Health Care and Freedom

Was talking to a liberal (he would say Progressive) friend the other day about health care. One point I raised was that these debates often devolve into fine points about what system is most efficient at delivering medical care to people, but that individual liberty is of value by itself. This country was founded on the notion that each of us is free. Maintaining that value is worth some inefficiencies, right? Certainly a common leftist attack on free enterprise is that efficiency becomes improperly exalted to deity status, ignoring what's really important to people. But apparently liberty is not one of those really important things.

My friend pointed out that one benefit of universal health insurance coverage is that the insurers would have incentives to get people healthier. There are a couple of problems with this, though. First, so-called "healthier" people are not necessarily cheaper to insure. Eventually, nearly everyone who lives a long time ends up with a chronic condition. It's much cheaper for the insurance company for you to die of a heart attack out of the blue at 55 that to live to 80 with a collection of chronic illnesses. Second, insurers already have an incentive to get people healthier, right? Even though the incentives are poorly aimed, with companies paying with tax-exempt dollars for a portion of the premiums that go to their employees' insurance, still if insurers could reduce claims by encouraging healthier lifestyles, they would be more competitive. And there are cases of them doing just that. But how can this concept be squared with community rating? It's certainly true that if insurers can actually charge you what they think you will cost them, their competitiveness will improve, and your insurance rate will be affected (positively or negatively) by your lifestyle. But the progressives want community rating.

So given community rating and a desire by insurers to get people healthier (let's stipulate they would want this for the sake of argument), how would they bring about their desire? Apparently, through legislation, which is exactly what the U.K. is doing. If you're too fat, N.I.C.E. might not pay for your operation - you're not keeping up your end of the social compact, you see. Nearly any food that might contribute to poor health could be outlawed or taxed in the name of health care savings. My friend's view was that this would be unfortunate, but after all, you have to break a few organic eggs (discarding the cholesterol-laden yolks, of course!) to make this omelette.

The impact this would have on individual liberty would be extraordinary and should be viewed as yet another reason not to combine community rating with universal coverage. Imagine a world in which individual people actually were free to contract with any agency they wanted to obtain health insurance. If wellness programs were financially sensible, no doubt insurers would offer them, just as auto insurers offer discounts for safety and anti-theft devices. Then individual people could choose to adopt them or not as they saw fit. Perhaps I'm willing to forego a hamburger a week to save $10/month on health insurance. Or maybe not. But it should be my choice, not one collectively made for me by Washington and insurance industry lobbyists.