Tuesday, January 13, 2009

The latest attack on universal health care...

Now that something like 70% of Americans have decided that they like the idea of universal health care and elected a president and congress that might take steps in that direction, the Christian Science Monitor has come out with a new and pernicious attack on the idea of universal health care. The idea is that because health care costs money, if you put the government in charge of health care, the government will engage in a new big-brother operation to make us live healthier lifestyles.

I don't know whether to laugh or cry.

Here are my reasons for wanting universal health care:
  • Tying health care to employment is economically inefficient. It creates an inappropriate incentive to stay in a job, and indeed it creates an inappropriate incentive for the creation of jobs that are economically inefficient, because your job is how you get your health insurance, and you have to have health insurance.
  • Similarly, tying health care to employment limits beneficial risk-taking. It increases the cost of trying a new business idea, and prevents older people, whose health care risks are higher, from pursuing new business ideas.
  • Widespread unavailability of health care is a serious public health problem. Ready access to health care prevents the spread of disease. People who argue that they shouldn't have to share the cost of a poor person's health care should ask themselves how willing they are to take antibiotics for a year if they have the misfortune to be exposed to antibiotic-resistant tuberculosis - a disease that exists in the world as a result of poor access to health care.
  • Unequal access to health care is expensive. We as a culture do not have the disregard for human suffering that would be required to absolutely refuse care to a person who needs it. But by making health care as expensive as it is here, what we do is to ensure that people who can't afford health care do not try to get it until it is a life-or-death issue. At this point a problem that could have been fixed very cheaply winds up being very expensive.
  • Much of the motivation for societal problems like excessive personal injury litigation, cronyism and nepotism, is health care insecurity. When you hurt me in a way that prevents me from being employed, I have to get as much as I can out of you because my future health care is at risk. If I am not very skilled, I want my buddy to get me a sinecure job because that way I will have health coverage.
  • One major cost in malpractice insurance, which itself drives up health costs, is the fact that once you have been hurt by a medical mistake, you need to recover your future medical costs. Even though mistakes are simply part of health practice, once a mistake has been made, the cost lands on the practitioner who made it, not on all practitioners as a whole. If you are assured of getting health care after a medical mistake, this substantially reduces the need for malpractice insurance - removing an entire level of inefficiency in the system.
  • There are lots of things that people like to do, and that are beneficial, that simply don't pay very well. These are societally valuable activities, but because we tie employment to health insurance, these jobs wind up going undone, because nobody can afford to do them - they don't come with health benefits. This is particularly a problem because one aspect of health care insecurity is that people have to plan their lives around it - they have to do things throughout their life that are optimized toward making sure that they have access to health care when they are older. This disproportionately punishes people whose ideal job is something that doesn't create a big retirement savings account.
A lot of what I'm talking about here are social justice issues that many libertarian and pro-market people would say are simply not their problem. Fortunately, the recent economic meltdown has given us some perspective. Much of the work that these free market people do is crap. It produces no value for anyone except the person doing it. It impoverishes the people in our society who actually do things of value, like growing crops, building things, teaching our children, writing books, making music, cooking our dinner, feeding us.

So now the Christian Science Monitor comes back with this nonsense idea that if we have universal health care, the government will crack down on fat people.   There are two problems with this.

The first is that the two examples they give of governments that have engaged in this activity are Japan and Britain.   These are poor examples.   Japan is such a different culture from ours that it hardly bears explaining.   The fact that the Japanese government can get away with doing something like this doesn't really say anything about whether or not we would allow it.

Less intuitive, but equally true, is that Britain is actually very culturally different than the U.S.   We think of them as being very similar to us because we speak roughly the same language.   That is not at all true.   Britain is a much more homogenous and conservative society than the U.S. (sorry, Nick!).   The British have accepted universal camera surveillance, something which I really don't think would fly in the U.S.   Britain does not have citizens - it has subjects.   We fought a war against Britain not that long ago.

I don't mean this to put down Japan or Britain - I've been to both countries and view them with a great deal of fondness.   But to argue that because the Japanese and British governments have done something, the U.S. government could do it is absurd.

The other side of this is that in fact there is precedent for government involvement in public health issues in the U.S.   The CSM article talks about this.   Our government's approach has been very different than the approach of the Japanese or British governments.   Our government has laws about food labeling.   These laws typically do not force businesses to do anything other than be open about what they are selling.   And they don't force citizens to do anything at all.   They simply give citizens the ability to make informed choices about what they should put in their body.   Our government trusts us to make the decision for ourselves.

The second example I would use is the recent tobacco litigation.   The model here was that there was a public health cost associated with tobacco consumption.   This is a real cost, that has already created an extra tax burden.  The legal theory was simply that the tobacco companies should shoulder that burden, not the citizens who pay the taxes.   So the idea here is to simply de-externalize a cost that the tobacco companies saw as external.   The key point here is that the government did not pass a law outlawing smoking, as the Christian Science Monitor suggests it might; rather, it addressed the problem in a way that did not take away anyone's freedom, but rather simply insisted that they pay the cost of that freedom.

Similarly, in many larger towns now there are smoking laws.   These laws do not say "you may not smoke."   Rather, they say "you may not impose your smoke on others."

So when the Christian Science Monitor spreads its fear, uncertainty and doubt about what universal health coverage might mean, let's get a little perspective here.   There is not going to be a law requiring you to lose weight.   More likely you will pay an extra $0.25 for your pint of Haagen Dasz.

Isn't that a price worth paying so that the people you love, and the people who make your wonderful lifestyle possible, can stop worrying about a health care catastrophe in their future?


Anonymous Patricia Lemon said...

I am shocked and dismayed that the Christian Science Monitor has set the basis for a new "John and Mary" publicity campaign like the one that sank the Clinton initiative and keft us where we are.

Your outline of the situation is the best I've seen to date. Thank you for taking the time to lay it out so clearly and persuasively. Maybe we can use it as as basis for supporting an Obama initiative.

Tuesday, January 13, 2009 3:56:00 PM  

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