Tuesday, December 1, 2009

On Mandatory Health Insurance

I am on record in this blog as being in favor of making the possession of a minimum level of health insurance mandatory. This is not a view widely shared in the conservative policy community, and it is to some extent, in opposition to other views I hold about the relationship of the government to the governed. Therefore, I feel the need to explain the view.

First of all--in a perfect world, I would not advocate mandatory health insurance. If a citizen wishes to roll the dice with financial ruin, well, that's their business. But alas, this is not the world in which we live.

We live in a world in which we find it abhorrent to think that someone would be refused emergency care simply because they do not possess the resources to pay for it. This is a price we pay for being a civilized society. Yet the costs associated with the care of those who cannot pay for their care must be borne by the remainder of those paying into the system. Put another way, hospitals must spread the cost of emergency treatment of the uninsured around to the rest of its paying customers.

Were we as a society to simply agree to let uninsured people die in the event of emergencies, there would be less of a need for mandatory insurance. But our compassion creates a case for it.

The second contributor to my sense that mandatory health insurance is necessary here is our (also) societal disdain for the concept of denying people insurance coverage for pre-existing conditions. Putting aside for the moment that the entire insurance industry rides on the concept of predicting and pooling risk--and that requiring coverage of pre-existing conditions isn't insurance at all but a new brand of entitlement--there seems to be a growing sense in this country of the injustice of people being denied insurance on the basis of a known malady. Why there isn't a recognition that this is a fundamental threat to the stability of the insurance industry is beyond me, but I digress. This is the world in which I live. As long as our society continues to move in the direction of requiring insurance companies to provide coverage to those with pre-existing conditions (a bad and expensive bet for them), there must be a concomitant deepening of the risk pool through additional policies sold to healthy people--i.e young, healthy people who today choose not to buy insurance because they are--young and healthy. Because it is probably not in their economic interests to buy such a policy, such people must be compelled to buy them.

As a minor libertarian, I am of course, aghast at my own thinking on this subject. But more than a libertarian, I am a policy pragmatist. And on this front, the long march of history tells me that the longer we hold off on reforming the present healthcare system in meaningful ways that address the uninsured AND costs, the more likely we will be to move to a single-payer government run system. Give up our societal inclination to treat the uninsured and cover the already sick--and there will be no need for mandatory insurance. I just don't see that happening.

12 comments:

  1. I agree. I detest the idea of government making me buy anything but it's time to look at the lesser of two (or more) evils. I think the Dutch system is something I and my fellow conservative/libertarians could live with. Here's a good outline of their system.
    http://pajamasmedia.com/blog/in-the-netherlands-a-third-way-on-health-care-that-works/

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  2. That's a reasonable position, but IMO it's better to oppose mandatory coverage of preexisting conditions. I think "health insurance" should be insurance, not an agent who is paid to pay on a patient's behalf.

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  3. CW - Well-thought, well-articulated. I do not find personal bankruptcy (itself a government sponsored redistribution of wealth) an inhumane price to pay for one's life, but then I'm a cold-hearted conservative. There ought to be a price one pays for having highly-trained professionals extend his or her life beyond that which his or her current physical condition would otherwise dictate. If we can get people to pay, up front, like most Americans, then I suppose that is the only condition under which I would accept, very begrudgingly, having citizen proprietors of insurance required to cover pre-existing conditions. But those conditions ought to also cost more than you and I pay.

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  4. Ghost of Halloween PastDecember 01, 2009

    Well said, CW. I don't object to paying my part into the pool for police & firefighters, schools, or to ensure that health care is available not just for me but for my community.

    I wish though that we were actually funding the health care industry with our contributions rather than building the coffers of an enormous financial services gambling machine as middleman.

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  5. It may not be just and it may not be fair but the "pre-existing" argument constantly harped on by the Dems is very powerful. We're going to get something, so we may as well strike the best deal we can. The thing about the pre-existing hurdle is, it need be jumped but once. If everyone has health insurance, and pays premiums, there are no more pre-existing conditions. I understand that government mandated insurance is freedom lost. But we also lose when hospitals are shut down due to freeloaders. We lose when we pay 10 bucks for two tylenol to subsidize freeloaders.
    I indicated earlier that I like the Dutch system, but there are pitfalls. If the population gets too old or you have too many non-payers (welfare scum, illegals etc.) it can crash and burn like any other business. But it gives us choice and efficiency and flexibility at a reasonable cost. And we could do away with the Byzantine rules and regulations of medicare and medicaid and the associated fraud and abuse. Everybody would have private health insurance, although regulated by government (what else is new?) it would not be run by government.

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  6. If we are to go to a government sponsored health insurance program, it should apply to "ALL" citizens of the United States of America. In the interest of parity and cost reduction, all government workers and military both active and retired should be required to be participants in this program with a 5% discount in recognition of their service to the country.

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  7. "government workers"..."5% discount in recognition of their service to the country".
    Are you friggin' crazy? Our beloved government workers will steal 5% before their first morning break.
    If I die and go to Heaven I will be a human resource officer in charge of firing the living hell out of every parasitic mindless bureaucrat I can get my hands on.

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  8. No GHP--you'd rather fund the coffers of an enormous cosmically inefficient provider of services middleman--a.k.a the US Government...

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  9. GHD,
    You fail to notice that it has been the very government workers within the bureaucracies that you demean who have helped keep our country running and safe dispite the efforts of some politicians who have never seen a dollar they would not spend to buy a vote or many CEOs who would sell their mother for an improved profit.

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  10. Ok bureaucrats are people too, I concede the point. But will you agree that by it's very nature bureaucracies are self serving and inefficient.
    I refer you to one of the Austrians (no not him who's name must not be spoken). A sane one.
    http://mises.org/etexts/mises/bureaucracy.asp

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  11. WHOSE, WHOSE! My spelling and grammar are getting worse, must be that old-timers thing.

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