Government Health Insurance as slavery
On some talking heads program on NBC today, various strangers were talking about the effects and validity of employers charging employees more for health insurance or firing outright employees for smoking or engaging in other risky behaviors. As I watched, I concluded that it was within the employer's right to hire or fire on any basis he or she chose, and that either employer action above was justifiable as a reasoned response to the expense of such employees to the company's health insurance premiums. Then I was left with the unshakeable suspicion that some level of government had caused this problem.
When taxpayers pay for everyone else's medical expennses, it is inevitable that personal behavior shall constitute a cost to taxpayers. That is, smoking, which is an exercise of individual foolishness, now raises costs for all citizens by requiring an additional expenses: a cessation program, respiratory treatments, cancer treatments, and even transplants. This becomes not a consequence to the individual, but what amounts to misuse of government funds. The logical extension, then, if all citizens should receive medical services for free, is that all citizens must be subjected to scrutiny and even penalty for engaging in activities that require more medical service.
Let me note at this point that health care is a myth: it doesn't exist. There are medical services and medical products, and then there are the choices that individuals make about diet, exercise, sleep habits, employment and nonemployment activites, etc. As above, universal health care requires subsidization of food, mandated exercise, a government nanny to put one to bed and get one up, and a government coach to keep one from taking unnecessary risks. Medical services and medical products are commodities, not rights or gifts, and should be treated as such, just as food, posturepedic mattresses, and Thighmasters are.
Think of taking your car to the mechanic. He looks it over, gives you an itemized estimate for the cost of repair, and you decide whether or not to have the repair performed at that time or place. Auto insurance companies actually require competitive estimates when they have to pay. Contrast this with a doctor's visit: you walk in, pay the check-up fee (or copay) and are billed separately for any tests that are run or any additional services provided. Doctor's overcharge, insurance companies underpay, each anticipating the other's intention. Wouldn't you rather get a reasonable diagnosis, be apprised of costs for further tests, and be given an estimate to fix what's wrong with you? Wouldn't it encourage lower medical costs if insurance companies required competing estimates for costly procedures? Granted, like the tow truck fee, you're stuck with a certain expense in emergencies. But once the car's off the road, and your condition is stable, economics can kick in. Take a look at this discussion on the evolution of health care costs.
But back to the government. State government requires all health insurance companies to cover specific medical services, varying by state. The federal government mandates other health insurance provisions for companies. This raises the cost of health insurance, which creates the alleged crisis in health care: many persons cannot afford healthcare unless it is subsidized by the employer and the government (one should point out that the pre-tax status of company health insurance premiums means that Americans who cannnot afford insurance are still paying part of the cost of those who have it provided by their employers). This reduces the ability of individuals to shop around for health insurance, or be comfortable not having any. It is analagous to the situation now of realtors trying to impose state regulation on all real estate transaction assistance, requiring them all to provide full-service, essentially forcing all realtors to charge more -- all to eliminate competition. Medical providers, including pharmaceutical companies are under no obligation to reduce prices on their products when government subsidizes those prices, either through elimination of competition, or through guaranteeing that those prices shall be paid by picking up the costs of, say, senior citizens, or other Medicaid recipients.
So, to come full circle, employers have to find a way to reduce the expense of group insurance policies. The most obvious way is to exclude or require extra funds from individuals engaging in behaviors that insurance companies identify as higher risks. If employees don't want to pay out of pocket, they have to put up with the drug tests and other measures the employers may enact. I'll note here that the International Workers of the World and other labor groups opposed the creation of company-based healthcare, for fear that the worker would become a slave of the all-providing company. That they failed to see the same danger in government-provided healthcare doesn't make them wrong about company-based healthcare.
As to the harshness of the title, I conclude that this situation constrains individual options to such a degree, by artificially increasing the consequences of certain choices, as a form of slavery. I view tax laws regarding 401k and other IRA plans, as well as Flexible Spending Accounts, Healthcare Spending Accounts, etc. as enslavement as well, and I'll talk about that in another post. The bottom line is that state regulation becomes a tool of sectors of the economy -- whether medical specialists or full-service realtors -- to restrict choice and increase cost for the consumer. Regulation also costs all tax-payers more, of course, because of the universally-borne cost of enforcement. The first step to rationalizing the cost of any product or service is to enable the consumer to choose among multiple providers of that product or service. See the Libertarian Party position on all this here.
Undoubtedly, some of you reading will ask what would happen to those who need medical services and can't afford them. As with all charity, my response is this: if you care enough about it, give your own money and try to persuade others to give theirs: don't enable the state to use its force to take property from everybody, or, worse yet, to distort the entire economy to ensure that only those within specific niches, can pay for the services in the first place. That's not generosity: that's tyranny.
