MaxedOutMama
Tuesday, October 26, 2004
I. Mad dogs and absolutism and biting insects
...should be avoided at all costs. I've just finished reading Ronald Bailey's article Mandatory Health Insurance Now! on Reason's website. Ronald Baily is a science writer, and a good one, but I have two criticisms of his article.
First, Ronald Baily doesn't properly establish his fundamental tenet - that the US should avoid a socialized health care system at all costs. He treats this as a given, but the reason why so many people want to move towards socialized health care is that it seems like a good, safe, and ethical idea. Without explaining why it isn't, he can never win the public policy debate. I'll help him out on this one in a later article, just to celebrate being alive.
My second criticism of his article is that his solution, which is to have the government require that people purchase private health insurance, is fatally flawed. There is no small "tweak" to his proposal that can rehabilitate it. It can't work, and in order to defend my right to live I will show why in yet another article. You may be reading the last sentence as meaning "my right to live the way I want to"; if so, you're wrong. I'm going to be defending my right to live at all. Believe me, in a prison I'm not going to be getting the medical treatment I need to live.
I'm an incurably optimistic and compulsively analytical person, so I will conclude this series with some articles about what will work, and why it will. There are always solutions if you take time to understand the underlying problem. I believe Ronald Baily is both well-intentioned and sincere. He quotes many statistics in his article, and I believe those statistics are valid. But there is an epistemological problem here, and its very existence serves to show the perils of allowing scientists to determine public policy. Scientists believe in statistics and numbers, correctly so. However, probability and statistics can't be used to understand a poorly-understood problem. They can only be used to quantify a well-understood problem. Ronald Baily doesn't understand the entire problem, and therefore his honest statistics present a false picture. Before pontificating he should spend a year or so in doctors' offices talking to both the doctors and the persons who work for them, and then he should spend another year talking to their patients.
Unfortunately I have a degree of hard-earned personal knowledge about this topic. I have an incurable but treatable disease, and no private insurance company will write coverage on me. I've been trying to get coverage for several years now without luck. Several sympathetic independent insurance agents have helpfully sat me down and explained how to establish a false identity under which to get insurance, but I'm not going to do it. Fraud is stealing, and it's wrong.
Unfortunately the only way to support my right to live is to disclose rather personal information about myself, but I'm warning you now not to pity me. I consider myself about the luckiest person alive. I'm doing well, and I expect to be doing better a year from now. I have a happy life and probably more security than most of you. The fact that I am living happily is a good incentive for me to defend my right to continue my life without being made a criminal. If anything about my argument inspires you to compassion, invest it in someone more needy than I. If you look around your community I can guarantee you'll find someone who needs your help. I don't. I just need you to prevent the government from forcibly assisting me into an early grave, prison, or Social Security Disability. Any assistance you can give me in that would be welcome.
I'm astonished that Baily would advance such an inane and almost vicious proposal, and I'm even more astonished that it would appear in a journal that believes itself to be somewhat libertarian. If this is libertarianism, God save me from it. What is the difference between taxing individuals to establish a socialized health care system and legally requiring people to support such a system? In both cases those who evade the arm of the state will be imprisoned, although the charges might vary. In one case, after all, one would be evading taxes, and in another one would have failed to spend one's own money in the way the government required. I don't see the difference.
I suspect there isn't one, especially since Bailey's proposal requires government to establish new controls over a broad sector of the economy. The reason that no company will write insurance on me is that the expected cost of covering me far outweighs the premiums they can reasonably expect to get from me. Nor are they unethical at all in refusing to cover me. The only way they could write insurance on individuals like me without running the risk of going in the hole and being unable to pay claims would be to charge premiums so high that no individual could pay them for long. This would also be a form of fraud, because they would be taking money in the knowledge that almost certainly I would have to let my coverage lapse before I made a claim. Insurance is a statistical game, but ethics play a part in it as well.
So the only way that private companies can underwrite insurance for individuals like me is if the government will essentially agree to insure them for the additional risk. If the government must do this, the government must, of course, establish controls. And thus my medical treatment will, by some mechanism, be limited to that of which the government approves. It is not a good prospect at all for people like me.
