Almost daily we're bombarded with apocalyptic warnings about the 47 million Americans who have no health insurance. Senator Hillary Clinton wants to require everyone to have it, to require big companies to pay for it, and have government buy policies for the poor.
That is a move in the wrong direction.
America's health-care problem is not that some people lack insurance, it is that 250 million Americans do have it.
You have to understand something right from the start. We Americans got hooked on health insurance because the government did the insurance companies a favor during World War II. Wartime wage controls prohibited cash raises, so employers started giving noncash benefits like health insurance to attract workers. The tax code helped this along by treating employer-based health insurance more favorably than coverage you buy yourself. And state governments have made things worse by mandating coverage many people would never buy for themselves.
Competition also pushed companies to offer ever-more attractive policies, such as first-dollar coverage for routine ailments like ear infections and colds, and coverage for things that are not even illnesses, like pregnancy. We came to expect insurance to cover everything.
That's the root of our problem. No one wants to pay for his own medical care. "Let the insurance company pay for it." But since companies pay, they demand a say in what treatments are—and are not—permitted. Who can blame them?
Then who can blame people for feeling frustrated that they aren't in control of their medical care? Maybe we need to rethink how we pay for less-than-catastrophic illnesses so people can regain control. The system creates perverse incentives for everyone. Government mandates are good at doing things like that.
Steering people to buy lots of health insurance is bad policy. Insurance is a necessary evil. We need it to protect us from the big risks--things most of us can't afford to pay for, like a serious illness, a major car accident, or a house fire.
Imagine if your car insurance covered oil changes and gasoline. You wouldn't care how much gas you used, and you wouldn't care what it cost. Mechanics would sell you $100 oil changes. Prices would skyrocket.
That's how it works in health care. Patients don't ask how much a test or treatment will cost. They ask if their insurance covers it. They don't compare prices from different doctors and hospitals. (Prices do vary.) Why should they? They're not paying. (Although they do in hidden, indirect ways.)
In the end, we all pay more because no one seems to pay anything. It's why health insurance is not a good idea for anything but serious illnesses and accidents that could bankrupt you. For the rest, we should pay out of our savings.
Friday, September 21, 2007
I Demand My Oil Change Insurance