David R. Henderson  

Unintended Consequences of De-Insuring Insurance

PRINT
Uber Wars Update... The Key to victory: Run agains...

Kevin Drum alerts us to some unintended consequences of a law that he advocates.

Over at Mother Jones, Kevin Drum has noticed that some health insurers are charging a huge co-insurance rate for HIV drugs. He writes:

If all your HIV drugs are expensive, then people with HIV will look for another plan. Technically, you're not discriminating against anyone with a pre-existing condition, but you're sure giving them a reason to shop around someplace else, aren't you?

At the moment, this practice appears to be confined to just a few insurers and a few classes of drugs. But if it catches on, it will prompt everyone to follow suit. After all, you can hardly afford to be the insurance company of choice for chronically sick people, can you? This is worth keeping an eye on.


Under ObamaCare, health insurers are no longer allowed to price for risk. (The one major exception is that insurance premiums for the elderly can be as much as 3 times as high as premiums for the young.) In other words, ObamaCare has taken the insurance out of health insurance. This is a set-up for what economists call "adverse selection." (I have written about adverse selection here, here, and here. Bryan Caplan has written about it here.) The standard way to avoid adverse selection is to price for risk. People with pre-existing conditions tend to be higher risk. So the obvious way to avoid adverse selection is to price higher to people with pre-existing conditions. This is no different, in principle, from charging higher auto insurance premiums to single young men than to middle-aged married women or charging higher life insurance premiums to men than to women.

So, if an insurance company is to do well, it will look for ways to come as close as possible to charging for risk. One way is to charge high co-insurance rates for HIV drugs. This isn't as good a method as charging directly for risk because the insurance company doesn't want to dissuade people who are low-risk for HIV but who want to be insured for it. The best the insurance company can do is lump those who already have HIV together with those who don't but who might get it. That's one of the problems with the ObamaCare law.

Kevin Drum nails it with his second-last statement quoted above:

After all, you can hardly afford to be the insurance company of choice for chronically sick people, can you?

Exactly. Which is why we should expect to see more of the practice that Kevin Drum decries. But I predict that none of this will cause Kevin Drum to reconsider his pre-existing view that pricing for pre-existing conditions should be illegal.

H/T to Tyler Cowen.


Comments and Sharing






COMMENTS (33 to date)
Bostonian writes:

The risk factors for getting AIDS are well known, and the male homosexuals who get AIDS should pay for their own AIDS drugs.

Greg G writes:

The risk factors for AIDS may be well known, but apparently not well known enough. They are not limited to male homosexuals.

David R. Henderson writes:

@Bostonian,
The risk factors for getting AIDS are well known, and the male homosexuals who get AIDS should pay for their own AIDS drugs.
I don’t know how you reach the conclusion that "the male homosexuals who get AIDS should pay for their own AIDS drugs.” By way of analogy, the risk factors for getting Type-2 diabetes are well known also, but I think that people who want to buy insurance for it should be able to do so and insurance companies should be able to sell it to them. What shouldn’t happen is that insurance companies not be allowed to price for this risk.

MikeDC writes:

But... we should admit that the current insurance regime is set up poorly to handle pre-existing condition issues.

Which is why lefties like Drum point to the problem and say we need a government takeover and libertarians like (most of us) bemoan that we're so bad at understanding insurance.

In this case though, it's evident that the market/regulatory apparatus is screwy. The whole "pre-existing condition" issue could be done away with if health insurers covered events (as with other insurers) rather than a stream of care.

That is, if I get HIV, my insurer at the time of coverage should be responsible for paying for my treatments regardless of whether I continue indefinitely with that insurer.

There are a few ways this could work (e.g. if I switch insurance, the old insurer could render a payment to the new insurer), and I'm always a little surprised that this sort of system hasn't been worked out. Has it been regulated into illegality?

------------

@ Bostonian,
What about the non-male and/or non-homosexuals who get AIDS? Would you be a jerk to everyone, or just to a group you dislike?

MikeDC writes:

But... we should admit that the current insurance regime is set up poorly to handle pre-existing condition issues.

Which is why lefties like Drum point to the problem and say we need a government takeover and libertarians like (most of us) bemoan that we're so bad at understanding insurance.

