Al's Opinions

In yesterday's post (see below) I commented on a recent Libertarian argument against a proposal to provide universal health insurance to all by means of a single-payer system. Canada has such a system, as do many other industrialized countries. I am not satisfied with my own critique of the Libertarian argument against such an approach. I know that there are others who are much more able than I am to mount a convincing defense of single-payer and a devastating attack of the Libertarian argument. However, I will attempt such an attack anyway.

The writers made the following four arguments against proceding now with setting up a single-payer plan:

1. A single-payer or universal plan doesn't provide timely access to certain expensive medical procedures, such as joint replacements or organ transplants.
2. Lack of personal health insurance or personal wealth does not preclude Americans from obtaining health care from hospital emergency rooms.
3. Statistically, one can not show that having health insurance correlates with having better health.
4. The additional cost of caring for the uninsured is no more than three percent of the total cost of the American health care system, the writers say.

Rather than proceed with a single-payer or universal plan, the writers recommend that we should try to do something about things that drive up the cost of health care to mericans. We should adopt such remedies as health savings accounts, a standard health insurance deduction in the personal income tax, and deregulating the insurance industry.

1. Access to such procedures as joint and organ replacements are delayed in some countries by a shortage of facilities to perform the procedures, not by the bureaucratic inefficiency of the government's health care plan. In addition, in our own country, these precedures are not available to persons who lack both insurance and the money to pay for them. We read in the papers of accounts of poor, uninsured persons who do receive such procedures, but they are the exceptional cases in which some generous person or organization pays the cost. Libertarian point #1 is not a valid argument against universal health care.
2. Emergency room care also does not provide expensive treatments like organ or joint replacements. It provides only the medical services needed to prolong a person's life or to treat an illness. If you have a weak heart and have a heart attack, the emergency room staff will resuscitate you but will not give you expensive treatment for your condition.
3. There are several possible explanations for the lack of correlation between having good health and having insurance. One is that a majority of Americans do have health insurance. The lack of correlation simply means that insured Americans, on the average, are as healthy as the average uninsured American. A good fraction of uninsured Americans are young people with good health who either can't afford the insurance or don't see any need for it. Another is private insurance is not structured to encourage one to stay healthy by having frequent check-ups. It is structured to enhance profit by discouraging visits to the doctor unless the patient has a case that is convincing to the insurance adjuster.
4. To argue that the cost of caring for the uninsured amounts to "only" three percent of the cost of the American medical care system and then to argue in favor of such controversial and untested remedies as deregulating the insurance industry, setting up personal health savings accounts, and an insurance deduction in the income tax seems rather hypocritical to me. I have no doubt that providing insurance to the uninsured would reduce that three percent cost to something less.

Anyway, for what it's worth, there is my answer to the Libertarian argument against universal health care or universal health insurance. I welcome your comments.

Labels: Cato Institute, delays in expensive medical treatments, Libertarian, single-payer, Universal health care