People really like to ask me what I think about the health care reform proposals being thrown around nowadays. Believe me, it’s not like I don’t have an opinion. I do, however, want to make sure that my position is well thought out before I go spouting it all over the interwebs. (Don’t worry, y’all will be the first to know when I do.) It seems as though other people don’t have the same qualms about the spouting, unfortunately. From Lee Siegel at The Daily Beast:
“Most consequential of all, even if limitations were put on certain tests and procedures, the only people who would be affected by it would be the people who, presumably, are the ones meant to be rescued by the very plan that would be imposing those limitations. The financially strapped, in other words, who are the intended beneficiaries of the health care plan would be the only people forbidden access to expensive life-extending technology. The rich will always be able to afford it.
Once the technology to extend life has become available, you cannot restrict its availability. That would be like only letting some people use cell phones.”
I don’t know a whole lot about medicine, but I do know about economics and even a tad about this thing called common sense. So let me make my point clear: WE DO ONLY LET SOME PEOPLE USE CELL PHONES. IN FACT, WE LET EXACTLY THOSE PEOPLE WHO PAY FOR CELL PHONES USE CELL PHONES. (Yes, I know that cell phones can be free with a service plan, but work with me here.) In this way, prices do the job of “restricting availability” once a technology becomes available. If a particular medical test were not covered by insurance, it would in fact be exactly like the cell phone, save perhaps for the unlikely nature of the “get the test for free if you sign a service contract” pricing structure.
The focus of the debate, at least as a starting point, should be over whether health care should be treated in the same way as cell phones, but it’s hard to have a debate over the right questions when people can’t even analyze the comparisons properly. To aid the discussion, I will throw out some values questions that in a reasonable world need to be answered before an appropriate plan can be developed:
- Are we deciding as a nation that everyone *should* have access to health insurance? (By this I mean the guaranteed ability to purchase an individual policy, not necessarily getting it for free. Even this would be a deviation from the current system.)
- Are we deciding as a nation that everyone *should* have affordable health insurance? (By this I mean that prices would be set such that health insurance prices would not be out of reach for any households. Given that healthcare is expensive, this is going to require some sort of subsidy.)
- Are we deciding as a nation that everyone *needs* to have health insurance? (This is not necessarily a question of paternalism. If emergency rooms could turn patients away, this would be a very different question. The fact that emergency care is not restricted to paying customers means that health care at least partly takes on the properties of a common resource or common good rather than a normal private good like oranges, cell phones, etc. Free markets generally only function well for private goods, so there is a potential case for regulation to be made.)
- Are we deciding that the government is going to organize the paying for health insurance? (Note that this does not follow from the above question- for example, Massachusetts requires its residents to purchase health insurance but doesn’t organize the funding of the program via taxes, at least not on a universal basis.) Note also here that there is a sub-question of whether certain groups (eg. children) need to have health insurance in order to guarantee that their best interests are being protected.
- Are we deciding that government is going to administer the provision of health insurance and/or health care? (This is also different from the above, since it is possible for something to be government-funded without being government-run.)
- For each of the above questions, what level of health insurance should be provided? Is the entitlement to basic services or an all-inclusive package? Should there be a guaranteed option to purchase more high-end/experimental/lifestyle-driven coverage?
These aren’t easy questions, and there is certainly not a “right” answer to any of them. The point is that these questions get even harder to answer when they are mixed in with the implementation debate.
Since this site is supposed to be at least marginally humorous, I will leave you with a couple of cartoons for the occasion, courtesy of The Cartoonist Group: