It should be illegal to live in the US without health insurance (or we need universal health care)
America is very good at innovating for older-, richer- people diseases. Our health care system produces many innovations that poorer countries (as well as more socialistic countries) would consider luxuries. We're not as concerned with producing a higher quantity of low-cost drugs to cure malaria or to vaccinate against tetanus. We're not as concerned with creating lower-cost higher-efficiency diagnostic methods and materials and machinery and hospital administration--we're more concerned with curing cancer, degenerative diseases, muscular distrophies, and finding the latest cures for the most difficult-to-treat diseases. To poorer countries with endemic malaria and low vaccination rates, curing cancer is a luxury. As a richer country, we have an appetite for such "luxury diseases" just as richer folks have an appetite for caviar. Trimming down the system might promote greater efficiency in some areas while curbing the appetite for more luxury diseases (and thereby curbing the funding and incentive for cures for these luxury diseases), which is a tough but necessary trade-off for us to face.
I am self-employed and get health care for ~ $90/month, which isn't a big deal at all, even after having Lyme Disease, asthma, IV antibiotics shoved into my heart, a heart monitor, several EKGs, etc, etc, all in my medical history, I still managed to get insurance after the third provider I applied to. I also don't substitute health insurance money for non-necessity goods. Even when income used to be tighter, I didn't go out and buy stereo systems instead of paying my health insurance bills.
Somehow, though, people in this country buy iPods instead of health insurance. Some other people choose to live in areas that are consistently hit by hurricanes. Both are risky situations, but the government only bails people out on the latter. What role does the government have in protecting us from ourselves? I think that's the most interesting question. People tend not to be risk-averse when they should be, some are biologically-disposed to risky behavior and any notion of "will" on their part is really quite questionable. Should the government keep people from being risky and protect them from themselves? Yes, they should: the government should (1) provide us with the means to obtain affordable health insurance and make it mandatory (otherwise you don't get to live here, just as you don't get to drive in MN if you don't have auto insurance) OR (2) they should provide health care to us for "free" out of our tax money. Suicide is illegal. Alcohol and nicotine are regulated and drugs are illegal. Speeding comes with heavy fines. This country functions under tenets that believe in protecting its citizens from themselves...except in the case of health care. All highly-risky behavior is illegal in this country except for the behavior of not obtaining health insurance.
The military is a public good which is there to protect us from other people, and every single individual is charged for it since we'd otherwise encounter the free rider problem. So then why isn't protecting us from ourselves equally a public good? It should be, and should be provided as such. The government should also make it illegal to live in New Orleans without proper hurricane/flood insurance, and apply this similarly to other high-weather-risk areas around the country, with a phase-in period and ass-booting-out-of-the-city thereafter. On the subject of free riders and the problem of public goods, if public health care were provided by the government, all cigarette smokers should pay the government a monthly fee, all ambulance visits to the hospital due to intoxication should come with a major fine, and all polluting factories should pay a monthly fee towards health care costs. The alternative to the New Orleans example is to let people fend for themselves the next time a hurricane hits (which will be soon because of global climate change): this is a shitty alternative and morally-corrupt given the choice of the aforementioned alternative. Letting people live in New Orleans and bailing them out with taxpayer money is not good policy. I'd apply similar logic to health care, and we certainly wouldn't let our citizens fend for themselves if we were to be attacked by another country.
The only way out is through increased efficiency in the system: we need to start pretending we're India, with an exploding population that we need to figure out how to treat with not much money, as efficiently as possible. Research institutions are contributing to cures for luxury diseases faster than Wikipedia is growing, and millions of dollars are being poured into these institutions so that they can do so, and millions of dollars of tuition money are being earned by the research institutions who make the most (quantitative) progress in this domain. Progress is always complicated and not necessarily about more, more, moar. Our institutions need greater incentives to spur knowledge creation that involves efficiency in diagnosis and treatment. Efficiency doesn't bring in the top students, efficiency doesn't necessarily even bring Nobel Peace Prizes, but our debt-ridden, maxed-out-credit-cards, no-savings country needs a change of culture that points towards sustainability and efficiency. We need to understand sustainability and efficiency. We need to learn to want sustainability and efficiency. Our current health care system is fundamentally, perversely designed to continue its vicious cycle: it's only going to get worse if we don't change, change hard, and change quickly.
