What Vinehout's story really illustrates

Over the weekend, I noticed a piece on Sen. Kathleen Vinehout's health insurance woes, offered as an illustration of what is wrong with our health care system. Perhaps it is, but my first reaction to the piece was to wonder why no one asked the Senator the simplest of questions.

Why were you unable to pay for health insurance when you were able to contribute almost $9000.00 to your own Senate campaign?

Here's the story.

Apparently, Vinehout and her husband are a pair of professionals who, at some point in their late youth or early middle age, decided that farm living was the life for them. It seems that some unspecified event in 2005 caused them to lose their health insurance or to decide to stop paying for the insurance they had. Just what that was - perhaps a decision by Mrs. Vinehout to go into politics fulltime - is left unstated.

We are also not really told why they decided not to pay for insurance. It was to "pay farm expenses" but what does that mean? Was it a choice between health insurance or groceries? Insurance or losing the farm? Based on the article, we don't know.

What we do know is that, although they saved something in the neighborhood of $23,000 in premiums over the 23 months that they went uninsured, they didn't quite make it unscathed. Shortly before Sen. Vinehout won election to the senate and its Cadillac health care, their son required an emergency appendectomy which wound up costing them $10,000. They say they had to borrow to pay the bill.

On his show this morning, Charlie Sykes apparently spent some time emphasizing the fact that Sen. Vinehout and her husband made a choice and so they did. But what kind of choice?

These are not unimportant questions if Vinehout's "tragedy" is supposed to be instructive on our health care woes. This is because we don't have an "accessibility problem," although do have some accessibility problems. If you don't take the time to understand them and how they are distinct, preferring instead to detour off into babble about how health care is a right and should be '"free," you aren't going to get the diagnosis right. And you'll cobb up the cure.

While we hear about the uninsured, there are many reasons why people are uninsured. Some are effectively uninsurable due to pre-existing health problems. That presents one problem set. Apparently, this wasn't the case with Sen. Vinehout's family. It certainly wasn't for her son.

Other people can't afford insurance. While we are supposed to conclude this was the case here, that is not clear. In fact it seems like it almost certainly wasn't. Apparently the family had the capacity to borrow to cover the uninsured costs of their son's surgery. Couldn't they have borrowed to cover farm expenses until the crops came in?

Even more to the point, it appears that Kathleen Vinehout contributed almost $ 8000.00 to her own campaign. Her husband, Douglas Kane, threw in another $1000.00. That money would have covered much of the premiums that they chose not to pay (remember that, as self-employed farmers, they could pay them with pre-tax dollars, while political contributions are after tax) and it would have covered about all of young Nathan's surgery.

This brings us to where Senator Vinehout's family seems to belong. Another group of people have no insurance because they choose to gamble on their health. Most frequently, this is young people (for whom it may be an arguably rational choice) but it can also be older people who don't want to make a difficult choice to provide for their health as opposed to spending the premium money on some other (often worthy) thing or doing something else that will cause them to forfeit their insurance. I may think it is crazy for a 49 year old with a kid to decide to go naked, but it does happen.

It looks like that is, at least in part, what happened here. I am all for middle-aged people following the dream - be it politics or keeping the farm- before it's too late. Heck, I'm in the process of doing it myself in a less dramatic and more conservative way. But the idea that the rest of us should pay for it carries a bit less sympathy and may suggest different policies than the story of someone who just can't buy or afford insurance.

This is not to say that the Kane/Vinehouts' choice, even if it was a bad one (although it looks like they came out dollars ahead), is uninteresting from a policy perspective. There is a "free rider" problem here in that we aren't going to let people (or their children) die because they made imprudent decisions. (Little Nathan was going to get that appendectomy no matter what.)

Sure, I'm speculating on some of this, but the article leaves me with no choice. In that sense, the reporter becomes emblematic of our health care debate. If there is a heartrending story to tell (and this is not much of one - nothing bad happened and no one was ever in danger), we ignore all the tough questions.

We do it on policy too. Universal health care is not free. Universal is not unlimited. People and businesses will react to the incentives and costs that reform creates and this, too, will have an impact on real people and their health. Compassion is an necessary part of the health care debate, but it is not sufficient to end the debate. It resolves little of interest.