Health hazard

Health Care for All points to an important and typically terse article in the New Yorker by Malcolm Gladwell, the author of The Tipping Point and Blink. Gladwell essentially studies how people make decisions, as a group and as individuals.

"Moral Hazard" is the idea that if something is freely available, people will use too much of it. Essentially, you can break down liberalism vs. conservativism as concern about Injustice (liberals) vs. concern about Getting Something You Don’t Deserve (conservatives).

Gladwell tears down the idea that the problem with health care is that our demand needs to be externally controlled: In fact, limiting consumption of health care is what causes it to cost so damn much in the long run. When you "disincent" someone from going to the doctor via co-pays or deductibles, they are less likely to get care they actually need, and get sicker because of it. That’s expensive.

?Moral hazard is overblown,? the Princeton economist Uwe Reinhardtsays. ?You always hear that the demand for health care is unlimited.This is just not true. People who are very well insured, who are veryrich, do you see them check into the hospital because it?s free? Dopeople really like to go to the doctor? Do they check into the hospitalinstead of playing golf??

The frame that we need to work on, though, is something that Governor Landslide has declared: Every man and woman is an island in health care:

”It’s the ultimate conservative idea, which is that people haveresponsibility for their own care, and they don’t look to government totake of them if they can afford to take care of themselves."

Well, maybe health care isn’t the place for playing around with "Ultimate Conservative Ideas".

Basically, it comes down to this: If you think that health is:

• the individual’s responsibility
• that people get what they deserve and deserve what they get
• that if you were just smarter you wouldn’t have gotten diabetes, that broken arm, or if you’d just brushed harder you wouldn’t have lost your teeth to decay;
• etc.

… then yeah, health care is the individual’s responsibility, like car insurance.

On the other hand, if :

• you think health has a huge component of luck;
• if you hope to get old and therefore likely incur some big expenses someday;
• if you’re young and hope to have children soon;
• if you brush and floss and get exercise and yet still get sick sometimes;
• etc

Then we need another model of health care. It’s called social insurance, where people take care of each other. Look, if this were happening through the free markets, that would be great. But it’s not. We need to government to step in.

Public policy, like all management, is largely about what kind of problems you’re willing to put up with.  The kinds of problems we have now are unspeakably cruel to many people. I’ll gladly exchange a bureaucratic problem for making sure people can keep their teeth and don’t die young, unnecessarily.