When taxpayers pay for everyone else's medical expennses, it is inevitable that personal behavior shall constitute a cost to taxpayers. That is, smoking, which is an exercise of individual foolishness, now raises costs for all citizens by requiring an additional expenses: a cessation program, respiratory treatments, cancer treatments, and even transplants. This becomes not a consequence to the individual, but what amounts to misuse of government funds. The logical extension, then, if all citizens should receive medical services for free, is that all citizens must be subjected to scrutiny and even penalty for engaging in activities that require more medical service.
Let me note at this point that health care is a myth: it doesn't exist. There are medical services and medical products, and then there are the choices that individuals make about diet, exercise, sleep habits, employment and nonemployment activites, etc. As above, universal health care requires subsidization of food, mandated exercise, a government nanny to put one to bed and get one up, and a government coach to keep one from taking unnecessary risks. Medical services and medical products are commodities, not rights or gifts, and should be treated as such, just as food, posturepedic mattresses, and Thighmasters are.
Think of taking your car to the mechanic. He looks it over, gives you an itemized estimate for the cost of repair, and you decide whether or not to have the repair performed at that time or place. Auto insurance companies actually require competitive estimates when they have to pay. Contrast this with a doctor's visit: you walk in, pay the check-up fee (or copay) and are billed separately for any tests that are run or any additional services provided. Doctor's overcharge, insurance companies underpay, each anticipating the other's intention. Wouldn't you rather get a reasonable diagnosis, be apprised of costs for further tests, and be given an estimate to fix what's wrong with you? Wouldn't it encourage lower medical costs if insurance companies required competing estimates for costly procedures? Granted, like the tow truck fee, you're stuck with a certain expense in emergencies. But once the car's off the road, and your condition is stable, economics can kick in. Take a look at this discussion on the evolution of health care costs.
But back to the government. State government requires all health insurance companies to cover specific medical services, varying by state. The federal government mandates other health insurance provisions for companies. This raises the cost of health insurance, which creates the alleged crisis in health care: many persons cannot afford healthcare unless it is subsidized by the employer and the government (one should point out that the pre-tax status of company health insurance premiums means that Americans who cannnot afford insurance are still paying part of the cost of those who have it provided by their employers). This reduces the ability of individuals to shop around for health insurance, or be comfortable not having any. It is analagous to the situation now of realtors trying to impose state regulation on all real estate transaction assistance, requiring them all to provide full-service, essentially forcing all realtors to charge more -- all to eliminate competition. Medical providers, including pharmaceutical companies are under no obligation to reduce prices on their products when government subsidizes those prices, either through elimination of competition, or through guaranteeing that those prices shall be paid by picking up the costs of, say, senior citizens, or other Medicaid recipients.
So, to come full circle, employers have to find a way to reduce the expense of group insurance policies. The most obvious way is to exclude or require extra funds from individuals engaging in behaviors that insurance companies identify as higher risks. If employees don't want to pay out of pocket, they have to put up with the drug tests and other measures the employers may enact. I'll note here that the International Workers of the World and other labor groups opposed the creation of company-based healthcare, for fear that the worker would become a slave of the all-providing company. That they failed to see the same danger in government-provided healthcare doesn't make them wrong about company-based healthcare.
As to the harshness of the title, I conclude that this situation constrains individual options to such a degree, by artificially increasing the consequences of certain choices, as a form of slavery. I view tax laws regarding 401k and other IRA plans, as well as Flexible Spending Accounts, Healthcare Spending Accounts, etc. as enslavement as well, and I'll talk about that in another post. The bottom line is that state regulation becomes a tool of sectors of the economy -- whether medical specialists or full-service realtors -- to restrict choice and increase cost for the consumer. Regulation also costs all tax-payers more, of course, because of the universally-borne cost of enforcement. The first step to rationalizing the cost of any product or service is to enable the consumer to choose among multiple providers of that product or service. See the Libertarian Party position on all this here.
Undoubtedly, some of you reading will ask what would happen to those who need medical services and can't afford them. As with all charity, my response is this: if you care enough about it, give your own money and try to persuade others to give theirs: don't enable the state to use its force to take property from everybody, or, worse yet, to distort the entire economy to ensure that only those within specific niches, can pay for the services in the first place. That's not generosity: that's tyranny.
posted by heavynettle at 10:48
3 Comments:
You make some interesting points. But one widely accepted statement that you repeat here (not that it is central to your arguments) is also one that I've never seen proven; that is, that smokers end up consuming more tax-generated resources than non-smokers. Smokers, on average, die earlier than non-smokers. Now I know the accounting is supposed to keep retirement funds (especially social security funds) separate from other government acconts, but this has been a fiction for some time. So, given that retirement benefits come out of the same pool of money that health benefits for come out of, how much more, REALLY, do smokers cost us?
