Sunday, November 8, 2009

Obamacare and Civil Society

If government is paying for everyone's health care, then it would seem to have an interest in promoting "healthy" lifestyles. This might sound innocuous, but it has troubling implications.

Consider, for example, the question of weight. Existing evidence seems to suggest that being overweight is bad for one's health and causes higher than average health care expenditure. So, government might want the health insurance plans it subsidizes to include incentives for exercise and weight loss.

Yet that approach runs headlong into a ban on pre-existing conditions, a crucial feature of Obamacare. This ban implies that overweight people get the same insurance, at the same price, as everyone else. This defeats an attempt to improve health by discouraging obesity and generates resentment from the non-obese who believe, accurately or not, that they are being forced to subsidize unhealthy behavior by others.

In a private, unregulated insurance market, competition between insurers would determine whether obesity actually predicts higher than average health expenditure. (Even if the obese are less healthy, their lifetime health expenditures might be near or below average because of shorter life expectancy.) Competition would determine whether provisions like required exercise regimes actually improve health. People who are overweight might face higher premiums, but they would bear the burden.

The same issue arises for an enormous range of behaviors: smoking, excessive drinking, downhill skiing, and so on. Government takeover of health insurance, implicitly or explicitly, takes a stand on all these issues. Government will not always get it right, no matter how well-intentioned, and competitive forces will not be allowed to correct the mistakes. In addition, imposition of a particular approach, with the implied cross-subsidies from the healthy to the unhealthy, constistutes one more way in which government intervention promotes an embittered, polarized society.

20 comments:

Anonymous said...

The house has passed a health care bill.

There will be a revolt, one way or another.

Best Regards
PoliticalPen

Shakes The Clown said...

I wonder sometimes about the expensive care provided to gang members with criminal records of gun violence. If we start to ration care for the elderly, well my mom has always paid her taxes. I would vote for her care over expensive treatment for gang members with their gun related crimes.

David Welker said...

What evidence do you have that France is more of an embittered and polarized society than the United States?

What evidence do you have that the current system where people are denied healthcare due to their pre-existing conditions and where, according to a recent Harvard study, 45,000 deaths per year are associated with a lack of health insurance will not lead to more embitterment and polarization?

I mean, that you personally become embittered and angry that other people who didn't have health insurance now have it is not exactly a good measure for the whole of society.

MatyaNoBaka said...

Your comment on the relative cost of healthy and less healthy behavior is well taken. Smokers die hard, fast and cheap, contrary to the claims in the big tobacco settlement.

David Welker said...

MatyaNoBaka,

Smokers dying "fast," regardless of the financials, is anything but cheap.

jeff in indy said...

so, we should expect our "leaders" (i.e., congress) to set the life-style example? aside from other destructive life-style choices, i wonder what the obesity/bmi factor alone is in congress?

Steve M. said...

David,

How important is liberty to you? Just curious.

I'm sure there is a gov't solution for every single one of society's ills. Do we suggest that we enact them?

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