Health Insurance Misdirection

I wonder the same question that [another commenter] asks: When the decisions are made about how to allocate our resources, will society take the so-called lifestyle choices into account?


When I say this, I’m not hoping it will happen. I’m fearing that we will attempt to do it and make an awful mess of it.


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Framing the question is important. At its roots this topic goes well beyond medical care and insurance. The same people who absolutely can’t afford insurance also have trouble paying their heating bills or buying nutritious food or any number of other necessities. This isn’t just a health care problem and a food problem and a heating oil problem — it’s a poverty problem.

(Yes, I know it’s not a simple matter of poverty causing all the other problems. There are feedback loops; as someone already mentioned, people who are sick a lot have trouble holding down a job.)

So Bush addressed the question in the terms in which it was asked rather than getting at the root of the problem. People complain that medical insurance costs too much, so he trots out a plan where some of the people who can already get insurance might find it a little more affordable.

Meanwhile, I am wondering if he has any thoughts about how to help the poor.

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Who will make the decisions? That’s what I want to know about any proposed plan. And I’ll give anyone else’s proposals just as much scrutiny as Bush’s.

It’s not enough for the new system to be different than the current one. It has to be better.

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I think [another commenter is] answering the right question with your suggestion of coupon books for medical care. As someone else mentioned, the fundamental problem of economics is allocation of resources. The idea here, as I understand it, is to make people aware of the actual cost of providing various kinds of care, to help them make better decisions.

But you know what? We already have coupons for health care. They’re called dollars. And as we’ve been discussing throughout this thread, the system isn’t working very well.

Superficially, the coupon books sound like an improvement. They couldn’t be used for anything besides health care, so people wouldn’t be faced with the choice of spending their money for other urgent needs instead of for health insurance and medical care. But if we actually tried this, I’m sure people would find ways to buy and sell the coupons, and we’d be back where we started.

So I think this is on the track of the right answer, but hasn’t gotten all the way there yet.

[Originally posted during 2008.]

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