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August 4, 2003
Fixing healthcare
Much of the discussion about how to fix healthcare goes in the wrong direction--as it attempts to put the burden for our health on the state or our employers. This is the problem, not the solution, argues Hoover's Scott W. Atlas, building from many of Milton Friedman's ideas.
First and foremost, decisions to purchase medical care should be made by the patient desiring the care. People must spend money directly for medical care in order to become cost conscious. The current system encourages patients to neglect cost when they use medical care. Income allocated to health insurance costs is given special tax treatment if provided by the employer. Why is this done uniquely for health care costs? Other essential items, including even food and clothing, are not offered this exalted status. This was basically an accident of history, when companies began offering health benefits to lure employees during World War II. Because the tax code did not specify that these benefits were taxable, they were not taxed. Years later, this was codified.
In a world where there was no collective responsibility for health care finance, either through the State or through companies, who would pay for those who were too poor, too often sick, or who otherwise unable to take care of their health care provision? I merely ask.
You might as well ask how do we feed, clothe, or employee people without taking collective responsibility. You can have programs to feed, outfit, and fund the poor without forcing everyone to get their food, clothes, or jobs through the state, or through state assisted programs. We don't need to pervert an entire system just to take care of those that struggle at the margin--why catch everyone in that net? It is dangerous to create systems that punish the responsible for the sake of the irresponsible--for that will breed irresonsibility. If you want to create programs to address the poor, the sick, the indigent, then do so. But don't ignore the problems caused by trying create a system that tries to squeeze everyone in the same box.
Fair enough. It's a reasonable response: and one that I probably agree with. I was merely concerned that your decollectivisation would affect our social responsibility for marginal cases. Would marginal cases, in your scenario, receive significantly worse care than those who took responsibility for themselves?
We can determine as a society to provide whatever level of care to marginal cases, and what that level should be can be up for debate. My point is that the entire system shouldn't be built around the execptions but to the majority. There is nothing inherent in my "scenario" that marginal cases would receive sub-standard care.
If marginal cases received the same standard of care as people who took responsibility for their health care, and their health care of their families, would that remove the moral hazhard from your scenario? Or would the moral hazhard be the absence of choice? Would there in other words, be a value utility in choosing one's health care?