I had private insurance, and once I knew of my eventual fate I was willing to sacrifice everything but my life to maintain it. The plan I had purchased had prescription drug coverage, but I had never used it. Eventually the day came when my doctor had to prescribe some pretty expensive drugs. My condition was degenerating rapidly and I would have died without those drugs. I had a form of meningitis, among other things. For the first few months I paid for them myself, but later, when my condition improved, I returned home and applied to my insurance to cover the next few months of treatment.
It was an off-label treatment prescribed by an out-of-state doctor. They denied coverage (a pretty routine practice among insurance companies), and I would have had to go to court to get them to pay for the drugs. I believe I would have won, but I would have had to pay my own legal expenses, because the insurance company had protections under law. So I had to make a very hard choice, and in the end I let my insurance lapse and used the premium money to buy the drugs. That was over seven years ago, and I have to say it was one of the best decisions I've ever made. The essence of Ronald Baily's proposal is to make it illegal for an individual like me to make that decision.
In his article, Ronald Bailey compares such a requirement to the requirement for house insurance and for car insurance:
"But the increasingly successful campaigns to privatize Social Security and expand school vouchers suggest a way out: mandatory private health insurance. Under this system, in effect, purchasing health insurance would be not much different from buying car or homeowner’s insurance today. As a result, we could preserve and extend the advantages of a free market with a minimal amount of coercion."
This is a terribly bad analogy. Flood insurance is required for improved real estate (buildings) in flood zones. One can always buy a house outside of a flood zone in order to evade the requirement. Car insurance is required, but one is not legally forced to own an automobile. Further, car insurance is only required up to a certain point, and it's a pretty low one. I believe it's $15,000/30,000 in the state where I live, whereas medical insurance covers much higher liabilities and is therefore far more expensive. Ronald Baily's proposal would require an individual to have health insurance as a condition of living as an adult. This seems, well, just a touch unfree to me, and as I say, it would have prevented me from making the choice that eventually saved my life. Is that a "minimal amount of coercion"?
That's all for tonight.
First, Ronald Baily doesn't properly establish his fundamental tenet - that the US should avoid a socialized health care system at all costs. He treats this as a given, but the reason why so many people want to move towards socialized health care is that it seems like a good, safe, and ethical idea. Without explaining why it isn't, he can never win the public policy debate. I'll help him out on this one in a later article, just to celebrate being alive.
My second criticism of his article is that his solution, which is to have the government require that people purchase private health insurance, is fatally flawed. There is no small "tweak" to his proposal that can rehabilitate it. It can't work, and in order to defend my right to live I will show why in yet another article. You may be reading the last sentence as meaning "my right to live the way I want to"; if so, you're wrong. I'm going to be defending my right to live at all. Believe me, in a prison I'm not going to be getting the medical treatment I need to live.
I'm an incurably optimistic and compulsively analytical person, so I will conclude this series with some articles about what will work, and why it will. There are always solutions if you take time to understand the underlying problem. I believe Ronald Baily is both well-intentioned and sincere. He quotes many statistics in his article, and I believe those statistics are valid. But there is an epistemological problem here, and its very existence serves to show the perils of allowing scientists to determine public policy. Scientists believe in statistics and numbers, correctly so. However, probability and statistics can't be used to understand a poorly-understood problem. They can only be used to quantify a well-understood problem. Ronald Baily doesn't understand the entire problem, and therefore his honest statistics present a false picture. Before pontificating he should spend a year or so in doctors' offices talking to both the doctors and the persons who work for them, and then he should spend another year talking to their patients.
Unfortunately I have a degree of hard-earned personal knowledge about this topic. I have an incurable but treatable disease, and no private insurance company will write coverage on me. I've been trying to get coverage for several years now without luck. Several sympathetic independent insurance agents have helpfully sat me down and explained how to establish a false identity under which to get insurance, but I'm not going to do it. Fraud is stealing, and it's wrong.
