What Makes Health Care Different?
By Arnold Kling
1. I do not think that the economic differences between health care and other goods are as fundamental as the difference between the believers in Expertism and the believers in Masonomics. We can all agree that outcomes in health, education, energy, are different from what would ideally want. But the Left concludes that to get better outcomes we need Experts to fix the problem, using the power of government. The Masonomists believe that when markets fail, use markets, because solutions are arrived at not by centralized experts but by decentralized trial and error.
2. Nowhere in the developed world do you see individuals paying for a substantial share of health care out of pocket. This includes the United States, where, if you take into account private insurance and government spending, the proportion of health care expenses paid for by individuals is even lower than in Canada!
I think that (2) is an important empirical fact. It suggests to me that there is a natural human aversion to seeing people pay for their own health care. We have to take this into account in thinking about health care policy, because it creates a dilemma for conservatives. The economically “correct” approach of having people take on more of their own health care expenses (using variations on catastrophic insurance) is anything but conservative. On the contrary, free-market health care is radical and therefore inherently dangerous. That is why I would prefer more cautious experiments with my ideas (say, at a state level) than a wholesale adoption.
What explains people’s aversion to having a commercial exchange with their doctors?
1. Paying for health care is like paying for sex. People want healing to come as a gift, and paying for it demeans its value.
2. People who need health care are suffering. When someone is suffering, to compound their suffering by demanding payment feels immoral. I have noted the similarities with usury–which was deemed morally repugnant because back in the day the borrower was likely somebody who was having trouble feeding his family, not somebody who was trying to develop a fancy shopping mall.
3. Robin’s view is that health care is something we want to give to others. It isn’t so much whether your terminally ill grandmother wants hip surgery or not. You want her to have the best quality of life possible in what little time remains. Robin would say that, even more important, you want to signal to her and to others that you want this.