Strengthening Constitutional Self-Government

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Are the Democrats Winning on Health Care?

They may well be so far. And here’s why: In an increasingly dynamic, individualistic society, people are changing and losing jobs more than ever. Employer and employee loyalty are on the decline. So they’re increasingly anxious about a system that connects coverage with employment. But people also are suspicious of becoming dependent on a national bureaucracy and about the affordability of universal coverage. Is it possible to come up with a way of alleviating anxiety through a largely market-driven system? Please don’t tell me that security-driven herd animals are craving a softer and wider safety net. The concern here arises with the steady erosion of protections to which we’ve become accustomed. And I still say the Republicans can win on this issue if they’re smart (see the wisdom of Yuval Levin).

Discussions - 7 Comments

If health insurance were as easy to come by as car insurance, and sold on much the same terms, would that answer?

The decline of the employer who recognizes his employees as family people and as needing substantial security, not merely a fair contract, is a deadly serious problem. The public demand for state-provided health care (however direct or indirect the provision may be) is an example of the profound truth that, as civil society and social capital decline, government steps into greater and great authority. The problems with statism are enormous and varied. But one is the fact that it further weakens civil society -- in this case, the civilized and responsible employer.

No, I think that is silly. There is no reason but history that health insurance should be tied to employment and an employer. Insurance companies must come to terms with this problem, else we will turn to government by default.

I found a $8 per pill of Tylenol on a family member's medical bill.

That, example, while anecdotal, is, in my opinion, symptomatic of the health insurance problem.

We do not have real values in place for things in the medical field. Moreover, we undervalue certain, more common medical visits, and overvalue others to recoup.

But, hey, this is a government regulated industry that, it appears, the Dems wants to be a fully government run industry.

In other words, expect less service and less treatment, with more cost if this truly becomes the European/Canadian style of healthcare that Hillary and the Dems want.

If it weren't for employers offering it, health insurance probably wouldn't have nearly such a dominant role in the health care process as it does today. It was originally a way of getting around wage and price controls during World War II--companies began offering it as a means of securing employee loyalty in a time when labor was in short supply.

I'm inclined to believe that the ubiquity of health insurance is part of the overall problem. To the extent that payment for medical services is pushed off to a third party, the health care consumer has little incentive to economize. Health isn't like fire insurance, life insurance, or automobile insurance. It's obvious if your home or property is damaged in a fire, you've died, or you've gotten into a car accident. On the contrary, "health" is an entirely subjective category.

John: If you've got gangrene, is it an "eniterly subjective" matter whether or not you're healthy? How about cholera? Acute asthma?

With respect, libertarians will lose on health care if they make claims like this, which might sound OK in the abstract, but don't actually make a lot of sense.

Your suggestion seems to be that we should make health insurance less widely available (presumably by making it more expensive), which will mean that people who can't afford health insurance will economize. Do you also support closing off emergency rooms from those who can't afford to pay? That might be your best chance to make such a plan practical, because otherwise, we're all paying for the acute care.

Okay, so I was rash in using the term "entirely" subjective. But you must admit that the question of whether or not someone is healthy is far more complicated then whether his or her house has caught fire, or whether he or she has been in an automobile accident.

And I'm not suggesting that health insurance be abolished, either gradually or all at once. It was, and is, after all, a voluntary arrangement that was made in response to a real demand. A libertarian would be the last one calling for government elimination of this. I am simply suggesting that, by shifting costs away from those who make health care decisions, it contributes significantly to the rising cost of health care overall.

I am constantly frustrated by the discussion I see regarding the supposed health care crisis (which, as Yuval Levin suggests, is probably more apparent than real). If the cost of health care has risen more quickly than the cost of other necessities, such as food and clothing, I would think it would be worth exploring why this is the case, rather than the traditional game of blaming pharmaceutical and insurance companies--as if the people who own them, or manage them, are any greedier than the rest of us. Health care, after all, is about the provision of goods and services, so we ought to be looking at what is keeping the market from working as it generally does. Can you imagine, for example, if in order to buy a loaf of bread you had go to a licensed bread practitioner, who had to examine you and make a judgment as to whether you really needed the bread, what kind of bread it ought to be, and how much of it you should be permitted to buy? And then, after receiving your bread prescription, suppose you had to go to another officially licensed location, where you would present your prescription and receive the precise type of bread in the prescribed amount. Of course, nearly all of the price of the bread would be charged to a third party, either an insurance firm or, in the case of the indigent or the elderly, the government. And the baker, to be able to market his product, would have had to navigate a massive bureaucracy called, let's say, the Food and Bread Administration, spending billions of dollars in the process.

I'd think we'd expect to see a substantial increase in the price of bread under those circumstances, don't you?

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