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

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.


  1. Frank,

    Thank you. It is important to point out that when those who are against socialist health care complain about its likely effects we aren't absolving the current system of its numerous ills. We do need changes in the way health care is administered in our country. The current system is broken...but turning it over to our nation's most inefficient and corrupt administrative body possible (the United States Government) isn't an acceptable option.

  2. 60% of all health insurance is now provided by the government -- to children (CHIP), the poor (Medicaid), the elderly (Medicare), military veterans (VA) and government employees and contractors. They are the most efficient plans around. But they are far from perfect -- prompting many to use the private sector to purchase supplemental insurance. They have been prevented by politicians from using their clout to negotiate lower fees and to take advantage of economies of scale.

    Indeed, the only people who are not eligible for a government sponsored plan are those who are employed in the private sector and pay for everyone else. I suppose it is ironic that the person who pays the bill is the only person not invited to dinner. I will never understand why small business owners, the most adversely effected by the current system continue to be the greatest opponents. They have hurt no one but themselves -- and indirectly the rest of the community that suffers the higher costs when they can't pay and the resultant bankruptcies.

    It is time to recognize the marketplace cannot provide all of the answers about how to finance health care. Health care is not a commodity. You cannot negotiate the price of the ambulance ride if you are not cognizant. Indeed, you cannot negotiate the price even when you are fully aware and know what the treatment options are and their cost -- I know, I have tried. The doctor insisted that it wouldn't cost as much as I knew it would, so I consented to treatment. The hospital insisted that the doctor had no knowledge and no authority to negotiate price and charged me anyway. The small claims court upheld the hospital's claim.

    Commodities respond to supply and demand. No one ever got an appendectomy because they were on sale this week. No one chooses to start chemotherapy who does not have cancer.

    While I am not generally a fan of government run health care providers and facilities, I must say that I have had far superior service for immunizations from the Salt Lake County Health Department than from any private provider. Indeed, I wish they would go back to delivery of flu vaccines in their clinic rather than the mass clinics of recent years. When they did it in office, I could update all immunizations at once.

    We can come up with an American solution to universal health care that is not single payer or single provider, but utilizes the market where it makes sense. It strikes me that the first thing is to require private insurers who sale to the public sector to include any resident in the covered jurisdiction in the pool of insured at the public rate if a person or business wishes to buy in. I suspect that this simple step would take care of most of the current hard cases.

  3. I am skipped right over my comment about how we are paying for the uninsured one way or another.

    Here is the problem with your entire premise when it comes to the uninsured. Medical costs are the number one cause of bankruptcy, when a person receives medical care and then defaults on paying those costs then what do you think happens? Does the hospital just eat the cost? No way! They pass that cost onto the rest of us in higher costs.

    We are paying for the uninsured one way or another and somehow Republicans can't get that through their heads.

    Except here is the big catch, if the uninsured would of had basic health coverage to begin with then the wouldn't wait to get treatment and the medical issue would have been caught much sooner resulting in lower cost for treatment.

    This is what happens, the uninsured wait until the medical issue becomes so serious that they end up going to the emergency room where treatment is required by law (probably some of the regulation you complain about, just let the body pile up at the door, I am sure that is what Jesus would have done), the treatment costs so much more and also there is more of a chance that the hospital will never recover the full cost. But those costs don't just disappear, they are passed onto the rest of us.

    And you know a post is really going to be something meaningful when it starts off with a picture of hitler and stalin. I find that Republicans just insert the word socialism as need to justify why are healthcare system isn't working in this country. Good to see you have dropped that even a notch lower.

  4. Todd,

    You make a good suggestion about ways to improve insurance coverage. I agree. But I don't agree that since 60% of all insurance is provided by government that we should just insure us all. Government is the problem that has made it "necessary" for government to masquerade as the "solution".


    You're right. We are paying for the uninsured one way or another. It is a huge problem. But HOW would making government be the final arbiter of health care solve the problem when government IS the problem?

    My point for illustrating the post with pictures if Hitler and Stalin is to show what we can become if we allow government to take control of every facet of our lives. Socialism IS the reason that health care sucks here. Didn't you see my point about China, Cuba, Canada, and the Soviet Union? We used to have good health care. But now we're becoming just like everyone else with substandard health services. (It is also important to mention that government-caused inflation and ambulance-chasing lawyers have contributed significantly to the problem as well. But those topics would take two separate articles to discuss. Stay tuned.)

