There you go again
Saturday, February 14th, 2009 By Mike MaurerOne of my favorite experiences ever was at a committee hearing on the chronically ill and uninsurable.
They’re uninsurable, you see, because they’re already sick. This isn’t all that hard. When you have a risk of loss, and that risk (along two dimensions, mind: frequency and amount) can be calculated, and investors (yes, remember them? Take a good look if you see one, as they’re disappearing fast) believe they can earn a fair return without going to jail, then, thank your lucky stars, you can buy insurance.
It’s a wonderful thing. So what happens at this hearing? An “expert” testifies about the folks who are already ill and says, “They want to buy insurance. They have jobs. They have income. They just can’t afford it.”
Indeed. What he means, of course, is that they’re willing to pay the insurance rate for insurable risks, i.e., the rate for people who aren’t already sick. What the heck, me too. I’d love to pay $800 a year for car insurance, but only after I have the accident. The other years, I’d just as soon save the money.
So this nonsense is back. Gov. Strickland doesn’t understand it, according to this story, and that’s surely the truth.
If the governor wants to pay welfare to this class, and that’s what it is, let him propose policies to do so. But let’s be honest, it’s not insurance, and there’s no reason to force policy holders to be the special class of taxpayer to foot the bill. If we pay this welfare, we should do it out of general revenue. (Of course I’m being too kind to the governor; this is a strategy to collapse the health care market so there are no private insurers and the government is the only option. Then we’ll never have anyone get ill again, and you’ll always get everything you want from the government.)
February 14th, 2009 at 12:56 pm
Yes–the proverbial closing the barn door after the horses have escaped. The problem is–we all end up paying anyway–these folks end up getting “free” care from hospitals or end up on Medicaid eventually.
Eventually almost everyone is going to need medical care, and those without insurance will almost always be without the means to pay the bills in any meaningful way.
I have been intrigued by what they have tried in Massachusetts. A liberal state, but with a plan that was enacted into law by none other than Mitt Romney when he was Governor there.
My understanding of the plan is that it requires individuals to have health insurance. Employers have incentives to provide coverage, and the state has a program to help individuals afford coverage where they cannot get it from their employer. I have read that very few people remain uninsured in that state.
We have laws requiring drivers to have auto insurance, but not health insurance. Yet, while the chances of needing auto insurance are high, it is almost a certainty that one will need their health insurance. In addition, unlike some risks that an individual may choose to take (e.g. buying stock), society often ends up paying for the choice to remain without health insurance.
As a society we have three choices: 1. Get people insured while they are healthy (the Mass. plan); 2. Let people be unisured, and then eventually pay for their care anyway (the current “plan” in the other 49 states); or 3. Deny treatment to the uninsured when they run out of money (a choice we are unlikely to make, and unlikely to stick to).
If you assume that option three is off the table, option one doesn’t look so bad.
February 14th, 2009 at 2:31 pm
Well, I had read that they already have massive cost overruns, and still quite a few uninsured, in the good ol’ people’s republic. Hard to believe they had Minutemen there once. I don’t really see any difference between 1 and 2 from your perspective, since we’re not talking a private market in either case. Since it’s welfare, let’s not confuse the issue. Let’s make it 2. You might say that’ll destroy the private market, but so will 1, so no loss. And I have faith in my fellow man: the free system will be so heinous that people will still be willing to pay to avoid it. Of course that’s a price distortion for people, which of course hurts the poor most, but it’s the option that harms them least
February 15th, 2009 at 12:44 pm
The difference between one and two is the difference between a liberal and a conservative.
Liberals might argue that a just society openly provides health care to all. That people shouldn’t lose their coverage when they lose their job. That people should be able to change jobs without fear of no coverage. That with over 40 million uninsured, most of whom have no coverage because they cannot afford it, it is a national problem deserving of a national solution. Our social sefety net has holes, and we should mend them.
Conservatives might respond with noting that most people eventually do get care. That to have universal coverage will be expensive, taking away still more resources that might have been invested into a business instead. They might also argue that expanding the social safety net should be called expanding the welfare state, creating one less incentive for people to form healthy families and to work for a living.
