You mean I should have read the end first?
Once again I return to Cato Unbound to comment in areas I have no business commenting on regarding fields beyond my depth. But hell, it’s better than working, right?
This month’s Lead Essay by Arnold Kling goes through all the mechanics of what he believes market-based health insurance would look like (which he refers to, surprisingly, as “insurance”) and what is wrong with the current system of going to your doctor any time you get a hangnail (described as “insulation”).
I did chew through the whole thing, in which there was a variety of interesting statistics, examples, anecdotes and arguments. I have done this so that you do not have to, a service of substantial value were it not that you would not be here but for reading Kling’s essay first. I recommend reading only and exactly two parts–the introductory section describing the premise of the Lead Essay, and the last paragraph.
Why do I say that? Because of the following items: (1) The public has proven and continues to prove to be amazingly resolute in ignoring logic backed by evidence in favor of temporary benefit and/or relief for discomfort (such as fear); (2) Kling spends what I consider to be an inordinate amount of time telling us what market-based insurance would look like, an exercise I consider to be a waste of time; and (3) the last paragraph contains the only useful information about what is going to motivate the public to seek reform.
With regards to the first point, I don’t see any other way to interpret the political data we have accumulated over the history of this country. We have gradually shifted from a relatively free (if generally dysfunctional) society to a relatively quite regulated (and still dysfunctional) society. Libertarians have as much ammunition as anyone should need for various evidence-based arguments, yet even under a historically limited-government political party we continue to slip further and further towards whatever end of the political spectrum guarantees us less freedom–sometimes moving both left and right at the same time on different issues, see, e.g., prescription drug benefit and civil liberties in the past couple of years. There is perhaps some small amount of evidence that libertarians are making inroads in specialized areas–local and state movements regarding marijuana, for example, but talk about sticking your thumb in a dike full of holes!
The point is that the public has become so mistrustful of and cynical regarding ”data” itself that I don’t know whether the dissemination of what libertarians consider to be fair and impartial data means much of anything except to those already predisposed to believe it. I believe Kling’s last paragraph provides the only real evidence people will believe.
With regards to my second point, Kling seems fairly comfortable describing what he believes the market would provide absent government incentives for the status quo. While I don’t have any outright objection to his doing so, I generally tread in these areas very carefully. Even given contemporary and/or historical examples, should anyone really feel comfortable claiming reliable speculation in advance as to what a market solution will look like? Perhaps Americans value insulation to such a degree that markets will adjust in a sustainable way to provide affordable levels of reasonable insulation. After all, if this millenium has shown us anything it is that fear is still the great motivator. What if Kling’s MRI results had shown a more serious injury? Or if his nephrologist has actually turned up something important to his health?
Perhaps he would not have been here to write his well-argued lead essay, but it would have been the optimal market result! At least it would be under his framework (and don’t get me wrong, I’m on his side). And perhaps that is the right answer, but I don’t know that I would foreclose the idea that people will spend a lot on their own health and the health of their loved ones. If you have trouble convincing people of the logic in arguments on a logic-heavy topics, wait until you try to convince them of something relating directly to the health and well-being of their children. That’s getting off-point a little bit (but is certainly worth noting in any discussion involving changes to our health care system), so I’ll just go back to saying that even someone as well-researched as Kling I believe will struggle to be accurate in predictions about how the market would react without the presence of government interference other than to say that market forces would impact the status quo very quickly and that the general direction would be towards more overall efficiency.
My final point of the three, and quite frankly if you’ve read from the beginning I’ll say that you almost certainly could have skipped directly to this paragraph, is that I believe the last paragraph carries as much persuasive power as you are ever going to get out of this subject, and no one is going to believe it until it happens. See point 1, re: data cynicism.
Good luck, Mr. Kling, you’re going to need it.
