Kids, it’s up to you to fix healthcare

For the past six months, I’ve been on a David Ramsey and @drisis-inspired mission to rid myself of debt. My grandmother instilled in me her Depression-era distrust of debt, but I lived in a way that forgave and demanded borrowing for years. I was told that her lessons were old-fashioned and tried to ignore the pains in my gut and the sleepless nights that debt gave me. In vain. I felt dread and a constant feeling of limitation imposed by what I owed.  Sweet Sweet Dave, as we call him, gave me permission to pay off my debt with missionary zeal, and at the end of this month, I will have paid off all my debts (except my mortgage). It feels amazing, like lead weights being lifted off me. More than that, like a hot poker being removed from my guts. It’s been a philosophical journey too, more than I would have expected. Ramsey was right. My family thinks I’m weird (and that’s being charitable). Rejecting the majority culture’s ends justifies the means view on debt has been challenging for a few of my relationships and better for others, but it feels very right.

The debt-free journey has also made me think differently about Obamacare. I watched the Democratic debate last night and was stunned by the disconnect between Hillary Clinton and Bernie Sanders on healthcare. Martin O’Malley is too level-headed to have any chance in this carnival of a race. Michael Cannon is the exception to the rule that intelligent libertarian is an oxymoron, and to my chagrin found myself agreeing with him:

https://twitter.com/mfcannon/status/688912764279083008

Clinton came out as the voice of “Obamacare is a good start, let’s keep going,” while Sanders, the unapologetic socialist pitched his just-announced, multi-$ trillion with a T “Medicare for all” plan. Sanders’s goal is to get private insurance out of healthcare (while claiming to support Obamacare, an insurance regulatory framework, proving that even socialists can be slippery). Others have written about the economics of his proposal: I applaud Sanders for being realistic about the costs and that taxes would be required (h/t @mikethemadbiol) to pay for his plan. Conservative gun-for-hire Avik Roy estimates that Berniecare would increase federal spending $28 trillion using Sanders’s own estimates.

Yes, government-sponsored, universal healthcare, like the rest of the industrialized world has embraced, is a good idea, but one without the support of the majority of Americans. And opponents of single payer have a point. Americans don’t have the stomach for European-style limits on healthcare, so universal healthcare in the US would be stupendously expensive. Add to that the opposition of goliath capitalist interests, the insurance and pharmaceutical industries, and you are a few miles away from a feasible proposal. Americans’ worship of freedom, love of capitalism and distain for European socialism are the reasons we wound up with the hybrid conservative approach of Obamacare. Frankly, as a transplant from the East-Coast to the Midwest, Democrats giving life to the stereotype that “we know what’s best for you because we’re smarter and are going to ram it down your throat” makes me a bit ill.

Half of America thinks Obamacare doesn’t go nearly far enough, and and the other half thinks it goes way too far. That, plus the fact that there is no real Plan B, makes me conclude that this may be as good as it gets. The system is messy and imperfect and there’s no end in sight for the arguments over it.

To get the most out of our current healthcare system, it helps if you understand that it is fundamentally a conservative system. Ramsey’s advice on personal responsibility are a good approach to fixing healthcare. If you want Obamacare to work for you, you need to follow three steps:

  1. Have an emergency fund. Ramsey suggests 3-6 months of living expenses, and it should be modified to cover your medical deductible. Healthcare is expensive and Obamacare doesn’t fix that. Having healthcare insurance will shield you from having to sell your house or go bankrupt to pay for healthcare, but to keep your monthly premiums under control, you will be responsible for unavoidably hefty deductibles when you use the system.
  2. Do everything you can to avoid touching your emergency fund. Subsidies are available for many and preventative care services are free. Do your research. Getting sick is expensive. Diet, exercise, no smoking..boring but good investments.
  3. If you have to spend your emergency fund on healthcare, haggle. It may seem strange suggesting that you treat the healthcare system of the most prosperous nation on earth like a bazaar, but here we are.

Navigating the healthcare system, finding out how much healthcare services cost, and what procedures and medicines are “needed” is a major challenge. The idea of consumer-driven healthcare  is not without its critics, but the current trends in medicine, including consumerism, is occurring with or without Obamacare. If enough of us can be prepared to pay deductibles and can be engaged in making cost-benefit decisions in healthcare, our medical system will be transformed. Time will tell about that. Staying out of debt and having an emergency fund is the best strategy you can take no matter what.  Politicians want to tell you that voting for them means you won’t have to work so hard for things you “deserve.” Free “puppies and rainbows.” Don’t believe them.

For all my kids’ lives, I’ve sheltered them and tried to give them things that I never had. Getting out of debt (or staying out) and putting aside an emergency fund required hard work and sacrifice. Period. But I’m happier now and more peaceful than I have been in a long time. I hope they see that.