Monday, November 2, 2009

Letting the Sick Die on the Street

Blogger Matt Yglesias has described my op-ed on health care as follows:

Meanwhile, in Harvard economist and Cato Institute senior fellow Jeffrey Miron’s dystopia, if your parents wind up with no money through bad luck or poor decision-making and then you get sick you’ll just die on the street for lack of money.

Did I really say such an outrageous thing? Well, I did not use exactly those words (as Matt makes clear), but yes, that is the logical implication of my position.

And I stand by it. Here's why.

First, my assessment is that even with no government health insurance, hardly anyone would die on the street for lack of health care. The poor would use their income transfers to buy some health care or insurance. The poor would receive private charity. And health care would be far less expensive due to elimination of the distortions caused by government health insurance.

Second, my position is that government provision of health insurance is enormously inefficient: it means worse health care for everyone, and it wastes resources that can be put to other uses. So the negative of having a few people suffer without government health insurance must be balanced against the good of having better medical care for all and against the good that can be accomplished with those saved resources.

That good might be lower taxes for everyone, or more government spending on education, or greater public health spending to combat HIV in poor countries. Whatever the alternate uses turn out to be, one cannot escape the fact that a tradeoff exists between protecting the poor and other goals.

16 comments:

Anne Shenton said...

I think that we make the mistake of confusing health care with health insurance. Most people can get some sort of health care, even if the are reduced to using..God Forbid..the Emergency Room.
However, it is argued that this drives up health care costs as people usually do not pay for their emergency room care causing the hospitals to lose enormous amounts of money.
Health insurance is going to cost more in the long run as the premiums will have to be paid somehow. Perhaps the hospitals might prosper, but the American tax payer will not.
It must also be noted that in our "compassion" we also provide emergency room services to all, including illegal immigrants who will theoretically not be included in any new plan. This is not an argument about the morality of providing this care: more just stating an economic fact.They will continue to create a burden for both the hospitals and the taxpayer.

Liz said...

How is it that every first world nation in the world has more affordable and more widely available healthcare than the US? I agree that mandated health insurance is not the way to go, but can we the people not design a health care system that compensates doctors at a reasonable rate and still provides us health care that is as available and as high-quality as other first world nations?

Mike Huben said...

The outrageous thing Miron would say if he dared is that he thinks the Federal Emergency Medical Treatment and Active Labor Act (also known as the Patient Anti-Dumping Law) should be abolished as a government interference with private business. This law requires every ED to provide a minimal level of care to all comers regardless of their ability to pay.

Abolishing that law would really let the sick die on the street, as they used to before the law was enacted.

But he has to sugarcoat his ridiculous views to keep his soapbox.

J E Schmidt said...

My guess is within 3-5 years it will be necessary to establish Federal Euthanasia Centers in all states, but most particularly in the larger cities. People in hopeless circumstances, starving, sick and in horrible pain may go there, sign themselves off; and then be painlessly put to sleep and cremated on site. Gone forever, forgotten, problems solved, no funerals or memorials which all cost extra money.

The USA is technically bankrupt right now plus many of the states. When the fiat money runs out, the welfare checks stop: then the food riots will begin, along with the vandalizaion and destruction of stores which will not be restocked, and their buildings will become empty hulks. To stop the riots, those people will have to be machine-gunned down and eliminated that way, with the bodies later scooped up and buried in mass graves.

Through this process, the largely dependent part of the "black culture" and surplus population living in slum districts and ghettos will be eliminated. There are many fine, well-educated and productive black people, but in most cases they have removed themselves physically from the "black culture of the ghetto" and live elsewhere in society, where they are welcome.

The USA needs to bring its military back home, particularly from the Middle East; and place one or two battalions of troops on our southern border with Mexico and SEAL IT SHUT with shoot-to-kill orders. All illegal immigrants need to be rounded up, captured, hauled to the southern border and put back in where they came from.

Until these things are accomplished, this one-great nation will continue to deteriorate until it becomes little more than a banana republic.

Tim Kowal said...

I agree with Mr. Miron. There is really no reason to treat health care from any other industry. That is, of course, unless we want health care to lag behind. The trouble is that, in order to overcome the moral wrinkle that comes with the question of health care, we need to make sure that everyone is able to take responsibility for his own interests, if he so chooses. That is, if someone can't afford fire insurance on his home, those are the breaks-he probably bought too much house. But if someone can't afford health insurance, most good folks won't be able to assuage their guilt at the thought of him dying on the street because he happened to get sick. At the very least, we need to be able to say, "sorry to hear that, but you should have done X."

This has mostly to do with the pre-existing conditions issue. In some instances, we can waive off this problem by arguing that so-and-so should have gotten health insurance before he got sick, or his condition was probably caused by his own behavior. This is perhaps true. But the fact remains that there are many folks who get terrible illnesses through no fault of their own. And even if they have health insurance, even one short lapse-which might occur due to a missed form, of which there are many-could forever banish them from the possibility of ever again being insured.

That is why, in my view, certain unknowns should probably be diffused across large numbers of Americans, as a matter of public policy. By this I assume that, while it just won't wind up sitting right to make each individual take on the entirety of the risk of the calamities nature might throw at him, it is also not right to make insurance companies take on unreasonable risk. Instead, because the health care system is one that we all want to be available to everyone who wants it-i.e., it is not like the Faberge egg industry-we might all need to shoulder slightly higher premiums so that certain pre-existing conditions do not unduly price individuals out of the market.

In this way, so long as everyone who wants insurance is able to obtain it at a relatively reasonable price, there is no reason-as a matter of social justice-to lament anyone "dying on the street" because they chose not to purchase it.

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