I submit that all of these arguments are true. It is a matter of weighing costs against benefits. As a liberal, I find that the benefits outweigh the costs. As a conservative, you find that the costs outweigh the benefits.
I am not even sure that there is an objective truth. Or if there is, that we are capable of seeing it. In the end, there is just a judgment to be made. What that judgment is depends upon each person’s outlook.
February 16th, 2009 at 8:26 am
I don’t know about that, TL. You’re taking the easy, can’t-we-all-get-along way out. I think it’s pretty clear that it doesn’t depend upon outlook, it depends upon the facts. The great difficulty is that what looks like kindness and generosity is its opposite; we can always see the person being helped and we can always feel good that “we” are helping them. But we can’t see the forgotten man who’s paying the bill, and we can’t quite tell why it is our society is impoverished.
Tell you what, though. When all our elected leaders start living as ascetics, or when your peers who talk about spreading the wealth around start showing it by spreading their own wealth to, say, poorer Africans, rather than their standard position of spreading Donald Trump’s wealth around to, surely not themselves, that would be selfish, but to the people they define as beneficiaries (with some justifiable overhead), when even one of those things happens, I’ll buy your position. (Say, have you heard of “Who Really Cares?”)
February 16th, 2009 at 10:45 am
Token liberal, you say “Liberals might argue that a just society openly provides health care to all. That people shouldn’t lose their coverage when they lose their job. That people should be able to change jobs without fear of no coverage. That with over 40 million uninsured, most of whom have no coverage because they cannot afford it, it is a national problem deserving of a national solution.”
Maybe because I’m a classical liberal, I agree with most of your statements here. Of course, the solution I propose isn’t to expand government programs. In fact, it is the government which has created the market distortions that have resulted in health insurance being tied to employment status in the first place. Furthermore, government regulations and mandates are in large part responsible for making health insurance unaffordable. Were we to move to a system of less government regulation and eliminate the tax code subsidies that promote employer-sponsored health insurance, we’d address many of your concerns.
To anticipate your next objection, I’ll freely admit if my suggestions were implemented it won’t mean that everyone will be able to obtain health insurance. My desired reforms would take care of many of our current problems, and would leave a much smaller number of hard-core uninsurables. I’m not necessarily opposed to the government providing care for this group of people who are too poor and too sick to obtain affordable coverage. Were we to give consumers in the health care marketplace more freedom, however, I’m pretty sure we’d find this was a pretty minor problem to deal with.
February 17th, 2009 at 6:24 pm
Mike and Marc:
I do not think I am taking the easy, can’t we all just get along view. I think that we will never “get along” because we see the same facts and will come to different conclusions.
Right now, we have a capitalist system that provides health coverage to many people, and a governmental system that also provides health coverage to many people. In between are over 40 million people without any coverage.
While we can tweak each of these systems to help them expand to fill the gap, at the end of the day, if we are forced to choose one or the other, I will pick a government program and you will not. I say this while being fully aware that government has many flaws, just as I am sure you will admit the flaws of the private systems.
Some facts lead to an obvious choice. But others, like this issue, lead to hard choices that will, in the end, be largely governed by one’s outlook.
(Come to think of it, the vote on the stimulus package is a good example. Everyone sees the same economic problems, and in the end the parties split over some pretty basic philosophic (and some not so philosophic, to be sure) differences.)
February 18th, 2009 at 1:05 pm
TL, we actually don’t have a “capitalist system” for health care coverage. When the government provides around 50% of the health care spending and the private sector is so heavily regulated, there isn’t much free market left in the health care sector.
What we should do in health care is look at the variety of problems we have. The uninsured are one problem but we also have many others: rising costs for health care procedures, too much unnecessary care, lack of coordination in some sectors, too many mistakes by doctors, too many lawsuits, etc. Addressing each needs to be tailored in ways that fix the problem causing them.
For the uninsured, many government policies come together to deprive people of insurance they desire. Fix these problems and you’ll find that maybe up to 75% of the uninsured will have insurance. The rest may be better served by going on a government program because they want insurance but can’t afford it.
I don’t pick a free market solution because of my philosophy. I pick a free market solution because government policies have created the problem (to a large extent). I think there is room for the government in this equation, but it should be a very limited role. The huge amount of interference by the government in the health care system today has had profoundly negative consequences.