible-to-explain “mistakes” that delay payments, and pay top executives ridiculously high salaries. Oklahomans face this very bravely. But the government really scares us.

We don’t especially like insurance companies, but our distrust of government is much greater than our distrust of corporations. How to explain this? We know we can’t vote for the leaders of corporations. Even though we can elect the leaders of our government, we don’t trust them. (And why should we when they get campaign contributions from insurance companies?) We see the private sector as “good” and the public sector as “bad.” We always like the word “free,” and when the business sector can mention the term “free enterprise” or “free market” that sounds really good to Oklahomans. Perhaps if the government described itself as a “free republic”–as in free from King George III–we would like it more.

For most of us Oklahomans however, the issue seems to come down to taxes, costs, and ultimately, how we view our fellow citizens.

Let’s take taxes first. We fear that a government health plan would take too much money in taxes. We would rather pay that money to an insurance company in premiums than see a government plan that would take our money in the form of taxes. That way, people who can afford it pay the insurance company. Then, they fight the insurance company to get claims paid. But, the silver lining is, since it is so difficult to cajole the insurance company into paying even legitimate claims, we can rest assured there are very few fraudulent claims paid.

And this brings up the second big fear–cost. We fear that the government will rubber-stamp any sort of crazy high-cost medical procedure someone might want (or a doctor might prescribe). You never can tell when someone might just decide to have a tonsilectomy for fun or an amputation just for a sense of adventure. And since doctors make money doing these sorts of things, a doctor just might tell someone to have brain surgery for a hangnail. Or a doctor might bill for a liver transplant while actually treating a wart. Did I mention our trust in doctors is, well, lukewarm at best?

And thirdly, we are so fiercely independent, we find it difficult to trust anyone–even each other! We feel we must constantly be on the lookout for rip-off artists. We feel each family should be all but completely self-sufficient. We have grave difficulty with the idea of pooling resources (in the form of tax money) to provide health care for all. We have a suspicion that our neighbors will game the system or that doctors will over-prescribe medical treatments. It’s more than a little amazing that we are willing to pool risk (by buying health insurance) at all!

Yet, we have to wonder… Are the administrative costs of the insurance system eating up so much money and resources that our fears of a government system are simply laughable? Or are the possibilities of fraud (and there have been some zingers within Medicare) that might be associated with universal single-payer health care substantive enough that we should continue to live with the current system? Is our lack of trust in “others,” whoever they may be, rational, or a form of collective paranoia?

Our current system, with the attitudes that underlie it, is very costly; just ask an uninsured Oklahoman.

Arden Rea lives  in Oklahoma City.