In this case though, it's evident that the market/regulatory apparatus is screwy. The whole "pre-existing condition" issue could be done away with if health insurers covered events (as with other insurers) rather than a stream of care.

That is, if I get HIV, my insurer at the time of coverage should be responsible for paying for my treatments regardless of whether I continue indefinitely with that insurer.

There are a few ways this could work (e.g. if I switch insurance, the old insurer could render a payment to the new insurer), and I'm always a little surprised that this sort of system hasn't been worked out. Has it been regulated into illegality?

Brandon Berg writes:

The problem is that the pre-existing condition restriction was solving a real problem, which is that people who have done the responsible thing and insured themselves need to be able to continue to insure themselves after acquiring a chronic health problem.

One solution to this problem is long-term health insurance, where you lock in a constant (or solely age-based) premium for life. But once you acquire an expensive chronic condition you're stuck with that policy. What if the insurer's service degrades, or the insurer goes out of business? Furthermore, they still don't want to pay for your expensive disease, so they still have an incentive to try to drive you away with expensive copays.

You can solve these problems with a lump-sum payment upon development of a chronic disease, that would allow you to afford the higher premiums associated with your disease even if you switch policies. Problems here include the fact that no one can predict how long you'll live, nor can future changes in the cost of treating your disease be anticipated, so the proper payment can't be reliably calculated.

I don't know. Maybe someone who's spent more time thinking about this can come up with a better solution, but I'm stumped.

Anyway, the Obamacare solution to this problem was not a particularly good one. In particular it rewards people who opted to go without insurance while they were healthy, and to some extent still enables that. Furthermore, it has a gratuitous element of income-based cross-subsidization that further increases implicit marginal tax rates. But you're not going to convince its defenders that it's bad policy by pointing out what they see as exploitation of a loophole. They'll just want to pile on more regulations to limit copays.

Brandon Berg writes:

It's worth pointing out that even with these copays, HIV patients are getting a pretty good deal with Obamacare. All the plans have out-of-pocket maximums well below the cost of HIV treatment, so they're still getting huge savings.

And I can't say I have a lot of sympathy. We've known how to prevent HIV transmission for thirty years. People who opted not to take those precautions (yes, I know some infants got it from their mothers, but they're a tiny minority) are imposing the costs of their irresponsibility on the rest of us. I don't see a problem with recouping a bit of that through higher copays.

Greg G writes:

David is quite right to point out that we have been in the process of de-insuring health insurance for some time. That is obviously true.

What is less obvious is whether or not the insurance model is the best model for a health insurance system. We don't use the private insurance model to provide national military defense, or police protection or a judicial system. Many of us feel that the private insurance model fails in healthcare for similar reasons to those it fails in these other areas.

Total writes:

This is no different, in principle, from charging higher auto insurance premiums to single young men than to middle-aged married women or charging higher life insurance premiums to men than to women.

Do we think of driving a car and getting healthcare in the same way? Because if you carry that comparison through, you end up not treating sick people at the hospital because they can't pay, just like a car dealer wouldn't sell a car to someone without money.

Let them die in the street.

MikeDC writes:

@ Greg G,
What are the similarities between provision of health care and provision of military, police and legal protection? I don't see any similarities at all.

I don't see why you would criticize the "private insurance model" when you acknowledge we do not now and have never really used it for health care.

Under a universal but private model of insurance, there wouldn't be much in the way of pre-existing conditions because everyone would be insured at the time the condition manifests. The insurer at the time would be liable for all future treatments even if the insured later switches to another carrier. Alternatively, the original insurer could sell the obligation to the new insurer at a market rate.

As best I can tell, the obstacles to this sort of market are largely regulatory.

BC writes:

Greg G, defense and the deterrent effects (in deterring crime) of police and the judicial system are non-rivalrous and non-excludable. That's why they are public goods. In contrast, health insurance and health care are both rivalrous and excludable. They are more like food and shelter: private goods that are necessary to sustain healthy life.

Health insurance does not "fail" due some positive externality that causes us to spend too little on it (which would be the case for private national defense). In fact, many people think that we already spend "too much" on health insurance.