Unfortunately the only way to support my right to live is to disclose rather personal information about myself, but I'm warning you now not to pity me. I consider myself about the luckiest person alive. I'm doing well, and I expect to be doing better a year from now. I have a happy life and probably more security than most of you. The fact that I am living happily is a good incentive for me to defend my right to continue my life without being made a criminal. If anything about my argument inspires you to compassion, invest it in someone more needy than I. If you look around your community I can guarantee you'll find someone who needs your help. I don't. I just need you to prevent the government from forcibly assisting me into an early grave, prison, or Social Security Disability. Any assistance you can give me in that would be welcome.
I'm astonished that Baily would advance such an inane and almost vicious proposal, and I'm even more astonished that it would appear in a journal that believes itself to be somewhat libertarian. If this is libertarianism, God save me from it. What is the difference between taxing individuals to establish a socialized health care system and legally requiring people to support such a system? In both cases those who evade the arm of the state will be imprisoned, although the charges might vary. In one case, after all, one would be evading taxes, and in another one would have failed to spend one's own money in the way the government required. I don't see the difference.
I suspect there isn't one, especially since Bailey's proposal requires government to establish new controls over a broad sector of the economy. The reason that no company will write insurance on me is that the expected cost of covering me far outweighs the premiums they can reasonably expect to get from me. Nor are they unethical at all in refusing to cover me. The only way they could write insurance on individuals like me without running the risk of going in the hole and being unable to pay claims would be to charge premiums so high that no individual could pay them for long. This would also be a form of fraud, because they would be taking money in the knowledge that almost certainly I would have to let my coverage lapse before I made a claim. Insurance is a statistical game, but ethics play a part in it as well.
So the only way that private companies can underwrite insurance for individuals like me is if the government will essentially agree to insure them for the additional risk. If the government must do this, the government must, of course, establish controls. And thus my medical treatment will, by some mechanism, be limited to that of which the government approves. It is not a good prospect at all for people like me.
I had private insurance, and once I knew of my eventual fate I was willing to sacrifice everything but my life to maintain it. The plan I had purchased had prescription drug coverage, but I had never used it. Eventually the day came when my doctor had to prescribe some pretty expensive drugs. My condition was degenerating rapidly and I would have died without those drugs. I had a form of meningitis, among other things. For the first few months I paid for them myself, but later, when my condition improved, I returned home and applied to my insurance to cover the next few months of treatment.
It was an off-label treatment prescribed by an out-of-state doctor. They denied coverage (a pretty routine practice among insurance companies), and I would have had to go to court to get them to pay for the drugs. I believe I would have won, but I would have had to pay my own legal expenses, because the insurance company had protections under law. So I had to make a very hard choice, and in the end I let my insurance lapse and used the premium money to buy the drugs. That was over seven years ago, and I have to say it was one of the best decisions I've ever made. The essence of Ronald Baily's proposal is to make it illegal for an individual like me to make that decision.
In his article, Ronald Bailey compares such a requirement to the requirement for house insurance and for car insurance:
"But the increasingly successful campaigns to privatize Social Security and expand school vouchers suggest a way out: mandatory private health insurance. Under this system, in effect, purchasing health insurance would be not much different from buying car or homeowner’s insurance today. As a result, we could preserve and extend the advantages of a free market with a minimal amount of coercion."
This is a terribly bad analogy. Flood insurance is required for improved real estate (buildings) in flood zones. One can always buy a house outside of a flood zone in order to evade the requirement. Car insurance is required, but one is not legally forced to own an automobile. Further, car insurance is only required up to a certain point, and it's a pretty low one. I believe it's $15,000/30,000 in the state where I live, whereas medical insurance covers much higher liabilities and is therefore far more expensive. Ronald Baily's proposal would require an individual to have health insurance as a condition of living as an adult. This seems, well, just a touch unfree to me, and as I say, it would have prevented me from making the choice that eventually saved my life. Is that a "minimal amount of coercion"?
That's all for tonight.
Comments:
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Interesting, to say the least. You make a good case for your point of view. Anytime the government gets involved it does establish control, with it a bunch of busybodies, which then judge your right to the benifits that government can provide. May work for most, but for those that fall out of the narrow scope of the government approved treatment plans, it means doom.
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# posted by 
: 12:33 PM
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