Why do we keep doing this again?

Early in 2010, as the climactic votes neared, a parade of the legislation's defenders—from the House, Senate and Obama administration—appeared across the media. All had the same message: pre-existing conditions. They named the names of families "victimized" by companies that had refused to sell them insurance, had canceled their coverage or had refused to pay their medical bills.

Wait a second.

If you have a "pre-existing" condition then you're not buying insurance.

Remember what insurance actually is: A small payment made to someone in order to obtain pooled risk against an unlikely but catastrophic event that one either cannot or chooses not to reserve against on one's own.

By its very nature insurance is a negative-sum game.  That is, if you take all the bad outcomes that happen across the insured population and sum their costs, the cost of the insurance purchased by that population must exceed the sum of the costs.  It cannot be otherwise or the insurance company will cease to exist as it will make continual losses and eventually run out of capital.

As such if the catastrophic event already happened you're not negotiating for "insurance"; you are now trying to lay off the cost of mitigating the damage that has already occurred on someone else ex-post-facto.

The common word for that attempted act is theft.

Consider the rest of your life.  What would you say to someone who demanded to be able to buy fire insurance on his house while the house was on fire?  Or someone who demanded the ability to buy auto insurance covering both liability and property damage after he got into a wreck?

You'd laugh at either of those attempts, and with good cause.

So why don't you laugh at someone who argues that after contracting cancer or HIV someone should be able to buy health insurance to cover the cost of that cancer treatment or HIV?

It's the same issue, yet one is quite-properly regarded as nothing other than an attempt to reach into other people's pockets and pay for your consensual decision to either live in a house without insurance or drive a car without having coverage while the other is demanded as a civil right!

We have no honest debate on this issue in America.  The Libertarian Party, in particular Gary Johnson, utterly squandered the opportunity to become relevant not only personally but as a party this election cycle by refusing to take this issue on face-first.  Neither Obama or Romney have any interest in it either.

The reason is simple; if you face this issue head-on you need to do two things.

First, you must tell people that if they are intentionally irresponsible or make decisions that come with the potential for catastrophic loss, including their death, that they both have the right to do so and the responsibility to bear the consequences, exactly as is the case where one has no homeowners or automobile insurance.  In all three cases the decision is made and the choice taken, irrespective of the reason for the choice.  In some cases the choice is economic, in others it's simply a matter of allocation of one's available funds -- people in some cases would prefer to have an iPhone and the data plan associated with it rather than buy homeowner's insurance.

Second, you must deal with the myriad and ridiculous monopoly-style protections that are currently embedded in our health care system.  Some of these adjustments would come automatically with the cessation of the ability to force cost-shifting on other people.  But others are ensconced in law rather than custom, and must be removed.  The most-destructive of these are laws that effectively force Americans to pay for the development of virtually every advanced drug and device used through the world at its reproduction cost, and come in the form of resale restrictions, cross-border pricing protection, abuse of the patent system and unconscionable acts by medical providers who take gross advantage of people who are "in extremis" and unable to effectively negotiate price.  These acts are illegal in virutally every other area of commerce and with good cause; a free market in medical care only exists where one can effectively negotiate for said care and its price and where parties are free to enter and exit providing medical goods and services as they wish.  None of this is true in the current system, and all of it is enforced at literal gunpoint through laws and regulations.

The latter is an extremely uncomfortable place for a politician, as he is sandwiched between the screaming Grannies believing they're being shoved under the bus (or worse) and the pharmaceutical and health industry, reaching all the way back to medical schools, who stoke the fear of those very same Grannies should any attempt be made to cut into their profit margins.  You have to be willing to gob-smack those people and put up facts and figures, such as the fact that if you took the 1963 cost of having a baby in the hospital and inflated it by the CPI to today's price it would cost under $1,000 for that procedure including four nights in the hospital for both mother and infant!

That's an 80-90% reduction in the price charged today.

And that, in turn, leads to some pretty-ugly conclusions.

The most-important of which is that were these changes to become law virtually all of what is currently complained about with "unaffordable" health care would disappear.  Even for catastrophic incidents such as cancer, where a $1 million bill is entirely possible, at 1/10th the cost the majority of people could find a way to pay for it.  For "more-routine" things that cost $100,000 a bill for $10,000 can be funded by most; they might have to take out a loan on their house or credit card, but it could be done.

Would there be those who can't cover it?  Yes.  But there were before we turned this into a debate about rights, and most of those people did get care.  It might not have been state-of-the-art, but charity goes a long way, especially when the price is 1/10th of today's numbers.  There were fraternal societies (such as Moose Lodges and similar), the original formation of which often occurred as a means to provide "group medical services" to the membership.  There were over 120,000 of these local affiliated lodges in the 1920s providing services to nine million members!

For those who say this is impossible I direct you to the Okahoma Surgery Center and their price list, which proves it's not.  Or, if you prefer, do some research on medical tourism in India and other places around the world.  The difference is competition and refusal to force entities to treat people who have no money.  The grift and scam embedded in the American medical system comes from those two primary factors, not, as is often claimed, "defensive medicine" or "tort abuse."

Now to be sure defensive medicine is an issue and we perform a lot of unnecessary MRIs for that purpose.  But the question isn't so much whether we should do those MRIs as it is why a mature technology should cost $2,000 a crack instead of $20.  That happens for one reason and one reason only -- there's no effective competition and everyone involved up and down the chain, from doctors to device manufacturers have bent both the ears and pens of legislators to insure that their gravy train of theft remains secure.

We will never solve the problems in our medical system's cost structure until we tell the truth on how we got here and call demands to purchase "insurance" after the fact what they are: an outright scam.