Daublin writes:

I believe the best core strategy is to rely on saving up. That doesn't always work well, so something like flexdollars can be provided for those narrow cases where public assistance will most obviously be helpful.

America uses this approach for food distribution, and it works reasonably well. Most people save up and pay for their own food on the private market. A few unlucky people cannot feed themselves this way, so they rely on food stamps and on charity. It's not perfect, it's good enough that starvation is unheard of in America. Troublingly, grand solutions that have been tried elsewhere in the world have often led to mass starvation. It seems very effective to put money in people's pockets and then get out of the way as they buy their life essentials however they see fit.

People talk about the worst case of such a system, but it's worth considering the scenarios that are within 1-3 standard deviations of normal. I believe it looks quite good.

*Most* people are never going to have a way to spend more than $200k on medical expenses and have them do any good. Yes, people spend more than that right now through their insurance, but such spending should be seen for what it is:exhorbitant spending that gives very marginal results.

$200k/person/life is an amount that most people can absorb. It's comparable to the cost of a house, a cost that many people do exactly once. Thus, to build intuition, you could think about a person buying a house and saving equity in it, and then selling it off if they have a sickness late in life.

Indeed, most medical expenses come later in life. If you work and save from 20-50, then you'll be in a good position in your 60s and 70s to pay out of pocket for whatever medical problems may come up. (I am the most scared of health policies that deny this sacred freedom!)

Moreover, of those unfortunate people who have medical expenses young in life, most of them have parents and family who can help them. Indeed, much of the decision making around having a child has to do with whether you can afford it.

Overall, savings + flexdollars looks like a simple approach to public health care that works reasonably effective. This is something that cannot be said for Obamacare. It seems to be riddled with holes for anyone who can stop gazing at Obama's benevolent smile and try to think through the actual economics.

Andrew_FL writes:

In fairness, taking the concept of insurance out of health insurance has been a long process begun long before Obamacare. Many "insurance" plans have long had to include coverage for things that can't properly be called "risks"-for example, routine medical examinations. Something which is routine cannot be a risk, by definition, instead it is a thing which is guaranteed to repeatedly happen.

Rick Hull writes:

I agree with Greg G that an insurance model is senseless as a policy. Insurance should be offered as a product in the marketplace, with regulatory oversight mostly limited to preventing abuse via obfuscatory legalese. [There should be very clear statements of intent for each legal contingency, along with tests and test cases that demonstrate accordance with intent.]

We can see that the insurance model for government health care is senseless by the absurdity of mandating its purchase and severely limiting choice. Somehow Sebelius got her head so twisted around by the absurdities and contradictions that she somehow tried to convince people that catastrophic coverage is not insurance when in fact it is the very essence of insurance.

Obamacare is the silliest thing that could possibly work.

josh writes:

http://www.motherjones.com/kevin-drum/2014/09/obamacare-isnt-perfect-thats-no-reason-give-it:

"David Henderson comments:

'I predict that none of this will cause Kevin Drum to reconsider his pre-existing view that pricing for pre-existing conditions should be illegal.'

Quite right. When it comes to Obamacare, there are two kinds of people. Henderson is the first kind. Whenever they hear about a problem, their invariable response is that this proves Obamacare is a hopeless mess and needs to be abandoned.

I'm the second kind. When I hear about a problem, my response is that we need to try to fix it. This is because I believe everyone should have access to decent health care at a reasonable price, and one way or another, we need to figure out how to provide it. We don't give up just because it's hard."

Dan C writes:

I still don't understand why we can't have a free market in insurance (and health care more generally) and just subsidize or hand out vouchers to those who fall through the cracks. I know it's not without its own problems but why is that not at least a politically acceptable solution to both liberals and conservatives (and libertarians)? Why would the Kevin Drums of the polity prefer the Rube Goldberg contraption that is the ACA?

Greg G writes:

MikeDC,

Healthcare is like military defense, the police and the judicial system in that everyone needs it and benefits from having it but a very significant part of the population will not save for it and be able to pay for it when they need it if government is not involved.

