While there are genuine debates about whether privatized health insurance or nationalized health insurance policies make more sense, there can be little doubt that guarantee issue policies represent the most immoral type of hybrid between the two. The argument that everyone should be covered by health insurance is an argument for a nationalized health care policy. By contrast, believers in privatized health insurance argue that a private system yields more efficient pricing and cost controls in the health care field. But with guarantee issue health insurance policies, an immoral situation is created that undermines the benefits of a privatized system by poorly and immorally implementing some of the edicts of a nationalized system.
Canada has a nationalized health care policy that many in the U.S. wish to emulate. While the idea of promising health care benefits to all citizens is appealing, there are downsides. For example, many in Canada are forced into long waiting lines to receive health care treatment. In fact, the Canadian courts just ruled that many laws which barred citizens from seeking alternative health insurance options were unconstitutional. If the health care system in Canada were capable of serving all citizens in a timely manner, there would be no need to seek alternate routes. The Canadian courts were correct to view laws limiting how people can spend their own money for their own health benefits as inconsistent with their fundamental freedoms. But barring those attempts by legislators to enforce a monopoly on nationalized health insurance, the premise of taxpayers supporting a nationalized health care system makes sense from an ethical point of view. In such a system all taxpayers are subject to the same benefits and burdens with respect to their existing tax structures.
Similarly, a privatized health insurance system like that in place in the United States makes sense from an ethical standpoint. While it can lead to tragedies where uninsured people contract illnesses and cannot pay for medical treatment, it treats people in a fundamentally fair manner. Everyone is free to make their own decisions, and pay or suffer the potential consequences. Those who wish to spend money to guarantee funds are available in case of medical emergencies are free to do so, and at a price that falls within their statistical risks.
But guarantee issue laws for health insurance companies are fundamentally unfair. They punish those who are willing to pay for insurance by saddling them with costs far beyond what they should owe statistically, or what they should owe in a nationalized system. Health insurance rates in guarantee issue states like New York and New Jersey are around 3 to 4 times what they are in other states. Is it fair for a consumer in New Jersey to pay three times as much for the same health insurance as they would in another state? Of course it isn't. These consumers have been unfairly placed into a statistical pool that isn't representative of their health care needs, and forced to pay far more for health insurance than their situation dictates. And they are forced into this situation precisely because lawmakers have chosen a terrible hybrid model that removes any pretense of fairness in pricing that exist in the more natural nationalized and privatized models.
As more and more people in the guarantee issue states become unable to afford health insurance, those states will be forced to answer for the fact that their policies have made them leaders in the numbers of uninsured. A new law called the Health Care Choice Act is being proposed to allow residents of one state to purchase health insurance from another. While legislators in guarantee issue states will oppose such laws, they'll have a hard time pretending they're doing so on behalf of their constituents who are actually paying for health insurance.
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