Kindly Póg Mo Thóin

Scott, Amanda and Roy all have excellent posts up in response to Jane Galt’s libertarian fantasia re just how good those old and sick people have it, after they had the temerity to age and fall ill! Quoth Jane:

Moreover, as a class, the old and sick have some culpability in their ill health. They didn’t eat right or excercise; they smoked; they didn’t go to the doctor as often as they ought; they drank to much, or took drugs, or sped, or engaged in dangerous sports. Again, in individual cases this will not be true; but as a class, the old and sick bear some of the responsibility for their own ill health, while younger, healthier people have almost no causal role in the ill-health of others.

What Jane seems to miss is that old people were young once, and sick people were often healthy, and young, healthy people do stupid, risky things. Meaning, that over the course of a lifetime, any given person will have different health care needs at different points in time. The whole concept of a risk pool is that the cost and the risk is spread out, and sometimes you pay in more than you get out, and sometimes you get out more than you paid in.

Additionally, I love how Jane lectures those who are sick because they “didn’t go to the doctor enough.” Heaven forfend we might put a system in place that would allow people to go to the doctor when they have a small problem, rather than forcing them to forgo healthcare until the problem is big enough and serious enough that they wind up at the ER, or miss time from work, or simply die because they haven’t been adequately treated.

Insurance and healthcare is on my mind a lot lately, for obvious reasons. Oh, trust me, I’d have loved to have gone to a doctor this week to get a scrip to clear up my sinus infection. And I’m sure that Jane thinks I’m irresponsible for not moving heaven and earth to find the money to get treated, and that it would be my own fault if I got some kind of systemic infection and died.

Rather than a libertarian, Jane sounds like a moral scold. As does one of Scott’s commenters, who gets the vapors about the behaviors that bring those nasty poor people into the ER:

The structure of a universal care system should somehow promote and reward healthy living.

How does one deter the freeloaders who take poor care of themselves and then overuse the system for years on end (as sort of mental health therapy)? “It will not happen” is a questionable response - it happens now.

Spend some time in the ER system, then tell me those system users have adequate incentives to a) take care of themselves and b) ration free/universal health care for themselves and their families.

We have millions who go see MDs less than they should and a large chunk who are over-users of MDs. Why would anyone overuse MDs? Depression, chronic, I suppose.

Oh, look! More hectoring people who don’t have health insurance or the money to see doctors about their irresponsibility for — not seeing doctors! We will leave the dig about “overusers” of MDs having depression for another time.

Scott responds here, with the very important point that — as I stated above — people tend to be consumers of health care at very different rates at different points in their lives, with rates of consumption much higher closer to death. If a person dies young, that means that they’re not going to be alive and consuming health care when they’re old, so lay off with the moral-hazard arguments already.

What Jane and Scott’s commenter are doing there is thinking like an insurance company — which will look for any reason whatsoever for denying coverage and booting sick people off their rolls. Yeah, the bottom line is great for insurers when they only have young, healthy people paying premiums and not using their services. But insurers, even when they cover healthcare costs, are often looking for someone else to pay. Which is where you have a lot of personal-injury and medical-malpractice litigation happening.

It struck me tonight, as I walked by the hedge where I was nearly disembowelled a couple of weeks ago, that if I’d been injured by those hedge clippers, I’d have had to have sued to recoup my out-of-pocket medical expenses. Because I have no insurance. But even if I had insurance, the insurer would have attempted to recoup the costs of the covered medical.* Which would mean, essentially, that the insurance company would hire a lawyer and file suit on my behalf to recover from the guy with the hedge clippers (who, assuming he was the owner of the house and not a hired gardener, would have paid any judgment by making a claim on his homeowner’s insurance).

One of the elements of damages in any suit to recover for personal injury (whether due to accident, illness or medical malpractice) is medical expenses. And those expenses can be considerable, particularly in a case in which someone will need medical care for the rest of his or her life. Tort reformers are always complaining about the high awards for medical malpractice and personal injury, and about high insurance rates. But let’s be real — someone has to bear the medical costs for injury, and in the absence of universal health care, it’s going to be, ideally, the person who caused the injury. And the simple fact is, if an insurance company pays out medical expenses to an injured party, they’re going to go looking for reimbursement from somebody — probably another insurance company.

Now, universal health coverage isn’t going to eliminate damage awards in personal-injury and med-mal cases, because you still have pain and suffering, lost income, and punitive damages which need to be assessed, among other things. But if you can eliminate the award for medical expenses because the state pays for those regardless of who’s at fault, and insurance is not necessary, is it inconceivable that we might begin to see a huge reduction in the amount of money paid out in these kinds of cases?

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* Back when I actually had insurance, I had to go to the ER because I was bitten by a stray dog I was fostering. I mean, my insurance had just kicked in the day before, so I was lucky. But while my insurance company paid the bill, they kept sending me forms asking me to describe the accident and give them any information that would allow them to assess whether someone else was responsible for the accident. I was pretty lucky — even though he’d bitten my hand, he missed all major tendons and the wound didn’t get infected (apparently, once you start messing around with puncture wounds (particularly bites) in hands, it can get ugly, if the tendons get infected or inflamed). Still, the bill for a visit to the ER, a wash with some disinfecting stuff, a sling, a shot of antibiotics and a referral to a hand surgeon should that be necessary came to over $800. Can’t even imagine what it would have cost had the hand surgeon been necessary. Or how much time I’d have lost from work, since it was my right hand.