If you think most everyone would do that without government then I would like to know where that has happened. The original plaintiff in the original legal challenge to Obamacare went bankrupt and defaulted on her own medical bills before the case came to court. She was replaced with a less embarrassing plaintiff.


BC,

Healthcare is like food and shelter in some important ways but major healthcare expenses tend to hit in ways that are much, much less predictable and less easy to anticipate accurately.

I agree that the problem is not overall spending which may even be excessive. I think that everyone should be required to contribute to some basic form of health coverage which would be available to everyone. The many people who would want more coverage than that should have the option to purchase it in the markets for real health "insurance." Obviously changes in technology will insure that what constitutes "basic" health coverage will be a moving target and permanent source of controversy.

michael pettengill writes:
The best the insurance company can do is lump those who already have HIV together with those who don't but who might get it. That's one of the problems with the ObamaCare law.

You mean like lumping together the rich and poor, lumping together the victims of a bombing or drive by shooting with those standing on the other side of the concrete barrier, or the people in front of the car t-boned by the drunk running a red light are lumped in with the people who were not so lucky?

If insurance does not pool the costs of mitigating getting snake eyes in the risk pool, what is insurance for??

If you are arguing that insurance is only for mitigating the cost for the remainder of the term year when you get snake eyes, then most risks are uninsurable.

As soon as the term of the insurance expires, everything that happened before is now pre existing conditions, and thus you argue uninsurable, even if you bought insurance for the previous 50 years from the available insurers who would sell insurance wherever you lived and worked.

I recall a conservative cartoon targeting Consumer Reports and Nader et al that pictured a kid protected by helmets, pads, eye protection, gloves, face mask, etc to go ride bike or play catch. If you become uninsurable after any random event, then that cartoon is totally inadequate in describing everything you must anticipate and prevent on your own to be able to buy insurance you will never need in a "free market" insurance market.

R Richard Schweitzer writes:

Insurance is the transfer of risk.

The business of insurance is not the taking on of risks, but the spreading of risks over larger bodies of income (premiums & investment returns), larger bodies of assets, time scales.

Health care contracts prescribed by statutes or regulations require that private contracts of insurance -also- perform the functions of spreading costs in addition to, but with economic impact upon, spreading risks.

When the cost spreading functions come to predominate the economic characteristics of the contract, it is no longer risk transfer, but an intermediary contract for services.
That is where we are.

John Goodman writes:

The problem Drum writes about is inherent in all managed competition systems, as I explained today at Forbes:

http://www.forbes.com/sites/johngoodman/2014/09/22/discriminating-against-the-sick/

David R. Henderson writes:

@michael pettengill,
If insurance does not pool the costs of mitigating getting snake eyes in the risk pool, what is insurance for??
Michael, I know you’ve been a regular reader of this blog for some time and so I’m not going to explain yet again.

michael pettengill writes:
I still don't understand why we can't have a free market in insurance (and health care more generally)...

Is there any reason you don't consider Africa's health care system and insurance market to be free market?

How well does the free market serve Africans in providing their health care needs?

If Africa does not have a free market in health care, what government interference is preventing the market from delivering superior care to that of the broken US healthcare market which is not a free market?

Somehow, "free markets" are some sort of magic as far as I can tell, but magic never seems to work anyplace in the world I know of. I would love for someone to point to a free market that really does not have a huge government payment system involved - eg, health care in Hong Kong is mostly funded by taxes, and is more "big government" than Obamacare by a huge amount.

Rick Hull writes:

@josh

I believe everyone should have access to decent health care at a reasonable price, and one way or another, we need to figure out how to provide it. We don't give up just because it's hard

Some immediate problems:

  • Reasonable price is subjective
  • Who is "we" -- the marketplace, voters, politicians?
  • Who is giving up? I'm sure you are not addressing the poster or commenters here

In my view, health care in the US is expensive on a cost basis. This is because the incentives are screwed up due to 60+ years of legislative mistakes. For example, our idiosyncratic tradition of employer-provided healthcare via private insurance is an accident of history relating to labor market interference and unintended consequences of marginal tax rates upwards of 90%. This tradition is now firmly entrenched in our body of law. Further legislative mistakes which provide bad incentives are barriers to market entry for insurance providers across state lines, for which holes are carved out only for certain entities.

