Health Insurance: The Politics of the Heart
Some people think that government is the solution for the inequities that currently exist with regard to health insurance and health care. Their hearts are in the right place. But their minds?
Update 7/05/2007: One commenter below suggested that the previous picture for this article (of Hitler and Stalin) was knee-jerk. I've taken some glucosamine and my knee is now feeling better. Besides, I found a better picture--courtesy of ProtestWarrior.com.
I appreciate Reach Upward for enlightening me on the problems with government-provided health insurance, as well as a few of his commenters who illustrate that they don't fully grasp the problems that are inherent to government.
RU says insightfully:
The underlying premise behind a requirement that each person have medical insurance is that your physical condition is public business. Why is your physical condition government’s concern? Only due to socialism. Since the public pays for a portion of your health care, your health issues impact the public’s pocketbook, so the public can tell you what you must do to minimize their costs.
What government begins to regulate it tends to increasingly regulate as time goes by. While markets improve by innovating in productive ways, government usually takes great pride in innovating in ever the same direction--by making dumb, draconian, unefficient laws even dumber, draconianer, and unefficienter.
One of Reach Upward's commenters responded:
Rather than say that your physical condition is public business, I think it is more appropriate to say that the society benefits when all its members have access to affordable health care. As a nation we would have less disease, a more productive work force, and more competitive businesses if we accepted our collective responsibility for the health care of our citizens.The commenter has a good point--to a point. We should all have access to affordable health care. But the way that health insurance costs escalate each year indicates that the current mode of insuring against loss of health is not working. To suggest that government can make an improvement in this lack of efficiency is less than observant at how government functions in practice.
Health plans should charge premiums based on risky behaviors. In very few instances they do, such as for smoking, and this may be the reason in those very few instances that some people can't afford health insurance. But if so, these people still have a choice. As it is now, premiums are essentially the same for everyone regardless of behavior, while those who practice unhealthy behaviors (motorcyle racing, homosexuality, smoking, obesity, etc.) use health care services at a much higher rate.
Alternatively, if health insurance coverage were provided only for catastrophic and chronic events, use of health facilities would drop. As it now stands, people are incented by their health insurance to go to the hospital or the doctor (and often do) at the slightest provocation.
Another baleful comment comment to Reach Upward's post was this:
...simply making the government with single payer for all health care costs...does not have any effect whatever on your choice of physician or hospital...
Reality does not square with the yearnings in the breast of some well-meaning individuals. Yet despite the perpetual unyieldingness of the round hole, they attempt time and time again to coax the square peg into it. Before one makes such implications about government benevolence, it helps to study what happens when government gets involved in health care; for example, Canada, China, Cuba, and the Soviet Union. When government becomes the single payer, it alone dictates which items it will pay for, and how much it will pay. As a result, some people wait interminably for the health care that they need (because government won't pay enough for it), while others will never get it (because the government won't pay for it at all), and lots of people die.
Here's another comment:
demand for health care is not based on price. In a normal economic good, demand increases as price decreases. If the price of apples drops, more people will buy apples instead of oranges in a supermarket. Health care decisions are not based on the price level. If you need a new heart valve, you're not going to get a hip replacement because it's cheaper. You're going to get the treatment you need, and do whatever you have to do to pay for it, regardless of the price.
I may have heard of heart valves being compared to apples before, but I can't remember where. I have heard this straw man argument ad nauseum. It tries very unsuccessfully to mask the fact that we don't, for example, need to get an antibiotic every time we get sick. But we do because it only costs $15 and has no effect whatsoever on our specific next-year's premium. Incidentally, there are far more people who get cheap antibiotics when the don't need them than there are people who need heart valves replaced.
Reach Upward takes to task those who compare health insurance with automobile insurance. He's correct in stating that they are very different. But here's one way that people and cars are similar. Preventive maintenance works wonders in both cases. And thus, another behavior that should be rewarded or punished by health insurers: if you don't have your periodic health checkup, your premium goes up.
RU reminds us that a significant number of America's uninsured, for whatever reason, choose not to be insured. Government getting its finger in that pie has some interesting consequences.
Kiplinger's reported that
Individuals who are deemed able to pay for insurance but who opt not to buy it will be hit with an annual penalty equal to half the annual premium cost of a policy. That could amount to thousands of dollars. And companies with 11 or more workers that don't offer insurance to their employees will owe the state a per-employee fee of $295 a year to help offset costs.Government health insurance anyone? I know a lot of people think they would love it. Hillary Clinton is salivating over it. But not me. It doesn't make sense, because trying to force your heart to do the thinking for you never does.