I just cannot believe that any advocacy group promoting "single-payer" health care today employs such disturbing practices as the California Nurses Association.  A particularly vile recent example is an article in the March issue of its Registered Nurse periodical. "Why does the insurance industry fear 3-year old Thomas Wilkes? Because he's proof that they have no business in health care." It continues: "It's hard to imagine anyone could hate Thomas Wilkes....but people do hate Thomas." The people in question, of course, being health insurers.

Thomas was born with severe hemophilia, and his health care costs about $1 million annually.  His father works at (and co-founded) a company that is covered in Colorado's large group market. After Thomas was born and his claims started coming in, the insurer started increasing the premiums drastically for the group. (The article does not state how many workers the firm has.) The shaken father, although an entrepreneur himself, has become an advocate for single-payer health care, convinced that the private insurers, not the government, are the problem.  Both his family's health and his business are at risk.

I am unlearned about hemophiia, so I investigated the experience of hemophiliacs in Canada, the developed world's most complete single-payer system. Yikes! Hemophiliacs need a safe and accessible blood supply. Over a decade ago, the Canadian blood supply was tainted with Hep C and HIV and many patients were infused with this blood.  It has taken years to re-build confidence in Canada's blood supply, according to Canadian hemophiliacs. While such a tragedy is not a necessary consequence of single-payer, I expect it would be caught a lot quicker in the U.S., where there is some competition between hospitals and other providers, so there would be more vigilant monitoring of the blood system.

But that is not my expertise, and that does not help Thomas and other children who are "uninsurable", which I put in quotation marks because insurance markets function well for North Sea oil rigs and orbiting satellites, so there is no reason why they cannot work for a child -- absent government interference.

Because his insurance has always been linked to his job, Thomas' father feels trapped.  His work colleagues too, if they do not want to bear the cost of Thomas illness, have to find new jobs.  Bizarre, isn't it? Imagine if everyone got their insurance individually, and insurers had competed to enroll Thomas' father when he was still studying for his engineering degree?  In such a market, that insurance would have been "guaranteed renewable": his premiums would not have gone up by more than those of the thousands of other young people enrolled at the same time in the group, the vast majority of which would still have minor health costs.

How would the premium increases have been much less than they are in the large group?  First, the pool (invisible to Thomas) would likely be much larger than for a small firm.  Second, if the insurer jacked up rates too much, the other (still healthy) members would drop out and buy cheaper insurance, leaving the insurer with less income.  (Remember, in this version the other people don't have to quit their job to change their health care, they just switch like we do car insurance today.) So, the insurer has a greater incentive not to raise rates than it does now.

I sound like a broken record, but the answer, as always, is to equalize the tax treatment of employer-sponsored versus individually purchased health insurance for waged employees.