Next we have the AMA lobby, which seeks legislative privilege for doctors as an employment class, noted by Wikipedia as "one of the largest political lobbying budgets of any organization in the United States." AMA undertakes supply restriction via licensing and other barriers to entry in order to provide economic rent for doctors.

All of these and more distort incentives and create opportunities for rent-seeking behavior to flourish. These raise the cost of health care. The call to reduce prices for health care, without addressing the costs that result from bad incentives and legislative mistakes, is either a request for "us" to pull a rabbit out of a hat, or a call for additional legislative mistakes to further distort incentives, increase rents, and raise the cost of healthcare. Even if "we" manage to provide low prices to a wide range of consumers, those costs will be paid, in an increasingly politically divisive and hostile manner.

My solution would be to roll back legislative mistakes which predetermine presumptuous market structures (think health insurance regulation), make consumers more sensitive to cost rather than less, where they are able to choose cost effective treatments on their doctor's advice -- akin to a consumer's relationship with his grocer, plumber, mechanic, or restauranteur.

Generally: let the market do its work in discovering efficient structures and mutually beneficial relationships, allowing innovation to flourish, and actually reducing the cost of healthcare across the board.

Mark V Anderson writes:

Dan C has it right. There will always be people who can't afford healthcare, whether it's because of some accident or disease not their own fault, or because of people ruining their health and not insuring themselves when they should. This could be quite a few folks, but still a minority.

I think it makes sense to provide some kind of welfare system for such people. But why have it been deemed necessary to put everyone in the country on this complicated insurance system to cover those who should be covered by welfare? Because Europe does it, we have to also? You'd think we were still an insecure colony, the way Dems feel we have to follow the rest of the developing world.

ted writes:

@michael pettengill

Is there any reason you don't consider Africa's health care system and insurance market to be free market

It's unclear to me that Africa does have much of a market (free or not) for health insurance. Probably bits of it do, but overall I don't think it does. It's too poor, to begin with. Most of it doesn't have the institutions required for protecting property - there's widespread corruption and violence. It's hard for markets to develop in these conditions.

For example, Africa generally doesn't have a market for sports cars. You might think that to be a "market failure" and that government should intervene, but it's not clear at all that it should be so.

Somehow, "free markets" are some sort of magic as far as I can tell, but magic never seems to work anyplace in the world I know of.
I can, it's easy. Most things I buy come from fairly free markets. Shoes, phones, hifi gear, clothes, music etc. Works well. Almost like magic. If the government would interfere less with trade barriers and onerous regulation it would work even better.

Where I live, in Switzerland, the government doesn't provide health care. It mandates that we must purchase insurance (which in my opinion is unnecessary) but overall it works much, much better than in the UK, for example, where I lived before, where there's almost no health care market because of the central planning of health care.

To give you an example of how badly the government screws up, in the UK some of the medicine I regularly buy was extremely expensive to buy privately, because the NHS centrally agrees on pricing with the drug producers, and then subsidises it for the population. Bad incentives all around.

Here in Switzerland the same stuff can be 2-3 times cheaper. And still, it's too expensive, because of the government (you cannot freely buy anything you want because you need a prescription, then a lot of people don't pay directly for drugs but the insurance company does - bad incentives all around).

I went to an Eastern European country where there's much less licensing for pharmacies (basically you can walk in and buy whatever you want without a prescription) and everything was yet again 2-3 times cheaper.

Free markets work. If governments would get out of the way, we'd get better and far cheaper health care and drugs. But governments love to take over and control our lives, using as pretext the small minority who'd be unable to pay.

Rick Hull writes:

Greg G,

Healthcare is like food and shelter in some important ways but major healthcare expenses tend to hit in ways that are much, much less predictable and less easy to anticipate accurately.

This is exactly the argument for preserving cheap catastrophic coverage. Can we count on your vote to defeat Obamacare in this respect?

Greg G writes:

Rick,

Obamacare is an awkward and ugly compromise, not anyone's ideal solution. I doubt we will see a vote offered that distills out this one issue but I agree with a good bit of what you have written in your comments above.

