Healthcare: “Insurance” Now Just Means Redistribution | Mises Wire

Burns on Health Care


Americans have been fighting over health insurance reform for ages. For example, 25 years ago, in 1992, over 200 congressional health care bills were introduced.

Unfortunately, while the rhetoric has focused on insurance, such as how many would supposedly gain or lose insurance if some change was implemented, that has not been the real issue. Income redistribution has. As Henry Aaron estimated that year, implementing a comprehensive national health insurance system would redistribute more income than any single national policy then in existence.

What Is Insurance?

How do we know insurance is not the real issue? Because claimed “reforms” violate so many principles of insurance.

Insurance is about reducing risk in the face of uncertain events. But insuring things that would happen for certain, say annual checkups, offers no risk reduction — it offers no benefits to weigh against the added costs of insurance administration that must be borne — yet such coverage is frequently mandated.

Similarly, small health care risks are cheaper to provide for from modest levels of savings, rather than bearing insurance administration costs. If one’s own resources were involved, absent government interventions, they would not be insured at all. Only when others are forced to bear much of the cost would people want insurance to cover such things.

Administrative costs are not the only issue, either. The benefits from risk-reduction through insurance would also have to outweigh the cost of the health care. This is made especially difficult by the fact that the insurance itself induces over-consumption of health care services.

However, when most health care costs are borne by third parties rather than individuals themselves, there are many margins at which those individuals will want better care (e.g., better and more specialized doctors and hospitals, more costly newer drugs, tests and treatment utilizing the latest technology, etc.), as well as more care. Since that added care need only be worth what an individual pays, net of insurance coverage, much of it is worth far less than its cost to society, further limiting what people would voluntarily cover based on the principles of insurance.

Those considerations explain why lunch insurance does not exist. You will almost certainly eat lunch, which also involves relatively small expenses, so there would be little risk reduction. And if someone else would pay most of your bill, you would order far more expensive lunches than otherwise, raising the premiums that you must be charged to pay for it. The benefits don’t justify the costs, again unless others are forced to pick up a substantial part of the tab.

Also, insurance is about risk reduction that people value more than the premium they must pay for it. Thus, voluntary market insurance would not mandate coverage of things people had virtually no risk of experiencing. Teetotalers would not willingly insure for alcoholism treatment. Those sure they would never use drugs would not insist on addiction treatment. Yet government “reforms” are full of such mandates. And a quarter-century ago, before many current mandates were in place, it was already estimated that up to one-quarter of the uninsured population traced back to such cost-increasing government-imposed coverage regulations.

The price controls reform proposals incorporate are also about income redistribution, rather than health insurance. Say that my age makes my actuarial risk six times that of my students. If, as Obamacare required, I could not be charged more than three times what they were, that does not reflect actual risks. Obamacare regulations simply force the young to subsidize the old. That rip-off of the young also explains why Obamacare threatened them with a penalty to force them to accept that bad “insurance” deal.

Read More: How Government Healthcare Interference Got Started in the U.S. and What It Will Lead To

Health Care

One of Ludwig von Mises’s keenest insights was on the cumulative tendency of government intervention. The government, in its wisdom, perceives a problem (and Lord knows, there are always problems!). The government then intervenes to “solve” that problem. But lo and behold! instead of solving the initial problem, the intervention creates two or three further problems, which the government feels it must intervene to heal, and so on toward socialism.

No industry provides a more dramatic illustration of this malignant process than medical care. We stand at the seemingly inexorable brink of fully socialized medicine, or what is euphemistically called “national health insurance.” Physician and hospital prices are high and are always rising rapidly, far beyond general inflation. As a result, the medically uninsured can scarcely pay at all, so that those who are not certifiable claimants for charity or Medicaid are bereft. Hence, the call for national health insurance.

But why are rates high and increasing rapidly? The answer is the very existence of healthcare insurance, which was established or subsidized or promoted by the government to help ease the previous burden of medical care. Medicare, Blue Cross, etc., are also very peculiar forms of “insurance.”

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