The Cato Institute’s Radley Balko, on taking the “Public” out of “Public Health”:
In the AP article, I made the case that HSA-type vouchers in Medicare and Medicaid instead of government blank checks might help instill some personal responsibility and ownership in individuals. I still think that’s true, but it of course isn’t a panacea. People will continue to make decisions about their own diet and lifestyle that will cause them to put on weight. I don’t think that MSAs or HSAs will magically make everyone skinny.
When I debate this issue, my opponents inevitably bring up Medicare and Medicaid. “Your arguments might apply in the private sector,” the argument goes, “but shouldn’t government do something to keep poor people from getting fat, so as to save taxpayers money down the line?”
No. For two reasons.
First, this isn’t a case of “pay now, or pay later.” It’s a case of “pay now and pay later.” If the report that came out yesterday is true, we have continued to get fat despite the incessant government and media warnings and dire predictions about how we need to start watching our weight. Why does anyone think that massive government intervention is going to work? Nine out of ten people who go on diets don’t lose weight, lose weight then put it back on, or end up gaining weight in the end. Does anyone really think government efforts to help people lose weight will be any more effective? If you think so, I’d like to introduce you to the War on Drugs, the War on Poverty, and just about every other society ill government has set up an agency, program, or department to eradicate.
Second, the purpose of the Medicare and Medicaid vouchers would be to give people control over their own health care again. If you know that the extent of your health insurance is limited to what’s in your voucher—no more, no less—and that money you don’t spend can go to your retirement, or to your kids, there is at least some financial incentive to take care of yourself. You’re still free to do otherwise. But you do so knowing that you and only you will bear the consequences. The taxpayers aren’t going to bail you out.
I’m certain that some, many, or most people on Medicare will continue to get fat. But under a voucher-HSA system, their getting fat will be their own perogative, and their own problem. The size of their pants will be between them and their doctor, not official government business.
What it would essentially do is eliminate the “public costs” argument public health activists like to put out in response to my argument that personal habits and “saving you from yourself” are none of the government’s damned business.
Precisely.
Yesterday, to my horror, I watched as Bill O’Reilly argued what is increasingly the standard populist postition that the government needs to get involved in policing “self-destructive” behavior, if only to save “the taxpayer” down the road from the (largely illusory) set of epidemics professional nannystatists—shrewdly disguised as concerned scientists—are always warning against. O’Reilly cited such behavior as over-eating (leading to obesity) and drug use (leading to addiction)—though to be fair, he was careful to point out that he wasn’t so concerned with curbing personal freedoms per se as he was with having to pay for the longterm effects of not having curbed them in some way, a distinction with a (minor) difference.
But as Balko points out, we have no reason to believe massive government intervention would solve the problem—and in fact, such an intervention would make things worse to the extent that it increases the government’s realm of influence over what should clearly be personal choice.
Unfortunately, the argument against rolling back individual freedoms is not enough to push back against those who are willing to surrender a measure of personal freedom in exchange for what they perceive to be a financial winfall down the road, either in decreased taxes or a drop in health care costs. Which is why Balko’s willingness to counter with a concrete solution—namely, a voucher system that places the burden on the individual user and his healthcare provider—is an important component to making the argument for keeping the government out of the waistline business.
Bingo.
I don’t have a concrete solution, but I do wish there were some way to legislate or institute a better form of self responsibility. I don’t necessarily want helmet laws for bikers, so if you choose to leave the brain bucket at home and end up a vegetable in some ICU, I also don’t want my tax dollars to pay for your care. Sorry.
Choose to smoke? Fine. Absolutely. But the lung cancer treatment comes out of your pocket.
Can’t control that craving for Village Inn’s French Silk pie each week? Then don’t. Have an extra serving! But I’m not paying for your balloon angioplasty, either.
Don’t know how to do that, but it’s the world I’d like to live in. Near absolute freedom and near absolute responsibility for your actions too.
Did someone mention pie?
Was just having this same conversation at Gutrumbles today. Why does it seem like the world is going mad before my very eyes?
How would you legislate self-responsibility? To me that sounds just like legislating morality, only with a different set of mores. It can’t be done. The only thing is to push back against the “do-gooders” and let people deal with the consequences of their own choices.
If we have to have *some*thing, I don’t mind the idea of a limited voucher. But people don’t think that way. The notion of healthcare “entitlement” is getting worse all the time. They’re going to look at their little slice of the pie and howl to holy heaven about how cruel and unfair it is that they don’t get a whole pie (because, well, they’re special). And politicians being what they are will capitulate. Then we’re right back where we were, looking for ways to cap rising costs and forcing people to give up their freedom for the good of the “collective”.
All this nannyism makes me want to stuff my face with pie and smoke myself blue. I’m going to sue O’Reilly
Being lazy, and frustrated in trying to come up with an appropriate comment, I will simply take the easy way out. I quote P.J. O’Rourke:
“Authority has always attracted the lowest elements in the human race. All through history mankind has been bullied by scum. Those who lord it over their fellows and toss commands in every direction and would boss the grass in the meadow about which way to bend in the wind…” [Parliament of Whores]
If you change that from “bullied by scum” to “trod upon by those who know better what is good for them” I think you have a nice summary of such nanny statism.
Uh oh, Major John, don’t say that aloud – I’m sure calls for mandatory exercise are just around the bend.
Two areas of the economy where costs/prices have risen fastest over the last three decades are health care and education. Any wonder why?
Increased government involvement: the government has provided large and increasing subsidies so that the consumer has paid a decreasing portion of the direct cost of the service.
Existing government policy, via subsidies to the consumer, results in increased and increasing demand; hence, ever higher costs/prices.
Want better self-responsibility, or morality? Change the incentives.
I realize many find the previous question horrid, but we already “legislate” self-responsibility, or the lack thereof, by the programs in-place.
Why are education vouchers so powerful? Because they introduce individual choice, while at the same time breaking up the low quality, high cost of the state’s education monopoly–also known as opening, an otherwise closed market, to competition.
I don’t need to repeat Balko’s argument regarding health care vouchers, but the implication is to change the demand side incentives to the point where there are actual costs or savings depending on how the consumer utilizes the vouchers.
I almost choked on my Twinkie when I saw this segment.
O’Reilly was the inadvertent “spokes-per-child” against socializing health care.
The panic of “scientific community” is likely overstated by at least two orders of magnitude, much like the hoax of “global warming”. To answer any eco-moonbats who picked up this post with their tin-foil helmets, yes, I have an engineering degree and I worked as a thermodynamic analyst on NASA enviroment control and life support systems (ECLSS) hardware programs.
W and his 47 bpm resting heart rate is overweight by goverment guidelines.
I would suspect that there is not only a significant positive correlation between the high-caloric carb/dairy loaded US diet since 1900 (thanks to refrigeration and, dare I say, preservatives) and the increase in obesity rates, but also with increases in other metrics such as average height and expected life span.