I think the issue is a lot tougher than just needing to "roll back legislative mistakes" though that might be a good start. A lot of people have made important decisions based on existing arrangements and everything we thing of as waste, fraud and abuse is income to many influential people. The whole fee for service model is problematic.

It's not at all obvious what even catastrophic coverage should cover. Even a few days in the hospital for a common injury or procedure is an economic catastrophe for many people. As for medical catastrophes, wanting an experimental treatment or needing an organ transplant seem to me much further from "basic" coverage than treating severe burns even though the latter could be more expensive.

mike davis writes:

One small comment/correction: David says “Under ObamaCare, health insurers are no longer allowed to price for risk. (The one major exception is that insurance premiums for the elderly can be as much as 3 times as high as premiums for the young.)”

First, while getting old is properly considered a risk, why is it a risk that should be insured? There are other ways to smooth consumption over one’s lifetime.

Second,the health costs for old people are much more than 3 time the costs for young people (the number I’ve seen is about 6 times). The 3x rule is really an income transfer from young to old. Thanks, kids!!!

Dom writes:

If "pricing for pre-existing conditions" is the ideal, then would it be better still if the pricing were done so exactly, and with such predictive skill, that everyone essentially paid the market price for his or her own healthcare? And in that case, why have insurance at all?

It seems to me that insurance is meant to spread the risk. The healthy pay for the less healthy, but if there are more of the former than of the latter, the price is not too great. And they pay it because they may be part of the less-healthy group someday.

Hazel Meade writes:

@MikeDC

I proposed exactly the same solution a few years ago. Instead of doing away with "pre-existing conditions", the insurer of record should be responsible for paying for your treatment, and if you switch companies that should be negotiated between them (such as with a lump sum payment).

My thought is that because of the dominance of employer-based insurance this is not part of the standard individual health plan. Since the employer doesn't care what happens to you after you leave their employment they have no incentive to negotiate such a provision.

This is one of the reasons why I believe that the employer-based system is the root cause of the distortions in the insurance market.

Hazel Meade writes:

@michael pettengill

As soon as the term of the insurance expires, everything that happened before is now pre existing conditions, and thus you argue uninsurable, even if you bought insurance for the previous 50 years from the available insurers who would sell insurance wherever you lived and worked.

There is no theoretical reason why insurance can't cover a 5-10 year term or have provisions built into the original contract that limit premium increases or guarentee renewability. It will cost a little more, but there is no reason why theinsurance market MUST be based on 1-year terms.

IMO, the main reason it isn't because the individual market is so small and most insurance policies are sold via employers- who have no interest in making insurance extend beyond the employment contract.

It's not at all obvious what even catastrophic coverage should cover. Even a few days in the hospital for a common injury or procedure is an economic catastrophe for many people. As for medical catastrophes, wanting an experimental treatment or needing an organ transplant seem to me much further from "basic" coverage than treating severe burns even though the latter could be more expensive.

Typically "catestrophic" plans are defined as those that only cover expenses above a large deductible, such as $10,000 or $20,000 dollars. They are also limited to unpredictable events such as hospitalizations. (There are also "hospital-only" plans available which ONLY cover hospital stays).

The ACA requires coverage for all sorts of things that are normally not insurable events, such as intentional pregnancies. A catestrophic plan hence wouldn't cover things like substance abuse btreatment or mental healthcare (unless for some reason you wound up hospitalized for a psychotic episode and the charges exceeded the deductible).

Essentially, a catestrophic plan covers individuals for exactly the kind of situations that ACA advocates often cite as examples of uncompensated care: i.e. emergency room treatment after a car accident.

Jim Hlavac writes:

I see this comment above by: Bostonian writes:
"The risk factors for getting AIDS are well known, and the male homosexuals who get AIDS should pay for their own AIDS drugs."

"male homosexuals" aka Gay men -- do pay for our own AIDS drugs - we pay taxes like everyone else -- indeed, we pay at what some say is a higher single rate (others aver there is a marriage penalty) -- and our paying in a joint tax return causes the vapors for many yet.

It seems Mr. Bostonian does not realize that gay men pay taxes -- and gay men with HIV must work, and pay taxes - there is no Soc Sec Disability for HIV -- the drugs are too good.

