A few more snide remarks and hairy eyeballs under my belt, I’m going to take one more shot at this healthcare thing, after which I plan to go back to whining about air travel.
If you are healthy today, there are precisely three things that can happen to you over, let’s say, the next 12 months that would cause you to spend more on healthcare than you can afford on your own:
- Behind Door #1 are things that are bad but have no lasting consequences. These acute events are predictable in the aggregate but not in the individual. You have essentially no control over whether they will happen to you. And when they’re over, they’re over. These characteristics make them insurable. That is, a private market could pool and underwrite these risks.
- Behind Door #2 are things that are bad and that DO have lasting consequences. Unless an insurance company is willing to take you on for life, these risks are not insurable. Yes, you have SOME control over the odds that SOME of them will happen to you. You can eat better, lose some weight, get more exercise, stop smoking and – ahem – drinking. We should all be held accountable for those choices. But that wouldn’t make these risks insurable.
- And behind Door #3 is you getting older. This is not an insurable risk either, but it is one over which you have complete control. Not only can you reduce it, you can eliminate it entirely. Of course, that involves what most major religions consider to be a mortal sin, but that’s between you and your parish priest.
Daniel Patrick Moynihan once said, “Everyone is entitled to their own opinion, but no one is entitled to their own facts.” As a matter of moral philosophy, it is impossible to disagree with the notion that people should be accountable for their lifestyle choices. But Doors #1 and #3, which are not affected by lifestyle choices, have the most prize money behind them, while Door #2, on which those choices have some impact, has the least. The only way to pay for people who find themselves behind Doors #2 and #3 is to confiscate money from everyone else. Call that what you will, it is not insurance.
There is an excess of emotion and an absence of fact in this whole debate. The best idea I’ve heard yet comes from my friend Jack Carroll, who says that we should treat healthcare as a pension – you pay in early in order to be covered late – and supplement that ‘pension’ with private insurance to cover Door #1.
There are only two circumstances under which this would work. One is that we require everyone to participate – a confiscation of wealth, and therefore a tax. The other is that we allow people to opt out and agree to let those who do so go without medical care.
That, Monty, is the choice we ultimately have to make.