Arnold Kling  

Universal Coverage? I say Ma-a-a-a-ah

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Farewell to Alms Watch... Dying in Vain...

Notwithstanding what I wrote here, I try to make a case the "universal coverage" is no panacea for health care. I write,


I would like to see the abolition of the tax break for company-provided health benefits as well as the tax break for Medical Savings Accounts. Company-provided health benefits ought to be included with personal income and taxed at the personal income rate. There should be no special benefits for savings accounts labeled "medical." (I think that all saving ought to be tax-free, but that's another topic.)

...Although I prefer real health insurance to insulation, I do not want to impose my preferences on others. All I ask is that we reform our tax code so that it is neutral.


On the issue of universal coverage, I say,

most of the people who are uninsured today are reasonably healthy. They just do not want to pay for their own health insurance. In my view, they ought to be allowed to make that choice, but they should face the consequences. If they require health care, the cost should not be shifted onto other people who have insurance.


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COMMENTS (17 to date)
Dan Weber writes:

Are the people without health insurance really making an active choice to not have it? Or is it simply too much bother, especially since the market has traditionally been tuned towards serving businesses, not individuals?

Floccina writes:

How about trying to get the government to use a stricter definition of the word insurance, making it fraud to call our low deductible prepaid health care plans insurance. Perhaps this would shock some people into electing for real health insurance.

Of course I think educating the people is the best hope. If we could get John Stossel to interview you and Robin Hanson on 20/20 it might make a difference.

Chuck writes:

Many countries provide fairly generous universal health care a lot cheaper per capita than the US provides non-universal coverage. So clearly universal health care is a panacea for the problem of some people without health insurance of any kind because they can not afford it.

As for health care costs rising faster than inflation, I think the true, fundamental "cure" one should look for is some sort of magical nation wide coming to terms with mortality. Good luck with that.

chuck writes:

And while we're talking about it, it seems to me that the only part of the US health care system that isn't "free market" is the it is "subsidized" in that it is exempt from income tax.

Other than that, the system is completely open market, no?

The fact that people consume too much medicine is not about the income tax free purchase of medicine, which makes it cheaper. People don't enjoy going to the doctor. People go to the doctor because they are ignorant about health care and fearful of death, illness, and discomfort. That's all built in to the for-profit health care industry in the US.

The US health care industry isn't broken, it's working great - growing by leaps and bounds year after year.

Why would an economist complain about this? People are just buying what they want.

Arnold Kling writes:

Chuck,
Medicaid and Medicare together account for close to half of U.S. health care spending. If you add in government employees and the tax subsidy for private employer-provided health insurance, about 60 percent of U.S. health care spending is funded by taxpayer money. Other than that, we have a free-market system. Um, except on the supply side.

Dan Weber writes:
Other than that, the system is completely open market, no?

Public hospitals need to take anyone who walks in the door. That propogates issues out to every other part of the health care system.

And you surely don't want the emergency room to check for your insurance card when you are in an auto accident that separates you from your wallet.

Lord writes:

Do not want to pay, or cannot afford to pay? Can afford to pay the average cost, or cannot afford to pay the actual cost? Arguing about a wealthy few seems a waste of energy.

Kimmitt writes:

I maintain that anyone who is against universal health care has never had to fight an HMO.

jurisnaturalist writes:

My wife and I went for a while without health insurance because it was too expensive (I'm in grad school, she's sugar mama) and we are both healthy.

But we now are insured, because we have been experiencing some health problems. Just goes to show that health insurance is really just a cost-diffusion tool.

Jody writes:

I maintain that anyone who is for universal health care has never had to fight a government bureaucrat.

You can quit an HMO (though difficult). Try backing out of Social Security.

Arnold Kling writes:

Universal health care is an HMO, brought to you by the same people who gave you the DMV and the TSA.

George writes:

Floccina wrote: Of course I think educating the people is the best hope.

So you think it's hopeless, then?

Lord writes:

And of course, medicare, and the military.

Kimmitt writes:

Universal care most certainly is not an HMO; it is a PPO at most. Separately, the government doesn't make its money from denying me services.

8 writes:

The government won't make money denying you care. They'll deny you care for the common good.

Dezakin writes:

These neoliberal rants against universal health care allways strike me as ivory tower nonsensical slavish adhesion to ideology flying in the face of common sense and actual evidence.

Unless you really dont care about whats best for society and are filthy rich. Then you get the best care avaliable. But having had friends put in $500,000 debt because the insurance was canceled in a bit of lost paperwork is just a tad off; What fun for the family finances.

This sort of nonsense is not good for society.

Floccina writes:

Kimmitt wrote:

"the government doesn't make its money from denying me services"

IMO the biggest possible up side for Government provided health care is that it might deny more stuff than the insurance companies do. See the Rand Heath Insurance experiment or Robin Hanson's papers about it.

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