For Obamacare, TANSTAAFL

January 16, 2017
2 mins read

There ain’t no such thing as a free lunch.
Wise words, popularized by Robert Heinlein in The Moon is a Harsh Mistress. You have to pay for your lunch somehow.
Just so, someone has to pay for medical care. Medical education and training costs money. The consumables used such as swabs, alcohol, and laboratory solutions add up. Renting or buying space, capital equipment, non-medical staff—all these things have a cost associated with them. Drug development is another. For every drug that works out and passes safety and efficacy trials, nine that start clinical trials don’t, so on those that do, the developer is wise to pay for ten R&D programs with the proceeds from that one.
But we all want cheap insurance that covers everything. Isn’t that what Obamacare promised?
There are several provisions in Obamacare that are popular. The trouble is, it’s those very things that drive up costs.
Insuring children until they’re 26
This first one is not much of a driver, but it’s still worth mentioning. If your children are on your health insurance it costs about $20,000 to cover their medical expenses from age 18-26. Split up over eight years, that works out to about $2,500 a year or $200 per month.
“Free” preventive care
With the list of procedures that Obamacare mandates all insurance policies cover, and a basic physical costing around $200, I wouldn’t be surprised if this “free” care didn’t add over a thousand dollars a year to insurance premiums.
Coverage of pre-existing conditions
Under Obamacare, an insurance company cannot deny you coverage due to your having a pre-existing condition. If you have diabetes or cancer, you can get coverage at the same price as someone without. The trouble comes when people choose not to have health insurance, then decide they want it only when they’re diagnosed with something expensive. The individual mandate was supposed to alleviate this, but as much as insurance rates have risen, many people choose not to be insured. Imagine calling an insurance agent to buy a homeowner’s policy after your house already caught fire. Would that be a good risk for the insurance company to take?
No lifetime limits
When you buy car insurance, you buy a policy that only goes so far. If you have insured $20,000 worth of property damage, but cause $80,000, your insurance won’t pay more than $20,000. Not so with medical insurance. If your doctor decides you need a $2,000,000 procedure or a $500,000 drug and your insurance company has covered it for one person, then it’s covered. Before Obamacare, insurance companies could cap lifetime payments. Mine were capped at around $2,500,000 if I recall correctly. If, God forbid, I had something happen to me and exceeded that, they would no longer be liable for my care. But now, there is no end in sight to their possible expenses, and so there may be no end in sight to their premiums.
So what do we do?
wisdomWe need to change our attitude toward health care. It’s not something that there’s an infinite amount of, so we need to decide how best to allocate it. If the government (at both the federal and state levels) is going to be involved in it, we should define their roles. I prefer a free market solution as much as possible. Instead of expecting our insurance companies to pay directly, we as consumers know more if we see the price up-front. In doing so, we can evaluate what level of care we need. If something is too expensive, we need to learn to tell ourselves no.
We should get back to an insurance mindset, where we pay for a reasonable amount of care, and have insurance take care of what we cannot, instead of expecting it to take care of everything. Car insurance doesn’t cover gas and oil changes. House insurance doesn’t cover leaky faucets. Health insurance shouldn’t cover the cost of your annual check-up.
Everyone wants something for nothing. But nothing never has, and never will, be able to pay for something.


  1. Right there with you on auto insurance not covering oil changes. That’s the second of the two main problems with healthcare in the US. The biggest problem though is that healthcare services do not have prices in any traditional sense of the word. I think you alluded to this. I don’t exactly know how to solve the problem. It might be a situation where a law would help, require everyone providing a healthcare service to publish their prices on the internet or something.
    Side note: most single payer systems solve the price problem by having the government health services negotiate a uniform price with healthcare providers. So, for example, if you are going to get a cavity filled in France the dentist gets paid the same amount of money no matter whose cavity is filled or what city it’s filled in. How much they happen to get paid is negotiated yearly between industry reps and the government.

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