I’m beginning to understand the roles of the full-time Op-Ed writers at the Sacramento Bee. Dan Walters plays Dan Broder without the gravitas, while Daniel Weintraub plays a diet version of John Stossel. Today, we’ll have a quick look at Weintraub’s most recent oeuvre: an ode to his power to imagine a world without health insurance in response to Carole Migden’s introduction of a bill to require large corporations to provide health insurance.
Weintraub spends several paragraphs talking about how great the market is for delivering things like food, cars and houses, and painting a grim picture of how awful it would be if one’s employer controlled one’s access to those goods. That’s all true. The (regulated) market is really good at delivering those kinds of goods: lots of choices, fairly good information that regular folks can understand easily enough, prohibitions on adulteration and deceit, and generally, enough time to process the information one does get. One might note in passing that the regulation of these markets was fought hammer and tongs by the industries affected.
Then Weintraub gets to the nub of his argument:
[more on the flip]
While individuals once managed their health insurance themselves, paying for it out of their wages, employers began doing that for them during World War II as a backdoor way to increase compensation in an era of government-imposed wage and price controls. The custom stuck, the government rewarded it with tax breaks and today more than 60 percent of us have our health care managed through work.
…
Maybe, instead of trapping us into having our health care managed by others, we should emulate the ways we have more successfully provided food, shelter and transportation to almost everyone who needs it.
Individual choice. Individual responsibility. Voluntary transactions. And targeted help for the few who cannot afford to buy what they need on the wages they earn, with the burden of financing that assistance falling on all of society, not just on a few.
That all sounds great, don’t it? Forcing people to pay for their own medical care will provide great value for the dollar, and will keep prices down. Except that it’s utter hokum. First of all, Weintraub confuses the health insurance risk pooling allowed by the purchase of insurance through employers with “employer control”. While I’m not a fan of the current patchwork private insurance system, I hardly think that it amounts to “employer control”.
Second, the relevant markets for comparison are medical insurance vs. auto insurance and home insurance, not medical services vs. cars and houses. Medical services are potentially open-ended expenses that it’s hard to plan for. So are car accidents and fires. Cars and houses are known expenses that you can plan for; nobody buys “car-buying insurance” just in case someone unexpectedly forces you to own a new car.
You buy insurance in advance, because you don’t know when you’ll need it. The chances are that not everyone needs the payout at the same time, and the insurance company makes enough profit investing your money that it works for everyone. What employers provide with regard to medical insurance purchases is risk pooling and a form of bulk discount, neither of which you can get as an individual. In that sense, right at the outset, Weintraub’s comparison is inapt. People of moderate and more-than-moderate means do purchase their own medical insurance, either directly or risk-pooled through their employers. Poorer people get Medicaid, the elderly get Medicare (and supplemental insurance if they can afford it). That’s precisely the system that Weintraub proposes for spending on medical expenses, so apparently his whole beef is with the concept of health insurance.
Third, Weintraub pulls a classic Republican rhetorical trick: the hearkening back to the halcyon days of the Greatest Generation. Things were so much better back then. Except that medical science has advanced a great deal since 1941. We can do much more to save people with much more serious illnesses and injuries than we could in those golden-lit days of yore. And of course those new services mean that medical costs are higher. It’s not an apples to apples comparison to suggest that middle-class people can pay for the best medical service today (if they even could before World War II).
Last, if we were to compare apples to apples, medical spending is just plain different than most kinds of individual spending, even very large ticket items. It’s almost impossible to make truly informed decisions. The stakes are often life and death. The expenses are not optional.
- How much medical spending is too much? How much is too little? How do you know? Is that pain in your chest gas or a heart attack? Are you willing to bet your next mortgage payment on the answer?
- What is the best course of cancer treatment? The cheaper one, or the more expensive? You have to make that decision inside of a month, because your wife’s life depends on it. And so does your children’s college fund. And your house.
- Your son has a chronic illness. You can afford to pay for his care, but only by selling the house that your parents left to you. Of course, eventually you will become eligible for the subsidy that Weintraub believes the poor should receive.
Weintraub has an oddly active imagination. He imagines that health care is a largely optional service. He imagines that it’s possible for an individual heartsick with worry can be an informed consumer of health care, a field in which even the practitioners are hard-pressed to keep up with new developments. He imagines that health care costs would not bankrupt even upper middle-class families.
In fact, the only place that Weintraub’s imagination fails him is that he seems unable to imagine what it would be like for people to try to deal with a health emergency without insurance.
