Thursday, August 16, 2007

More on health care

There were two interesting pieces in the Wall Street Journal editorial page yesterday relative to the issues posed by health care reform. The first has to do with the "cost savings" that are always claimed for single payer or otherwise highly centralized plans. I have marvelled at the earnest faith with which people state that a plan like Healthy Wisconsin will save billions of dollars while covering more people and paying for more treatments. They sound as if they are reciting a law of physics.

A column by Merrill Matthews points out that, at least with respect to the total cost, there is a circularity about this. Countries like Canada and England spend less than we do for health care because the government has decided that it is all that is going to be spent. The demand for health care is determined, not by those who would receive it, but by those who will pay for it.

Substituting political demand for consumer demand is a critical issue with respect to government provided health care. It may be that Healthy Wisconsin will limit health care spending to 15% of state GDP. But it would be pure happenstance if it turns out that this is the optimum level of health care. I'd rather see that determined from the bottom up than from the top down.

The idea that expensive things can be paid for through administrative savings may not be precisely the equivalent of faith healing, but its close.

The editorial board of the Journal also criticizes Gov. Schwarzeneggger's proposed plan for California in that it requires people to buy insurance. This, they say, is a violation of free market principles and so it is.

The problem is that in most areas in which the market operates we are willing to allow people to fail. If you borrowed more than you can repay, you lose your house.

It's less clear that we are willing to let someone die because they did not buy insurance. Because we won't do that, it may be necessary to compel people to invest in their health to avoid the need for the taxpayer to do so.

8 comments:

illusory tenant said...

[I]n most areas in which the market operates we are willing to allow people to fail. If you borrowed more than you can repay, you lose your house.

It's less clear that we are willing to let someone die because they did not buy insurance. Because we won't do that, it may be necessary to compel people to invest in their health to avoid the need for the taxpayer to do so.


I really, really hope this is satire.

Joe Cisewski said...

"[I]t may be necessary to compel people to invest in their health to avoid the need for the taxpayer to do so."

I am pleasantly suprised to see you advocating for a government mandate. I knew there was a moderate deep inside of you!

I will take this as you admitting that government is sometimes necessary and not always evil.

Joe Cisewski said...

That should be: "surprised"

Dad29 said...

Satire? Mandates?

Gracious.

When Gummint mandates insurance, only in-laws will survive.

Rick Esenberg said...

Joe

Don't piss me off before school starts. I prefer "eclectic."

Seriously, I'm not sure a mandate makes sense but there is a freerider problem that needs to be addressed if we are not willing (and we are not) to kick people off the bus. I don't think there's any satire in that.

Joe Cisewski said...

I'll buy eclectic, but that is what moderates say when they want to associate with one side or the other and distinguish themselves from their more rigid counterparts.

In any event, I'm glad to see your reluctance to throw momma from the train.

Anonymous said...

Shark, did your client "Marilyn" in LaCrosse invest to cover the costs of keeping her alive, per your case? Or is that going to require a second mortgage by her family? Or will the public pick it up?

Rick Esenberg said...

qizmqbzbMy client in that matter is not Marilyn but Wisconsin Right to Life. We sought to intervene to inform the court regarding the implications of changing the law to permit a third party to order that someone be starved and dehydrated to death when the person to be killed has 1)left no advance directive and 2) is not in a persistent vegetative state. The guardian dismissed the case this afternoon because they did not think they could win given Marilyn R.N.'s current medical condition. He may or may not renew his request.

I do not think that people ought to be killed - or allowed to die -because they can't afford care. In that, I am, I think, in the makority which is why I am afraid that some mandate to those who can afford to insure to do so may be unavoidable.

Joe understands my point as you and Illusory do not seem to, although he seeks to tease me for wandering off the ideological trail. Fair enough.