Many decades ago an acquaintance had a serious accident but wasn't badly hurt. She wasn't wearing a seat belt. She was told that if she had been wearing a seat belt, her accident probably would have been fatal.
Seat belts improved chances of surviving almost all accidents, but before airbags seat belts occasionally increased the likelihood of dying. So how should we have chosen back then whether to wear a seat belt on any particular trip? The answer was easy: before setting out, determine which type of accident you will have and choose accordingly.
Of course this easy answer is facetious, it being impossible to know ahead of time whether we will have an accident or what kind it will be. A wise person would therefore forego making a retail choice before each trip, and instead make a wholesale choice to go with the odds and always wear the seat belt.
Recent discussions about medical insurance brought this episode back to mind. We are told that young people are less interested in insurance than those who are older. And on average, younger people are indeed less likely to have a serious illness. But this is only on average. Two students in my daughter's high school orchestra, for example, died of brain tumors.
Furthermore, not all medical costs are caused by illness. Recently a young person who lost a leg in a lawnmower accident had to be helicoptered 90 miles to a more suitable hospital; the transportation charge was $67,000.
Although freedom to choose is desirable in general, it may not be a good idea for people to have to choose whether to have medical insurance. Most of us are unwilling to stand by and watch people who don't insure themselves suffer untreated illnesses and die. And what of parents who choose not to insure their children? The Affordable Care Act (ACA) decided that such freedom is a bad idea, imposed penalties on people who remain uninsured, and provided subsidies to people who could not otherwise afford insurance.
The ACA still allowed freedom to choose what insurance to buy. But people had to choose among insurance policies that were impossible to compare systematically. And choosing a particular insurance policy automatically reduced ability to choose doctors and hospitals, since each insurer covered treatment only at narrow networks of providers.
Which kind of choice is more important: the ability to make a guess among complex insurance products, or the ability to choose our doctors and hospitals? I think most of us would opt for choosing our doctors and hospitals.
But if the law requires that people be insured, why put people to the bother of buying it? Why not just provide insurance to everybody and pay for it from general taxes? For nearly ten years I have been urging conservatives to reconsider their knee-jerk hostility to single-payer insurance programs like an improved Medicare-for-all. The conservative values of simplicity and cost-efficiency would be served by a properly designed program.
Any policies that decrease complexity make government more understandable and thus controllable by the electorate. But any national insurance policy short of single-payer increases governmental complexity, as the ACA obviously did.
People who value cost-efficiency should be be critical of a system in which insurance companies employ large staffs to figure out how to avoid paying claims. A large portion of current medical bills also pays for staffing — costing about $80,000 annually for every doctor — needed by doctors and hospitals to bill dozens of different insurance companies. Experience with Medicare indicates administrative costs would be much lower than with private insurance.
Large tax increases will be necessary to pay for an improved Medicare-for-all, but the average American will come out ahead financially thanks to elimination of four costs they now bear: insurance premiums, reductions in wages to cover so-called "employer-provided" coverage, deductibles, and most co-pays.
We should remember that single-payer insurance need not create a governmental monopoly on the provision of medical services. Many problems associated with single-payer systems in other countries result from governmental monopolies in providing treatment.
One more step may be required to develop a viable medical system in the U.S.: turn medical providers like doctors, hospitals, and pharmaceutical companies into regulated utilities. Treat them like many states treat gas and electric companies, which provide excellent service at reasonable prices while allowing decent rewards for their workers and investors.
Sometimes the best choices can be made by individuals. Sometimes it is best to make choices collectively, through our political system, and medical insurance is probably an example of this.
Paul F. deLespinasse is Professor Emeritus of Political Science and Computer Science at Adrian College. He received his Ph.D. from Johns Hopkins University in 1966, and has been a National Merit Scholar, an NDEA Fellow, a Woodrow Wilson Fellow, and a Fellow in Law and Political Science at the Harvard Law School. His college textbook, "Thinking About Politics: American Government in Associational Perspective," was published 1981 and his most recent book is "The Case of the Racist Choir Conductor: Struggling With America's Original Sin." His columns have appeared in newspapers in Michigan, Oregon, and a number of other states. To read more of his reports — Click Here Now.
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