It's hard to look a politician in the eye and tell him that his mother with Lou Gehrig's Disease might need to die sooner than later (with the best treatment available so far to guide her through it) so that we can all live a better life as a nation, shifting our focus towards what we already have and can do now and improving its efficiency versus what we could possibly do in the future and in what quantity. It's hard to make a university student care about such things when her friend's mom is dying of cancer now, and it's hard for me to think about myself living in a world that was still ignorant of treatment and diagnosis of Lyme Disease several years ago. While the luxury-efficiency trade-off may be difficult for us it is by no means mutually exclusive with quantitative progress in medicine: we can still make progress in medicine but we need to start making it sustainable, and we need to start now.
This post was inspired by a post of queueball 's.
I am self-employed and get health care for ~ $90/month, which isn't a big deal at all, even after having Lyme Disease, asthma, IV antibiotics shoved into my heart, a heart monitor, several EKGs, etc, etc, all in my medical history, I still managed to get insurance after the third provider I applied to. I also don't substitute health insurance money for non-necessity goods. Even when income used to be tighter, I didn't go out and buy stereo systems instead of paying my health insurance bills.
Somehow, though, people in this country buy iPods instead of health insurance. Some other people choose to live in areas that are consistently hit by hurricanes. Both are risky situations, but the government only bails people out on the latter. What role does the government have in protecting us from ourselves? I think that's the most interesting question. People tend not to be risk-averse when they should be, some are biologically-disposed to risky behavior and any notion of "will" on their part is really quite questionable. Should the government keep people from being risky and protect them from themselves? Yes, they should: the government should (1) provide us with the means to obtain affordable health insurance and make it mandatory (otherwise you don't get to live here, just as you don't get to drive in MN if you don't have auto insurance) OR (2) they should provide health care to us for "free" out of our tax money. Suicide is illegal. Alcohol and nicotine are regulated and drugs are illegal. Speeding comes with heavy fines. This country functions under tenets that believe in protecting its citizens from themselves...except in the case of health care. All highly-risky behavior is illegal in this country except for the behavior of not obtaining health insurance.
The military is a public good which is there to protect us from other people, and every single individual is charged for it since we'd otherwise encounter the free rider problem. So then why isn't protecting us from ourselves equally a public good? It should be, and should be provided as such. The government should also make it illegal to live in New Orleans without proper hurricane/flood insurance, and apply this similarly to other high-weather-risk areas around the country, with a phase-in period and ass-booting-out-of-the-city thereafter. On the subject of free riders and the problem of public goods, if public health care were provided by the government, all cigarette smokers should pay the government a monthly fee, all ambulance visits to the hospital due to intoxication should come with a major fine, and all polluting factories should pay a monthly fee towards health care costs. The alternative to the New Orleans example is to let people fend for themselves the next time a hurricane hits (which will be soon because of global climate change): this is a shitty alternative and morally-corrupt given the choice of the aforementioned alternative. Letting people live in New Orleans and bailing them out with taxpayer money is not good policy. I'd apply similar logic to health care, and we certainly wouldn't let our citizens fend for themselves if we were to be attacked by another country.
The only way out is through increased efficiency in the system: we need to start pretending we're India, with an exploding population that we need to figure out how to treat with not much money, as efficiently as possible. Research institutions are contributing to cures for luxury diseases faster than Wikipedia is growing, and millions of dollars are being poured into these institutions so that they can do so, and millions of dollars of tuition money are being earned by the research institutions who make the most (quantitative) progress in this domain. Progress is always complicated and not necessarily about more, more, moar. Our institutions need greater incentives to spur knowledge creation that involves efficiency in diagnosis and treatment. Efficiency doesn't bring in the top students, efficiency doesn't necessarily even bring Nobel Peace Prizes, but our debt-ridden, maxed-out-credit-cards, no-savings country needs a change of culture that points towards sustainability and efficiency. We need to understand sustainability and efficiency. We need to learn to want sustainability and efficiency. Our current health care system is fundamentally, perversely designed to continue its vicious cycle: it's only going to get worse if we don't change, change hard, and change quickly.
It's hard to look a politician in the eye and tell him that his mother with Lou Gehrig's Disease might need to die sooner than later (with the best treatment available so far to guide her through it) so that we can all live a better life as a nation, shifting our focus towards what we already have and can do now and improving its efficiency versus what we could possibly do in the future and in what quantity. It's hard to make a university student care about such things when her friend's mom is dying of cancer now, and it's hard for me to think about myself living in a world that was still ignorant of treatment and diagnosis of Lyme Disease several years ago. While the luxury-efficiency trade-off may be difficult for us it is by no means mutually exclusive with quantitative progress in medicine: we can still make progress in medicine but we need to start making it sustainable, and we need to start now.
This post was inspired by a post of queueball 's.