How much do gay men pay in taxes? No one quite knows, no one looks -- I calculate upwards of $200 billion in all Federal, State, City and County taxes levied on persons and businesses. (here is not the place for the math, but I've done it.)

AIDS drugs paid for through Ryan White, the primary drug program, run about $2 billion a year. If a gay man has employee insurance, Union insurance, etc -- then he pays for his own drugs. Other HIV/AIDS services run also about $2 billion a year. In sum, as near as I can figure, counting even basic research for HIV/AIDs and immunology issues, and also foreign aid to Africa (primarily) just some $20 billion is spent on ALL HIV/AIDS spending of any and all kinds.

Since gay men pay, as I contend, some $200 billion, then gay men are a net positive impact to the tax coffers of $180 billion.

Since we don't leave behind a trail of unwanted children, women's safe houses, and other social ills that consume the heterosexual lifestyle, it would seem gay men are paying for lots of things we never use. Like schools, perhaps.

And too, gay men pay for the lawsuits against us -- that is, every state (down to 34 now,) has spent at least a Million Dollars a year fighting gay men in courts -- since the 1950s -- not just over marriage -- but the right to free speech, assembly, to have legal liquor -- the numbers of lawsuits involving gay issues is rather large -- and gay men paid for all the state attorneys to fight us in court. John Boehner spent $3 million in Gay men's tax money to trash us before the Supreme Court with bogus research ... we are paying for our own opposition, such swell fellows we are.

Then, finally, with HIV/AIDS - the drugs and research that came out of it have benefitted all Americans (and the world) -- over 1000 new drugs and therapies related to the immune system have come from HIV/AIDS research - which is quite an unseen, and thus unmentioned, economic contribution to society. We are the unthanked guinea pigs for the research -- perhaps Mr. Bostonian knows someone who benefitted from "male homosexuals" and HIV/AIDS.

If Mr. Bostonian wishes to separate gay men from society, as seems his purpose - then oh please refund at least the last 60 years of billions a year in taxes we have paid -- well, had taken from us.

Rick Hull writes:

Greg G,

Obamacare is an awkward and ugly compromise, not anyone's ideal solution. I doubt we will see a vote offered that distills out this one issue

Yes, of course. Such is the nature of political, one-size-fits-all "solutions", with predetermined homogenous structures applied without prior experimentation, innovation, or clear metrics for success or improvement in a competitive, distributed landscape as we might see in a market approach. As political solutions go, Obamacare might be the best we can hope for.

I think the issue is a lot tougher than just needing to "roll back legislative mistakes" though that might be a good start. A lot of people have made important decisions based on existing arrangements and everything we thing of as waste, fraud and abuse is income to many influential people.

Agreed, absolutely. My solution is pie-in-the-sky without serious legislative reform and the sunsetting of entrenched interests. Our legal and legislative system is foundering under its own cancerous growth, and I have no hope that we can save the structure. Likewise the problem of entrenched interests compounds inherent resistance to reform which I judge now as fatal.

Conceiving of laws and political solutions for economic problems is a dangerous game. Once birthed, these things rarely return to the womb and instead run amok, interacting with their environment in perverse ways that their caring parents never intended, yet defended and supported by those same parents, perhaps never to die a natural death.

Prophylactics are the only real defense against babes run amok. The USA Constitution provides a broad set of hard-won prophylactic devices, but the appeal to conception has sabotaged these gifts from our founding fathers.

It's not at all obvious what even catastrophic coverage should cover. Even a few days in the hospital for a common injury or procedure is an economic catastrophe for many people. As for medical catastrophes, wanting an experimental treatment or needing an organ transplant seem to me much further from "basic" coverage than treating severe burns even though the latter could be more expensive.

Luckily, we do not need Mr. Obama nor Ms. Sebelius to define a catastrophic coverage policy. That is, unless they have outlawed such provisions. Unhampered markets are very good at differentiating various consumer needs and providing a range of products to satisfy such needs, with a range of tradeoffs to accomodate different forms of wealth (time, money, family, transport, risk tolerance, etc.)

Comments for this entry have been closed
Return to top