And it's not just social security payments, the whole suite of end-of-life health care treatments from nursing home care to organ transplants to everything else would seem to cost LESS in the long run for smokers, even if you factor in a (likely) greater use of resources for non-lethal smoking related ill-nesses.
Again, the commonly accepted wisdom may be true, but I've never seen a balanced sheet that seemed to have all the real costs/savings to the larger system of smokers listed in an open, honest fashion. Perhaps that is too much to hope for when an issue gets politicized--naked truth loses its constituency.
Any evidence you come across for the claims that smoking results in a net loss to the government would be enlightening. Who knows, it might even be an accurate claim.
OK, I did some searching to try to answer my own question. Mostly what I found is that smokers fund a hell of a lot of stuff through "sin taxes" and other shakedowns, but that they do actually incur greater costs for health insurance.
BUT, this interesting study from the New England Journal of Medicine, which I believe to be a reputable source, shows that if we all quit smoking there would be short-term savings in health care cost for about 15 years, but after that the population of older people would have grown to the point that savings, as measured in health care, would disappear. The question on whether smoking is good or bad for society therefore has to be judged on whether or not a larger population of elderly would be a good or a bad thing for a society.
As for individuals, dude, smoking is idiotic. My neighbor across the street is dying a slow death from emphysema. If the oxygen tanks in her house don't kill her in a massive explosion, then she's looking at death by drowning over a painful 5-10 year period, in addition to severely diminished physcial capacity.
One place where I strongly support regulation is in advertising of addicting, lethal products to children. When I was in Guatemala some years ago, I noticed a candy-flavored cigarette with a clown on the package being marketed to kids. Buckley Jr. had a novel a couple years back called "Thank You For Smoking!" in which people attempted to kill a cigarette company marketing executive by swaddling him in nicotine packages. Ouch! Let the punishment fit the crime, I guess (no, I'm not advocating that for anyone, but one can fantasize.)
I know I'm opening myself up for charges of being anti-individual, pro-big government with such a statement, but so be it--marketing death to children is just wrong, and cigarettes belong behind the counter and smoked in the privacy of your own tomb..er, home.
Interesting discussion. As you note, it is peripheral to my topic: the cost to the employer is higher for smokers, because he doesn't pay for the medical services, but the health insurance, and insurance companies know that their payouts for the services they cover (long-term assisted living not among them) is higher for non-smokers.
I have an alternative for you on restriction of advertising: full disclosure. Any company advertising a product must provide a listing of ingredients and properties thereof. Addictive potential, links to diseases and other side effects, would be essential. The details I would have to work out, but the bottom line is that in the case of certain products, television advertisement would be impossible. Magazine ads could have a lot of small print, I guess, to get by -- but, frankly, caveat emptor.
Which brings me back to the main point of my post, which was that forcing everyone to bear the expense of each individual's consequences cheapens liberty and exposes everyone to expense not related to their own choices -- while raising the total cost through oligopolism and regulation.
Of course, the last thing, one which I mean to discuss at some point, is the final line: okay, so somebody fails to plan for his retirement and cannot afford housing. Do we let 'em die in the street? The alternative is a local tax-based shelter, and we're back to depriving individuals of property for the benefit of another. One counter-argument is that we might all find ourselves in that situation, but that's really a load of crap: for most of us, the number and kind of events that would have to happen to leave us homeless -- rather than housed uncomfortably -- make that eventuality practically impossible; similarly, for most of us, becoming homeless could occur only in events that would leave almost everyone homeless: war, disaster on a national scale, etc. But we're still left with a certain number of bodies in the street if we don't, at the municipal or county level, tax citizens for state-run shelters. Private, charitable shelter could pick up the slack, and would be a better target for individual contribution, but that margin is still the issue. At the same time, communities that provide no charitable support merely shuffle off part of their problem to other communities.
So some would say that I have just given the argument for federal welfare, but that is unacceptable: the level of compulsion, of price inflation, of corrupt redirection of funds is just too high to see such a federal program as desirable. It must be at a small, local, and easily supervised level.
Oh, well. As the Libertarians said in the '80s and '90s, we can't make paradise; we can only make the situation better than it is now. And dropping the mandated expense of state-subsidized medical care may not lower costs, but at least it will reduce the (tax) expense to each individual.
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