Imagine a country where the government regularly checks the waistlines of citizens over age 40. Anyone deemed too fat would be required to undergo diet counseling. Those who fail to lose sufficient weight could face further "reeducation" and their communities subject to stiff fines.
Is this some nightmarish dystopia?
No, this is contemporary Japan.
The Japanese government argues that it must regulate citizens' lifestyles because it is paying their health costs. This highlights one of the greatly underappreciated dangers of "universal healthcare." Any government that attempts to guarantee healthcare must also control its costs. The inevitable next step will be to seek to control citizens' health and their behavior. Hence, Americans should beware that if we adopt universal healthcare, we also risk creating a "nanny state on steroids" antithetical to core American principles.
Other countries with universal healthcare are already restricting individual freedoms in the name of controlling health costs. For example, the British government has banned some television ads for eggs on the grounds that they were promoting an unhealthy lifestyle. This is a blatant infringement of egg sellers' rights to advertise their products...
Just as universal healthcare will further fuel the nanny state, the nanny state mind-set helps fuel the drive toward universal healthcare. Individuals aren't regarded as competent to decide how to manage their lives and their health.
If this is what you want, you can't regard yourself as someone who values the Constitution, American values, or personal liberty and responsiblity.
I agree in principle. Yet, isn't it valid that the current market of system in the U.S. does no better? When individuals, who are in the same pool as I, aren't "competent to decided how to manage their lives and their health," my premiums go up as well. There is as much controlling of costs and rationing of care in America's HMOs, PPOs, and HSAs (with catastrophic coverage) as there is in the Japanese, British, or Canadian systems.
ReplyDeleteHealth care is simply different from many other sectors to which we compare it. If my neighbor idiotically burns down his house, it shouldn't affect my premiums. But if his unhealthy eating habits lead to huge expenditures for his type-II diabetes, my premiums are going up. It's happened every year for the last six years with my HMO, and they are very open about the fact that some members of the pool are driving up costs for others.
So, what to do. I still see a expansion of FEHBP or the Wyden-Bennett plan as the best option, as they preserve choice and offer a blend of public and private care, much like the Swiss. I would also assert that many critics of health care reform weaken the discussion by not distinguishing between national health care and national health insurance. Additionally, few critics of European and Asian health care systems have lived under them and are often misinformed.
As I recall, public education is different from many other sectors as well and if your neighbor idiotically burns down his house it sure as heck should effect your premiums.
ReplyDeleteInsurance, at least in it's classic definition, is a *voluntary* socialization of risk. Remove the voluntary aspect of the transaction and it just becomes another entitlement. The crucial factor of individually weighing the risk of paying premiums against the reward of getting your claims paid by the entire premium-paying population is gone.
A further knock on the concept of single-payer in any one of its various guises is that the cost-containing element of competition is gone.
Since there's nowhere to take your business costs can go up far beyond the "customer" base's perception of fair value. The price of the product becomes less a factor of perceived value then a measure of political clout.
> Additionally, few critics of European and Asian health care systems have lived under them and are often misinformed.
As are the proponents of European and Asian health care systems, few of *them* having lived under those systems.
And of those who have lived under those systems, what makes their view sufficiently objective to claim some special credibility? I knew a woman who lived in the Soviet Union under Stalin and she thought things had gone distinctly downhill since he died.
Allen,
ReplyDeleteI'm not sure why my neighbor's action should affect my premium, except for, as you noted, the socialization of risk. However, the claims in insurance other than health are not broad enough for that to happen. Though State Farm took a massive hit after Katrina and other disasters, my premiums are unchanged. However, medical claims are so numerous as to guarantee that effect. Many will never file house or auto claims, whereas everyone will regularly file health claims - that's the main problem. An office visit doesn't required coverage for most people, while an emergency room visit or cancer does; yet both are covered, and that's a huge mistake.
Single-payer doesn't necessarily eliminate competition if it's modeled on the FEHBP or systems like the Swiss. The free market bids to a single pool, and people choose their degree of coverage. Yet, the benefit from the socialization of risk help individuals negotiate the best prices.
You are right about many proponents of single-payer also having no experience, though for me that's not true, having lived in Taiwan for five years. I would argue that those with experience are definitely more credible - for the woman who lived under Stalin, her argument may very well be true. Having known and talked to residents of East Germany before 1989, the same was true, and life in a free market became much worse for them. The same is true for millions of peasants in China. As I've learned from many people, being poor but covered by the state system in Canada or Britain is far preferable to being poor and not covered, and unable to secure coverage in the U.S. Perspective is important, and that's why public policy decisions should be made with either dual experience (not easy to find) or wearing the veil of ignorance, which is not easy for many to do, stepping outside their own biases.
By the way, in terms of the public (or government-funded) education issue, you may enjoy checking out some comments on Malcolm Kirkpatrick's blog at www.freeharriettubman.blogspot.com. He provided some interesting and detailed examples to the question I had asked you about where non-government systems exist and succeed. I have always been intrigued by the idea of limiting the one-size-fits-all compulsory system and expanding the options. The state of New Hampshire is experimenting with some ideas proposed by the study "Tough Choices, Tough Times," and you might also enjoy reading about that.
When I was growing up, we had "emergency room insurance" only--and my dad was a union man! If we needed to go to our family doctor, we did, and we paid for it. We didn't go often! But when I needed stitches, the insurance was there.
ReplyDeleteThe comparison to car insurance is apt. You have insurance in case your car gets damaged, not for when you need an oil change.
I'm all for health clinics in Wal*Mart, "emergency room"-type insurance, et. al.
Oh, and keep the government completely out of it.
I agree again, in principle, with the emphasis on health clinics, express care. However, the Health Care Bureau of the Attorney General of Illinois was recently quite helpful in mediating and resolving a billing dispute I had with an express care clinic and doctor's management company that was, in all honesty, screwing me because they normally just bill the insurance companies who pay without questioning the deceptive billing practice. Because my insurance didn't cover the cost, I was faced with an outrageous medical bill for basic care. When the attorney general looked into it, the company immediately voided the balance.
ReplyDeleteFar too often the government are the guys in the white hats, and we shouldn't blame them more than their due.
Prevention of fraud and consumer protection are appropriate roles of state government.
ReplyDelete