  5. Frank, have you ever been to a hospital in Canada? Or even a hospital in China, Cuba, or the Soviet Union? I would really like to see some statistics to prove the difference in care rather than just annecdotal evidence, he said, she said, I read it in the paper, my cousins cousin said health care in canada sucks. I do agree that you shouldn't be forced to have health insurance, but I think that insurance should be provided to those who don't have any.

  6. Do I have to have been there to know what it's like? I have read "Against All Hope" by Armando Valladares to know what life was like for him in the Cuban "health care" system. I have read Aleksandr Solzhenitysn's "Gulag Archipelago" to know what health care was like in the Soviet Union. The travesty of Canada health care is in the news all the time. Okay, can I take a mulligan on China? I haven't read anything specifically about that, but how difficult is it to make a rational conclusion based on other evidence that when government control results in a substandard product in several places that it will an another?

  7. "If the uninsured would of had basic health coverage to begin with then the wouldn't wait to get treatment and the medical issue would have been caught much sooner resulting in lower cost for treatment."

    That's a lofty assumption Marshall. It sounds good on paper, but in real life, is it true? Would they go get treatment earlier? Some would I'm sure, but let's get some hard data to back that up. How much of their emergency care would still be left to emergency care even if they were insured?

  8. I think the Democrats need to back single-payer Medicare-style health care for every American. The current system has higher administrative costs and delivers less care.

    The insurance companies, HMOs and other private entities spend most of their effort trying to externalize costs and internalize profits. It's a big shell game.

    Single-payer = cheaper and better! Put that on a bumper sticker.

  9. Todd wrote, "It strikes me that the first thing is to require private insurers who sale to the public sector to include any resident in the covered jurisdiction in the pool of insured at the public rate if a person or business wishes to buy in."

    That is an interesting suggestion. Of course it would increase rates, but I'm surprised I haven't heard this suggestion more frequently. I'd like to hear the pros and cons fleshed out a bit.

  10. I think Todd's suggestion is the basis for a fair plan. I would prefer, though, to allow the insurer to charge extra for high-risk behaviors such as those I have listed in the main post.

  11. The travesty of the canadian health care system reported in the news? But isn't the news just liberal lies and propaganda? How convienent when it agrees with your arguement, but how ripe with lies when it doesn't....

  12. Ryan,

    Yes. There are some excellent canadian news sources that talk about the travesty of the canadian health care system.

    Would you care to broaden your attack on me?

  13. You have a lot of good excuses for not fixing the health care crisis. My Canadian friends are all quite happy with their health care... Perhaps there are problems, but I'd prefer those problems to the ones we currently have.

    Also, you said, "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."

    I'd like to change that to, "As it now stands, people are incented (is that a word?) by their health insurance to not go to the hospital or doctor unless they are actually dying, and maybe not even then."

    As a mother, I have sat with my injured child wondering if he was hurt badly enough to go to the doctor, and wondering if we did go, how would we pay for it. No one should have to do that.

  14. Fear keeps us from fixing our health care system in the US and is the irrational basis for opposing government intervention. We do not object as MM points out in 'SiCKO' that the government manages our books in the libraries, pays our fire fighters, the police, and our teachers. Why not let them develop a national health care plan along the lines of our neighbors to the north. As Allie observed, everyone Candaian I have talked with loves their system and laughs at ours. MM observes we are just ahead of Slovenia with our health care system, 36th in the world. Go see the movie, read about Obama's plan and Dennis Kucinich's. Forget Hillary.

  15. Allie,

    Sorry if incented is not a word. I was referring to the health insurance system that "incents" or incentivizes people to go to the hospital at the slightest provocation. Under a government payer system it would either get worse, or we would slowly have fewer health care options as there are becoming in Canada.

    There are clearly problems with our health care system--chiefly the pharmaceutical companies and the congress people that are in bed with them. But Canada and Mexico are able to take advantage of our research and development by producing for much cheaper the drugs that it took a lot more money for the US to invent. So if you want to wait a while, and then get a drug whose patent was infringed by canada, then the system is pretty good.

  16. I knew what you meant, and I really didn't mean to criticize, I just wondered if that was a word (because I didn't know).

  17. Sorry.

    I just like the way "incent" sounds, even though it's not in the dictionary.

    I do try to appreciate the magnitude of the problems with US health care. It's definitely got huge problems, but I think most of them are government caused.

    We should, as a society, be able to help our fellow men better than we do, but often government gets in the way.

  18. Frank,

    Sorry, let me clear that up, I make that as a broad generalization.

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