In the interests of full disclosure, I am aspiring to be an actuary (test in two weeks--wish me luck.)
Lately we've been hearing a lot of people bash insurance companies--they make too many decisions that doctors ought to be making, they deny people with pre-existing conditions, they are inefficient because their risk pools are too small.
All these accusations are valid, but they miss a couple important points. First and foremost, health insurance oughtn't handle routine office visits and checkups, any more than auto insurance should handle oil changes. It's simply not what insurance is all about. Second, I fear that demonizing health insurance companies will distract us from what should be our real goal: bringing down actual health costs in real terms.
I believe that government's role should be to provide a sort of a health infrastructure. There are several ways this can be done. The government should promote and subsidize preventative care, by making sure that there are more clinics in residential areas. We should be promoting generics, to ensure that there is free competition in the production of essential medicine. Finally, creating a national health database for use by doctors and patients (see http://www.change.gov) is a sound and long-overdue method for reducing health costs.The government should encourage and subsidize the production of vaccines. When I say promote, I'm talking about very serious, concerted promotion--posters, TV ads, netroots, door-to-door. (Given the success of these techniques in the 2008 campaign there's every reason to believe that our 44th President will excel at this).
The government should allow anyone who is willing to pay to buy Medicaid. One option should be a "co-pay only" plan--your private insurer, be it Aetna or Blue Cross, pays most of your bills and Medicaid picks up the rest. The government would make routine office visits cheaper in real terms, and one would hope that eventually we would no longer need health
insurance for those.
The fact of the matter is that capitalism is a cruel, ruthless system and would be unimaginably cruel if it were not for entities such as insurance companies. They cannot, and should not, go until risk no longer exists (guess when that's gonna happen?). It's only because of skyrocketing costs that insurance has been forced to pick up the tab for routine medical checkups and preventative care.
Let me make an analogy. Car insurance is mandatory, but not subsidized. But it is affordable, because we don't need to use our car insurance for things like oil changes, tire changes, etc. We do use car insurance to deal with unforeseen calamities. The government helps to make sure that we don't have to get our tires replaced every few weeks by keeping our roads paved, keeping them plowed in winter, maintaining gutters, and keeping our traffic lights working. This is what I am suggesting we think about in terms of national health care.
Maybe once government brings down these actual costs, our insurance companies can go back to doing what they're supposed to do: managing risk.