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 As we think about healthcare reform in this country, it might be a good time to contemplate the question of who really deserves to get healthcare paid for by others. (I have already, in a previous post, proposed the idea that much of the system remain the same and that those who cannot afford health insurance be supplemented through something akin to “Healthcare Stamps.”)
What I mean by this is: How much personal responsibility and accountability should we demand? For instance, if someone gets drunk and gets behind the wheel of a car, and gets into an accident in which he is injured, should the cost of that person’s medical treatments be borne by that individual or should tax dollars paid-in by others cover the costs?
The hypotheticals can get even more or less extreme. For an extreme example, if someone is robbing a bank and in the process accidentally shoots himself, who should pay for those medical treatments?
But it is the less extreme examples that will, I believe, stir more controversy. If a lifetime smoker ends up with lung cancer or emphysema, should that person be able to rely upon the hard earned money of others to provide for his expensive and self-induced healthcare costs?
If your answer to the above questions is “yes,” meaning that the individuals in all of the above examples deserve to get medical care even if they cannot afford it themselves, then I have a question for you: what sort of incentives are you suggesting we create? You would seem to be creating a system where individuals bear little or no financial responsibility for the voluntary and destructive decisions they make. Is that really the right direction to go?
If your answer to the above questions is no, that the individuals in all of the above examples should have to foot the bill for their own medical care and should not be eligible for taxpayer-based subsidies, then I have questions for you as well. If the smoker has to pay for his own medical care for smoking-related maladies, would you extend that principle to all areas of lifestyle and behavior-caused illnesses and injuries? A study was recently released (www.healthaffairs.org) that implicates healthcare costs related to obesity as now having exceeded that of smoking and drinking combined in the United States. So would you extend the principle of personal accountability and responsibility for behavior-caused illnesses and injuries to include treatment for Type 2 diabetes in the obese?
The answers to these questions are very straightforward in a world of private transactions between individuals and insurance companies. Insurance companies price insurance policies for different levels of accountability and different behavioral choices (as an individual, it is either more expensive, for instance, to get health insurance if you are a smoker, or the illnesses which are caused by smoking are specifically excluded from coverage). Hardly anyone could argue that this is unfair. But how do we deal with these issues in a taxpayer-funded system where everyone has the same coverage?
How about this: the taxpayer-funded portion of the system would be a Total Accountability system. That is, you are covered only for the things you don’t cause yourself. By necessity, this would then be a system focused on prevention, and so would have a chance to truly minimize healthcare costs. Then, if an individual wanted to be covered for other things not covered by the taxpayer-funded Total Accountability system, insurance companies would likely offer such policies (at a steep price, you can be sure, because they would just be licenses to behave recklessly and irresponsibly).
Defining and enforcing such a system could be complex, but I believe that most people would agree that we as taxpayers should not be forced to underwrite the medical expenses caused by the reckless and irresponsible lifestyle and behavioral choices of others.
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