Friday, April 15, 2011

Privatizing health care

I've been reading Tyler Cowen on Medicare, as well as some of the responses to him. Ezra Klein's recent response is especially effective:
Tyler Cowen and Matt Yglesias are going back and forth on the appeal of converting Medicare into a straight cash grant. This isn’t the Ryan plan they’re talking about. They mean handing seniors cash. As Matt writes, “If grandma wants to spend that money at the hospital, good for her. If she wants to spend it on heroin or a television, then that’s good for her, too.” Cowen concurs. “What would terrify the left,” he says, “is the likelihood that genuine privatized cash would actually win that competition.”

This has a lot of wonkish allure, particularly if you think, as I do and Matt does and Tyler does, that medical care is overvalued. But it misses the problem that leads to universal health-insurance systems: As a society, we are not willing to let people die painfully in the street, even if they have previously made decisions that would lead to that outcome. In reality, what terrifies all of us is what happens after someone takes the cash and then gets sick.
That's really it. And it's why I really waver on this issue. I believe in the absolute value of human life--one human life is not more valuable than another. But reality doesn't give us the option to put that into practice: preserving lives always comes at a cost, some lives more than others. Discerning the most life-affirming health care system (or economic system more generally) is tricky precisely because we don't know what it means to affirm the value of life in a world that generally isn't conducive to immortality.

But I still hesitate to accept Klein's conclusion, because I think there is a legitimate slippery slope argument to be made. If we're unwilling to hold individuals responsible for their decisions about health care, why are we willing to hold them responsible for other economic choices, like what food to buy or what career path to take? Since both of these choices really do affect long-run health, it seems only natural that a society determined to guarantee a certain quality of health care would eventually force its will in these common affairs, as well. After all, this may be the only way we know to lower health care costs while preserving health care entitlements.

To me the argument isn't solely about individual liberty, nor is it just about compassion. It's also about how we learn as a society. A society that respects free individual behavior doesn't necessarily do so because it thinks all people are entitled to be left alone, but rather because it favors experimentation and spontaneous innovation. Personal responsibility creates that sense of necessity which is the mother of invention. Who knows what kind of creative health care solutions people will come up with if they're free to use their money however they wish?

Such freedom comes at a cost, of course, but it is a cost we can measure. The problem with the alternative--individual mandates in health care--is that we can't measure the cost. We simply don't know what new ideas might have been discovered in a free system. In the long run, I would argue, what we don't know yet is more valuable than what we do know. This, to me, is the best argument for a free, privatized health care system.

On the other hand, I don't mind if we continue to waffle on the issue; being "too compassionate" is not such a heinous crime, after all.

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