September 04, 2009
My health care rant

An old high school friend, who has had many health problems, and who favors socialized medicine (of some kind) asks me what I would do about health care. Just off the top of my head and without much deep thought here's what I wrote:

Of course I would love to see no government involvement in health care or insurance at all, but government completely dominates almost everything about health care (as in finance). The system we have is based on the rules and incentives created by government. I honestly don't know what health care would look like without the government being involved. And given this starting place, it is all but impossible to disentangle the government's tentacles from the system.

But as far as logical first steps for policy: (1) end the tax advantage for obtaining health insurance from your employer. We HAVE to decouple health insurance from employment. Either allow individuals to deduct health costs or end the employer tax deduction. (2) End insurance policy mandates (e.g., mental health parity and the like) so people can buy insurance plans to fit their needs (3) Dramatically loosen (I would eliminate) medical licensing rules so that nurses and other health care pros can compete with doctors. (4) Drop prescription requirements for all drugs so we can get drugs without doctor approval.

It would be vastly better to handle most health care expenses out of pocket like we do everything else in life with insurance only used for catastrophic events. Medical savings accounts would help here perhaps. Insurance markets work well for fire, life, serious car accidents, etc. and can work for health care too but we can't insure day to day costs (well we can, but it is dumb to do so).

Alas, I expect we will always have some uninsured and some who have trouble paying for health care no matter what we do. Some people will die and suffer for lack of care or money. I know this bothers you. I don't like this myself but I accept that we live in a world of scarcity and that we will not have everything in life we want no matter how rich "we" become. I see health care as no more of a "right" than I do food or anything else. We can socialize medicine as you wish, but it will not end hardship or injustice. At best, socialized medicine will shift the margins of suffering to other areas (such as reducing medical innovation and economic growth in general).

Also I expect health care will continue to be very very expensive no matter what. If we want to drop a lot of money on wasteful and ineffective end-of-life procedures, which is the big problem, and we're spending our own money, then that's what we're going to do.

Posted by Robert Lawson at 04:15 PM in Economics

The statesman who should attempt to direct private people in what manner they ought to employ their capitals would not only load himself with a most unnecessary attention, but assume an authority which could safely be trusted, not only to no single person, but to no council or senate whatever, and which would nowhere be so dangerous as in the hands of a man who had folly and presumption enough to fancy himself fit to exercise it. -Adam Smith

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