The same is not true of privately owned and controlled insurance companies, who answer to shareholders only. If I am a client and not a shareholder, I have no say.

With government, I am a client AND a shareholder.

Re the cost of OHIP: I don’t know what it is, because you haven’t given me details, so I can’t say whether it’s valid or not. I do know I was insured by OHIP when I lived in Ontario, and was satisfied then. I can’t speak for now. I need more information to make a conclusion about your position.

I’m not clear how I’m mixing apples and oranges, though. For me, health is a public concern, not a private one; it’s all apples.
Or all oranges.

I’m open to adjusting my opinion, but I need something concrete to sway me. I can’t just take your word; you have a political position that shapes your opinion (as have I). But I have concrete reasons for holding my own opinion — some of them are my own experience, which I’ve shared with you. If you would provide me with concrete examples of how and why health insurance is better for the general public than public health service, then I could talk about the validity of your position. But so far all I have is opinion.

These are my assumptions for the basic requirements of governing and maintaining a functional modern society, in which strangers live and work very closely together with all the attendant risks.

Public health is a real issue. What you regard as individual personal responsibility is, to my mind, obsolete. When we were living as relatively isolated family units, whose connections were to people who we knew all our lives, perhaps your understanding of individual personal responsibility vis a vis our health was reasonable. However, modern societies learned, after centuries of dismal public health and widespread epidemics (the bubonic plague, yellow fever, smallpox, malaria, etc), that the responsibility for public health could not be left in the hands of individuals, who are far more likely to make choices based on their own personal interests, not on the greater public good.

Individuals haven’t changed. Public health is still a challenge. A person’s health is not just his or her business. Today we’re facing different potential epidemics, without realizing it. From obesity and the various chronic conditions that accompany it to HIV-AIDS to the secondary infections that have survived and grown resistant to our antibiotic regimes — TB, pneumonia, and dangerous flus — an individual’s health impacts the group.

I believe that the state has to assume responsibility for maintaining the health and the equilibrium of the group. That element is absent from your discussion, except when you admit that the state may have a responsibilty for those who cannot care for themselves. When the state abdicates its responsibility — as it has in the USA, whose system is fundamentally flawed, and whose system, because of its position in the world, affects global health through the development and export of treatments, drugs, and lifestyles — public health, not private health, is affected.

I want all taxpayers to have their taxes used in such a way that public health is maintained and regulated. And I want all taxpayers’ money to be used in a way that reflects contemporary needs. This discusion was not even valid half a century ago; no one disputed the importance of the state in health care. Every modern state provided polio vaccines, smallpox vaccines, etc. Public funds were used to find ways to eliminate the worst communicable diseases. Birth control was in the public arena in many states, because population control is a state issue, not a personal one.

Today, public health is threatened in a number of different ways, but it has not yet been transformed into a private matter. I agree with you in so far as I agree that each individual has a responsibility to his or her own health. Where I disagree is in the assumption that an individual’s health is the entire responsibility of the individual.

I didn’t get the flu three weeks ago from myself, for instance. I got it treated quickly, because I live in a country that provides me with the means to do so, by providing clinics and a public hospital that does not require me to have either insurance or money to obtain treatment in a timely fashion. Because I got it treated quickly, and because I took a course of antibiotics, my flu didn’t turn into pneumonia, as it has done in many other people. On the other hand, I have friends and relatives who soldiered on through their own attacks of flu, and who ended up spreading the illness to other people, some of whom ended up in the hospital. The result of that is not a private matter. Those who were working did several things: one, they may have infected their workmates; two, they put their employers in a position of losing their labour while they were in the hospital, and potentially of losing their labour for good; and three, they put their families — who didn’t give them the flu — in a financial position that they had never anticipated, even with personal insurance coverage.

What I am adamantly opposed to, Rick, is the idea that health is a private matter, something optional that can be maintained through individuals’ personal choice. I don’t see how that argument can be sustained, unless individuals walk around in bubbles and never have contact with other people. I have observed again and again, even in our society where we have clinics and a public which provide health care for the uninsured and which cannot refuse care to people who cannot pay, that those people who do not have insurance do not practice preventative or early health care. They wait until they can physically do no more, and that places a strain on every health care agency, from the government to the insurance companies.

If health care costs were kept realistic — and we don’t really know what that realism is, but the difference between the medical costs in the USA with brand-name drugs, insurance coverage, infinite health-care options, and so on and that in many other countries, ours included, suggests that the reality is probably more than it is in state-subsidized places and less than it is in “insurance”-controlled places — then perhaps people could make realistic choices.

I have a serious problem with the concept of health care as a commodity. I believe that people should have the option of obtaining reasonably priced medical attention for as long as they live. One result of prosperity is that we live longer. But that prosperity does not benefit us; it benefits insurance companies who collect our wealth while we are healthy and refuse to return it to us when it is no longer profitable to insure us.

The lie sold by insurance companies is that my money will help me later when I need it. But it isn’t true; when I become “uninsurable” my premiums are not returned to me. I would do far better to invest my money in the stock market or in a bank so that when I get sick (after I turn 70) my investment still stands. Health insurance companies do not serve the interests of public health; they serve the pockets of their shareholders.

I wouldn’t have an issue with the return of premiums to people who have not collected major sums on their insurance when the coverage is cancelled. I would be far less hostile to the concept of “insurance” if that happened. But I’m afraid that I regard health insurance as a scam that was invented to make companies richer. You have said nothing to convince me of anything different.

Help me out, Rick. I’m trying to engage sensibly with this, but your points aren’t convincing me; the problem with the lack of insurance for the elderly isn’t just the problem of the elderly, but of those who have to care for them — their children and their other relatives. How is this at all helpful for society, for individuals, for anybody other than the health insurance company?

My other beef with health insurance — earned from my experience with elderly relatives who paid health insurance all thier lives — is that individual health “insurance” coverage is automatically cancelled when people turn 70. If they have made no claims during their insured period, they lose all their premiums, and are not covered at a time when of course they are going to need insurance the most.

That is what I think is unconscionable.

Some health care should be provided (by the state? I would say so, but I don’t know what you would say here, as you would prefer to reduce all state-sponsored services to the barest minimum) for people who cannot purchase insurance.

Individuals should take responsibility for additional health insurance, should they want or need it.

Where we differ is on the drawing of lines.

With regard to those people who should have automatic health coverage, you categorize those people as indigent.

As I am not indigent, but cannot purchase insurance, and as all the members of my father’s family are in the same position, I don’t categorize those people as indigent.

I also include the self-employed, the people who have chronic diseases (or people who are healthy, but whose parents or siblings have chronic diseases), the elderly, and people who are already ill. All these people who are not in a position to buy insurance, as they have been excluded by insurance providers from access to reasonable insurance policies.

Further, we disagree on what should be provided. You say that we don’t know what the care is costing. I argue that in many cases the cost of health care is grossly inflated because of insurance.

In countries where the state covers the cost of health care, health care is not as expensive as it is in countries where insurers cover that cost. On the one hand you might argue that the costs are kept artifically low by state-sponsored care. I could argue that insurance has made the costs unnaturally high. The issue isn’t simple, true. Nor is it black-and-white.