David R. Henderson  

More on Callahan

The Real Health Care Debate... Keynesians vs. Rogoffians...

Arnold called for a real health care debate between him and Daniel Callahan and quoted from his book. Actually, some of that debate has already happened in my review of Callahan's book. Here's what I wrote on one of the issues Arnold addressed, namely his judgment about which procedures should be covered. After quoting Callahan, I wrote:

On some of these coverages, Callahan is right for the wrong reason. He seems to make it a moral issue: some things "should be" covered and others "should not be." But really, what is wrong with insurers covering these things if people are willing to pay for them with non-tax advantaged dollars? I predict that some of these coverages would go away if the government did not give preferential treatment, under the U.S. tax code, to employer-provided health insurance and if governments did not require coverages such as mental health. But because Callahan seems unwilling to take yes for an answer, he never draws on his allies in the health economics literature whose analyses would buttress some of his point.

One thing that doesn't come across in Arnold's post is just how extreme Callahan is in his willingness to prevent old people from using their own money to pay for their own health care. If you want to see just how extreme, check out my review or at least this graf:

That leads to Callahan's third option, which he seems to favor. He would have the health care system emphasize "health promotion and disease prevention" (he calls this "the carrot") and have "fewer expensive technologies with tougher eligibility standards for their use" (he calls this "the stick"). The problem here, he writes, is that we "will continue to find clever technological ways to keep people alive when they finally get sick." Oh, the horror! Solving this "problem" without rationing,he writes, "can best be done by not having the technology readily available in the first place." How would he enforce this? A few pages later he advocates forbidding certain "marginal" benefits, which he admits could be life-saving, to be covered -- not only by Medicare, but also by private insurance. Again, to prevent private insurance from covering these benefits would require coercion.

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COMMENTS (2 to date)
John Goodman writes:

What's wrong with people making their own rationing decisions in a free market for medical care? I show how this could be done in a future society in my article in Liberty here: http://www.ncpa.org/pdfs/How-We-Got-Well-John-Goodman-Liberty-Magazine.pdf

I resorted to a fable about Future World because I find that people can think more clearly about future worlds than they can about the present world.

Colin K writes:

The problem I have with the 'We should help the young become old, but not the old become much older' is that it's a false dichotomy.

Aside from homicide and motorcycle accidents, the things which kill people in their 30s and 40s are pretty much the same things that kill them in their 60s and 70s: heart disease, cancer, etc. They are simply less likely to occur. The extreme efforts taken 20 years ago to save an elderly grandparent are the routine measures used today to save a young mother or child.

Reading Callahan, I am reminded of Whittaker Chambers's "To a gas chamber--go!" remark. Between this and the increasing acceptance of euthanasia as a cure for elderly depression (should we call this "euthennuisia?") in Europe, this atheist is finding himself increasingly aligned with the Roman Curia, all the more because I do not share their belief in what lies beyond this mortal coil.

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