Peter responds
Wednesday, October 1 2008
Peter (of Medical Pastiche from the last post) has been good enough to correspond with me in comments, but I want to pick up his most recent remarks for a post of their own. They’re lengthy, and deserve a systematic response. You can read the full comments beneath my post, or on his blog, but I want to excerpt here to pick up a few points.
Peter’s probably right about this:
Those who are high-risk tend to remain high-risk, and those who are low-risk tend to remain low-risk. This is not a function of yearly benefits fluctuating among individuals. [...]
Nonetheless, I would still like to see some data. Specifically, I want to know whether or not this is generally true:
It is not like the ones who receive the most benefits will pay back their dues in the future once they’re healed [...]
As it happens, this is specifically untrue in one crucial case: mine. Though I have been a heavy user of the medical system in the past, I am hoping to significantly curtail my use thereof in the near future so that my insurance premiums go to subsidize others’ care. If I don’t, though, it’s important to remember that this is not a closed system: even while using up benefits in this one area, I have been able to contribute (perhaps significantly) to the fortunes of my employer. Were there no health insurance plan, or were I excluded from it via underwriting, I would not have had that opportunity. This is one reason why universal health care is important: it provides the necessary prerequisites for sick people – like me – to fully participate in society. In that respect, universal care is profoundly democratic, and so I find Peter less than compelling here:
Regarding opinions on wealth redistribution or socialism you may not agree with me: some praise Obama’s system precisely because it ushers in socialized medicine through the backdoor, others decry Obama’s system precisely because it simply is socialized medicine.
There are dozens of programs that Peter could call “socialism”, according to his overly broad definition – Medicare, Medicaid, food stamps, TANF, Social Security (retirement and disability), etc. The reason we have these programs is not that we are socialists, but because they address problems that markets ignored (or, in some cases, created). These programs may not work perfectly, but very few people argue we should discard them entirely. In general, and particularly compared to much of what the federal government already does, I don’t think Obama’s plan (pdf) is accurately described as socialization of the health care system. It depends crucially on private insurer involvement in the health care market, and in fact many progressives have criticized the fact that it depends too much on private insurers. In their view, it would be better if government were more involved – that is, what Peter would call more “socialized”. The only people I hear calling it socialized are those who have some ideological opposition and want to defame the plan with a handy epithet. It is that same agenda that prevents Peter from seeing the relevance he denies here:
Firefighting and police are not services provided by the federal government, so I do not know why you are bringing that up in a discussion about federally-provided healthcare.
I introduced these as examples of government being used to address problems that also could be addressed through markets. Government is a scalable concept, of course – which is why we have local, state and national governments. Firefighting is perhaps a local problem, but crime is sometimes not. So Peter is not entirely correct about police services: we have several national police services: the FBI, ICE, U.S. Marshals, etc. None of these are constitutional duties – at least not with the specificity that national defense is – because the Constitution is foundational, but no comprehensive. That is, the federal government does things – a lot of things – that are not specified in the Constitution. If Obama’s plan were ruled unconstitutional by the Supreme Court, that would be one thing – but nobody is arguing that it will be. Such programs usually fall under the Congress’s power “to regulate commerce… among the several states”. (Art. 1, Sec. 8). So Peter is less than compelling – again – here:
Socialized healthcare, or healthcare in general, is not a constitutional duty for the federal government. The states should feel free to enact such plans since that is in their purview.
I wonder again why what that which is truly morally corrupt at the federal level is okay at the state level; I don’t think the line between truly morally corrupt and not truly morally corrupt runs through the tenth Amendment, but this may be another area where Peter and I disagree.
So if Obama’s plan is not unconstitutional, what’s wrong with it? Peter again:
Insurance by its very nature of having a benefits-recipient disconnected from the true cost of a good or service by way of a third party payor, introduces the economic principle of moral hazard. Obama’s plan is the worst possible solution to moral hazard because the true cost of a good or service is completely disconnected from the recipient.
It seems to me that Peter’s real problem is insurance itself. As I said, Obama’s plan depends on insurance companies for a significant portion of health care access. If Peter wants to argue health insurance is immoral, that’s fine (albeit somewhat Old Order Mennonite). But then why this – what else is he proposing?
Employer-provided insurance is not a panacea. It is a broken system. Those who lose their jobs lose their insurance coverage. Employers are getting squeezed by increasing premiums and are likely to drop insurance all together. That is not fair.
Peter and I agree about the employer-provided system, but I suspect he and I disagree about what constitutes “fair”. He thinks fair means getting what you are able to pay for. I think fair means not discriminating against the poor and sick. In a health care system driven by insurance companies, that is exactly what will happen: the sick and the poor will not be able to afford health care, and they will suffer. Peter is against redistributing wealth, if it means helping these people – but that means he’s okay with insurance companies profiting from their misery. Call me a socialist if you must, but I’m not okay with that. The irony is that he’s going to med school, ostensibly to learn how to help sick and injured people heal – yet his political philosophy evinces no concern at all for their well-being, apart from their ability to pay his bills. The reader is perhaps excused for suspecting an ulterior motive to his ideology.
