Universal Health Coverage
By Arnold Kling
Is universal health care coverage possible? Ramesh Ponnuru of National Review says nay.
If you can’t get an operation because your country’s national health insurance system has you on a long waiting list, in what sense have you enjoyed “universal coverage”?
Jonathan Cohn of The New Republic says aye.
some countries with universal coverage don’t seem to have waiting lists at all, even for elective procedures. It’s hard to be 100 percent certain about this: France and Germany, for example, don’t actually keep official statistics on waiting times. But that’s because nobody in those countries seems to consider queuing a problem.
I think that it’s an uphill battle trying to argue that universal health coverage is impossible. I think that the issue is that there is no externality argument to justify such coverage.
As I wrote here,
If the state passes a law that says that you have to pay for your family’s health insurance, that’s mandatory health insurance. If the state passes a law that says that you have to pay for my family’s health insurance, that’s universal coverage.
1. Let us grant that there is an externality argument for providing for health care for poor people. Poor people doing without health care makes me unhappy, so go ahead and tax me to pay for that. We do not need universal health coverage to address this issue, however. You may have heard of something called Medicaid. If it works for its intended beneficiaries, then fine. If not, then fix it.
2. Take it as given that some people do not want to pay for their own health insurance (many people turn down health insurance offered by employers, because they do not want to pay even the subsidized premiums).
Am I so distraught that there are people who choose not to get health insurance that I want to see the government force them to get health insurance? I am afraid not. Someone needs to make a persuasive argument why this is an externality. It strikes me that this is a much harder argument to make for health insurance than for car insurance.
(With automobiles, an uninsured motorist might cause an accident and then not be willing/able to pay for damages to someone else. This suggests a need for mandatory insurance, although even in that case I could be persuaded otherwise–I hate car insurance and I think it’s a racket.)
But we are not talking about mandatory health insurance for those who shirk insurance. We are talking about universal coverage. What that means is that people who choose not to get health insurance should be rewarded with a health insurance gift from the rest of us. This seems to be an awfully peculiar basis on which to provide a government subsidy: those who devote their own incomes to obtaining health insurance get no subsidy; but those who choose to spend their incomes on other goods and services do get a health insurance subsidy.
I don’t think my book on health care policy (which, by the way, just became available and makes a great gift) even mentions universal health coverage as an objective. Since I’m not trying to win the Nobel Prize in Moral Vanity, I don’t see what the concept of universal health coverage has to offer.
UPDATE: for more on this topic, including data on the “voluntary uninsured,” see this paper by John Goodman. He offers some important perspective:
A proliferation of state lawas has made it increasingly easy for people to obtain insurance after they get sick. Guaranteed-issue regulations (requiring insurers to take all comers, regardless of health status) and community-rating regulations (requiring insurers to charge the same premium to all enrollees, regardless of health status) are a free rider’s heaven. They encourage everyone to remain uninsured while healthy