21 April 2010

My Brother's Keeper

A cornerstone of Obamacare is the sharing of risk, which means sharing the cost of covering that risk. In order to insure the uninsured and the otherwise uninsurable, we must compel young, healthy people to buy health insurance. So far, so good - as long as you don't think the Federal government's compelling people to buy something infringes on their liberty.

But then, young healthy people can jeopardize their life and health by engaging in risk-taking behavior, which could turn them from being a source of funds into being a very expensive sink. So, if your risky behavior puts my financial well-being in jeopardy, I might want to compel you to wear a helmet whenever you bicycle. I might want to make it illegal for you to smoke - anything. Maybe I want to monitor your drug and alcohol intake. Maybe I need to compel you to take all your medications, exactly as your doctor prescribed. Perhaps I should consider making you take anger management classes to keep you from hurting yourself or other people whose health care I may be required to subsidize. If I am my brother's keeper, I want some say over how well my brother takes care of himself.

You get the idea. There is an unavoidable trade-off between taking care of each other -  sharing risk - and curtailing individual freedom of action. At one extreme we have Libertarianism - which maximizes liberty by letting everyone go to hell in their own handbasket if they can get one, and at the other we have Woody Allen's dictator from Bananas proclaiming that everyone must wear underwear, and "Underwear will be worn on the outside, so we can check."

So, maybe you don't object to my keeping you from smoking, drinking too much alcohol, or abusing drugs. But maybe I need to prevent you from engaging in promiscuous sexual activity, because that puts the whole society at risk for Sexually Transmitted Diseases (STDs). Nah. That would never happen. I mean, if Social Conservatives ever come to power again, they would just dismantle Obamacare. They wouldn't just change it to suit their agenda, would they?

But then, the whole idea behind Obamacare is that the changes it makes should be very hard to reverse. This is supposed to be a permanent change to do permanent good. Right?


AnneB said...

My personal belief is we're sharing the cost already, it's just nigh-invisible. Hospitals may not require proof of insurance to provide care, or turn away the uninsured. When the poor and uninsured show up at my local hospital, it's reflected in what my insurance pays the hospital, and in turn, what we pay out in premiums. (I will note that the only party NOT hurting in all this process is my insurance company)

I don't see the arguments about risk-takers holding much water, because I don't see how it follows. Engaging in risky behavior without insurance is just more risk. By holding back unless one has insurance, one is being somewhat risk averse, no? It doesn't matter to me which way, though- because either way, I'm indirectly paying both financially and socially for their actions.

Before the pre-existing condition clauses in the current HC law, it was easier for insurance to risk out expensive patients. Which is worse- corporations with boards whose memberships I cannot control making choices, or the government, whose representatives my community has some say in? Or is there really any difference?

Scooper said...

Actually, there isn't much difference. Neither big government nor big business is necessarily your friend. But my point was that if the government gets into the insurance business, then the government will naturally try to control risk. It's a little too much concentration of power in one institution, I think.

AnneB said...

I'm afraid I totally disagree with your view of the outcome, here.

Insurance companies can and do try to control risk. If you work for corporate America, you likely have an insurance choice of "this one HR picked. Your deductible will double this year. Like it or lump it." There's your one institution.

The government already runs three insurance programs: Medicare, Medicaid, FEHB (gov't employees health care). These give people an option to select from a number of directly competing companies. Competition is opened up to individual consumers, not just one company negotiating for all its employees for a choice of one.

Governments, national and local, have never needed insurance programs to enact safety laws- seat belt or helmet laws, banning smoking in government buildings. Keeping them out of the insurance business, won't change that. We only allow corporate insurance to over-charge for the risk they're mitigating for, because they are operating in monopolistic environments.

I've been under the FEHB and then insurance from a private employer. I'm now self-employed and on my husband's insurance through the county. FEHB was the best I've been under, hands down, and where I felt we as a family had the most say in the situation.

Undergroundpewster said...

I wonder where "love the neighbor" becomes "control thy neighbor?" Or when we become our brother's keeper (as in zoo keeper) would he be better off living and getting ill in the wild or under our so-called protection?

P.S. Sorry, but it has been I while since I checked in on you.

Scooper said...

See also this post: Kobayashi Maru