Healthcare, simplicity, and “personal responsibility”

At Granite Grok, Skip is arguing that the government’s involvement in a healthcare system providing coverage to all citizens translates into a boondoggle. That it might indeed, and like Skip I think there are procedures carrying costs that clearly should not be borne by the herd. He mentions bariatric surgery; I would throw obstetrical care on top of that in the groundless hope that people would think a little harder before deciding to bud, but that’s a different issue.
Some of Skip’s ancillary points, however, drew my attention. He is, you see, is a fan of Personal Responsibility. (Actually, everyone is, at least in theory. I’ve never heard anyone claim out loud that the rest of the world should bear the brunt of their unruly…uh, never mind.) If you smoke cigarettes and weigh 300 pounds, I shouldn’t have to foot the difference between your and my health insurance coverage, and under a universal government plan I’d probably wind up doing just that. And if you stay safely indoors at night while I run up and down the streets with an MP3 player blocking my hearing, you probably don’t feel like paying the difference between what the actuarial tables say about you and what they say about me.
Regardless of how people feel about Uncle Sam’s role in health insurance, things are never as simple as they ought to be. One of the hallmarks of the “you break it, you buy it” crowd when it comes to healthcare is that they pretend to be stepping back and looking at the whole picture when all they’ve done is get their feet tangled up, fall on their asses, and fixate on a single dimly lit portion of the sky.
In assembling his case, Skip cites the “sage words” of columnist Walter Williams regarding Mississippi’s idiotic and dead-on-arrival House Bill 282, which proposed penalties against restaurants for serving fat people. Some of Williams’ “sage” commentary:

A daily salt intake exceeding 6 grams can lead to hypertension. A high-fat diet and high alcohol intake can also lead to diabetes. A sedentary lifestyle can lead to several costly diseases such as hypertension, diabetes and heart failure…You might argue that it’s none of government’s business how much fat, salt or alcohol a person consumes, even if it has adverse health care cost implications. I’d ask: Wouldn’t the same reasoning apply to helmet laws and proposed obesity laws?

I’d answer: Does Williams really believe that a cyclist’s decision whether to wear a helmet has a simple counterpart — in terms of both risk and simplicity of potential enforcement — in micronutrient intake? And as an African-American, would he cheerfully agree to pay higher insurance premiums because his statistical risk of diabetes is 70% higher than it would be were he white?
Williams is obviously equivocating when arguing against helmet laws on the basis of these being tantamount to the government regulation of dietary composition. This kind of argument is fraught with all sorts of obvious epidemiological perils (for example, people’s blood pressures respond to a given amount of sodium intake to wildly varying degrees), but it appeals to people who sees the world in convenient, completely unreasonable terms. The compulsion to simplify issues in a way that only complicates is a hallmark of “personal responsibility” champs who invariably reveal their ideas to be tenuous, inconsistent, or ignorant upon basic questioning.
Skip writes:

I’ve said for years that if someone chooses to ride without a helmet, let them. However, they had better have stickers all over the bike and helmet stating that they had insurance. If not, the EMTs had the ability to just leave them by the side of the road. Dr. Williams is right – why should all of the citizenry, via their government, be forced to care for those participating in risky behavior?
Note: my son rides….without a helmet. I consider him an adult perfectly able to make his own, rational decisions. And yes, I have informed him that if he dumps the bike and makes a vegetable of himself, expect no help from me….buy insurance!

Come on. Does this guy really expect people to believe that if he saw his own helmetless, uninsured son involved in a serious accident, he wouldn’t call for medical help because of a coverage issue or because his son had it coming? Or that if EMTs showed up anyway, he would tell them to go away because his son couldn’t afford to live?
I can see requiring people who drive motorcycles to purchase huge insurance policies to forestall the effects of catastrophic accidents, although unlike Skip I don’t think that merely being insured should be carte blanche to go out and behave with unmitigated recklessness. Perhaps Skip does not understand that such behaviors and their consequences feed directly into the costs of obtaining health insurance to begin with. Does he think that everyone on the coast of Florida should “just have” windstorm policies when practically no companies will even write them, much less make them available?
But having society intercede on the excessive risk takers at the level of an already bleeding and battered body is the sort of fantasy only the most narrow-minded people would conceive of. EMTs have one job: saving lives. Asking them to rush to an MVA scene, decide immediately if the bloody mess in front of them is insured, determine if there’s a helmet around, figure out who’s responsible for the accident (what if the motorcycle wasn’t speeding and was instead broadsided?), etc. is not only counter to their training, it’s impossible.
Skip, after describing the New Hampshire state senator underwent a gastric bypass and now thinks the procedure should be routinely covered, writes “I have no intention of demanding that government take care of me via mandates to insurance companies.” But most people have all sorts of intentions of getting the government to drop the hammer when it’s a blow for their side, even in areas that have no impact whatsoever on their own lives. This is from the same blog featuring a nutball who has agitated mightily for government intervention on homosexual behavior and believes that medical data indicate homosexuality is a reversible condition.
Like Skip appears to, I see a clear division between an insurer not covering bariatric surgery and deciding on the basis of something such as BMI whether to charge certain people higher premiums (and I say that as someone who could probably never get fat if he tried; the relationship between body size and morbidity risk is multfaceted and extremely complex). Similarly, I see a difference between regulating a binary behavioral decision such as helmet wearing and decisions about what to eat. I really can’t see finding a useful middle ground in “let people do whatever they want and the people will figure out how much to charge them for healthcare,” but apparently many people can.
Skip winds up with the observation that “Once again, we see people who can make law that just don’t get real economics.” I’m not sure what his solution is; maybe it’s to take the government out of the equation altogether and let the lynch mob decide on its own what is and what is not too costly to treat. We could start by denying care to the children of each and every dumbass parent who refuses for religious reasons to have their kids vaccinated and go from there. We could also require churches, those purveyors of divisiveness, fear, and antiquated jibber-jabber, to quit sucking off the tired tit of society and ante up their fair share in property taxes, because forcing sensible people to throw money into the bottomless mouths of imaginary beings unquestionably deprives them of personal liberty in the form of higher property taxes. Sound good?

  1. #1 by decrepitoldfool on March 12, 2008 - 9:55 am

    I’m all for making churches pay taxes. No idea how to get there from here, though.

    I can see requiring people who drive motorcycles to purchase huge insurance policies to forestall the effects of catastrophic accidents

    How about people who drive oversize SUVs with their proven higher kill ratio? Or people who drive small cars knowing there are SUVs on the road?
    It isn’t about what risks we take, it’s about the fact that we all take risks someone else wouldn’t approve of. And about the kind of society we want to live in.
    To those who complain that the gub’mint might screw up universal health coverage, it’s not a magic spell. We still have to run it competently, like anything else. But other countries have managed, I suppose we could too.

  2. #2 by Mark P on March 12, 2008 - 10:35 am

    Virtually all of these arguments are based on personal interest. As I said in a comment on another blog, I think the only people who argue against universal health care are rich or have insurance coverage from their employer. And by “rich” I mean that they can afford to buy decent insurance. Whatever anyone says, it is a national disgrace that we allow so many people to suffer from insufficient access to health care when we spend so much money on other things.

  3. #3 by decrepitoldfool on March 12, 2008 - 12:50 pm

    As far as I’m concerned, it’s very much in my personal interest to have everyone covered. I read somewhere that a Libertarian is someone who believes he never makes mistakes, has no dangerous faults, and is immune to bad luck.

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