Health Care, A Unenviable Choice

Arnold Kling discusses health care and the fact that most of our political leaders are not dealing with the important issues of Medicare solvency and actual costs to consumers, but instead are spending too much time talking about 45 million Americans without insurance as victims.

Kling addresses the uninsured problem in a way that should be appealing to fiscal conservatives and people who prefer individual responsibility over nanny-statism:

However, if I could pick any policy approach I wanted for dealing with the uninsured, I would try to move toward universal availability of health insurance, not universal coverage. I would encourage states to offer health insurance to the uninsurable. That is, there are people with pre-existing conditions that lead them to be turned down by ordinary health insurance companies. Many states address this problem by setting up "high-risk pools" that provide subsidized coverage for the uninsurable. That seems to me to be a sensible approach.

On the other hand, most of the people who are uninsured today are reasonably healthy. They just do not want to pay for their own health insurance. In my view, they ought to be allowed to make that choice, but they should face the consequences. If they require health care, the cost should not be shifted onto other people who have insurance.

Just because health care is expensive does not mean that we need insurance to pay for it. You can get a loan to pay for a car. You can get a loan to pay for college tuition. If you don't want health insurance but you need health care, then you may need to take out a loan.

My objection to "universal coverage" is that it reinforces our cultural taboo against individuals paying for medical services. This cultural taboo about paying for medicine is what led me to draw a parallel between health insurance and prostitution insurance. If medical service providers, particularly hospitals, could become less paranoid about dealing with the uninsured, then I would consider doing without insurance myself. (formatting and links in original)

This jibes with my experience. Most uninsured Americans fall into one of three categories--the "uninsurable," the "young, healthy, greedy people," and the "working poor." Kling talks about the first two. The third are those working Americans whose employer does not or cannot afford to offer insurance coverage, would like to have coverage but can't afford it themselves. In this regard, there are options for most of these avaialble through buy-ins to Medicaid or other state run insurance pools. If no such pool exists, perhaps the states could be encouraged to create one.

Kling's proposals for the uninsured would allow political leaders to look beyond this relatively small group (soon to be dwarfed by the baby boomers) of victims and focus on real problems in health care.