Feverish Fiat

UPDATE: socialism in action--Canada

Robert at Rubicon says America's a "sick, sick country." He wonders why the US is:

the only rich country that denies healthcare insurance to a large proportion of its citizens—the total number of Americans without is now up to 45.8 million.

In using the word "denial," Robert suggests governmental interference in the insurance market. Robert supplies no evidence for his claim, nor could he: No law or regulation forbids buying health insurance.

Indeed, Robert's formulation assumes his conclusion: that healthcare is some sort of individual right. Obviously, nothing in the Constitution obliges, nor empowers, Federally funded insurance. Yet nothing prevents the States from mandating and funding universal healthcare. Treating the post as talking points for legislative lobbying, has Robert made the case for socialized health insurance? No, for many reasons, and particularly these three:

1. Limits on the "right" to healthcare: Robert doesn't specify, but any healthcare right could not be absolute. Government is about priorities, and spending is not necessarily fungible. Appropriations and public policy always are "compared to what?" If one assumes healthcare follows the 80/20 model (20 percent of budget will serve 80 percent of the recipients; the remaining 20 percent "hard cases" consume 80 percent of the budget), must coverage aim to be universal? Even, for example, for substance abusers? And this is the result of underfunding.
   
   Not even socialized insurance can escape the long-standing debate over "rationing by price" vs. "rationing by queue" vs. "rationing by technology." But neither governmental fiat nor taxpayer funding sidesteps the need for rationing--and it's brutal consequences. Robert provides no guide for distinguishing appropriate public goods from vain or futile demands.



2. Public opinion surveys: I've no doubt polls say Americans want government-provided healthcare. Yet, I doubt it's a meaningful statistic. Most would welcome Washington paying their mortgage but "voting one's self rich" is an unworkable public policy.¹ Free goods, including free healthcare, will be overused. There's ample data on this covering the U.K., Canada, the EU and -- most recently -- France:

   There is no incentive not to indulge the slightest twinge. The French go to the doctor more than twice as often as the Swedes.

3. The number of uninsured: Even assuming the accuracy of Robert's numbers (which are disputed), the 45 million vastly overstates the extent of the problem,² thus possibly prompting over-dedicating scarce resources to healthcare. In particular, according to the Congressional Budget Office, the figure represents those "who are uninsured at a point in time during the year." Being less stratified than Europe, Americans enjoy substantially more income mobility, and commensurately greater insurance fluidity. Census Bureau data show (figure 11) that gaps in family health insurance last, on average, only 5.6 months. Indeed, in the late 1990s, CBO estimated that about 84 percent of the uninsured were covered again after two years." Only 21 to 31 million were uninsured all year.

I'm not advocating ignoring the uninsured. Still, the population most at risk is some 40 percent smaller than headlines suggest. This may both cast doubt on any systemic flaw in U.S. healthcare and militate against radical or far-reaching solutions.

Nationalizing healthcare or insurance wouldn't necessarily reduce costs, deter over-prescription, rescue patients from bankruptcy, streamline bureaucracy--or improve healthcare. So why are so many nostalgic for HillaryCare?

Tinker?--fine. Socialize?--not in my state.

More:

Real-world evidence from MaxedOutMama of Canadian health bureaucrats morphing into ostriches.

Still More:

Ric at Release the Hounds posts a Bill of Non-Rights, which includes:

ARTICLE V: You do not have the right to free health care. That would be nice, but from the looks of public housing, we're just not interested in public health care.

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¹ How many "yes" responders would backtrack if informed that funding would be reallocated from Federal aid to their local schools?

² Approximately 10 percent of the uninsured deliberately eschew coverage. Almost half the uninsured are in families earning over twice the poverty line (e.g., $39,000 per year for a family of four) suggesting causation other than cost.