Wednesday, 14 October 2009

Sacred Cows

Having titled this post before writing it, and then going in a slightly different direction than I'd intended, the title is going to seem really cruel. It turns out to be pretty funny though so I'm leaving it.

The two party system hasn't ever had a home for me. In broadest strokes, I'm somewhat socially liberal (but decidedly not socialist) yet economically conservative/Smith-ian. The Republican party, with which I never felt particularly aligned, seems to have gone to reactionary social policies and economic stupidity while the Democrat party seems to be all about entitlements and general nonsense.

I don't know where in the spectrum my opinions on health care fall. Libertarian? Free market? Whatever label you want to slap on it, fine.

I have no faith in the health care debate. As poorly as the system works now, I don't hold any hope that it will work better after we get done improving it. You know what kind of insurance works pretty well? Car insurance. You may have had a bad experience with it, of course there are going to be individual cases, but in general the market works pretty well. The basic tenet is that if you are careful and drive safely, you pay less than people who drive like dumbasses and get in a lot of wrecks. We had a big claim last year and our premium went up. Howling and screaming from us? Nope. I had a couch fly at me on the way to Walkersville, yet my car was good as new and the shop was repaid by the other guys insurance, all in about 5 days. People with DUI's get to pay a ton for insurance, but there is mandated availability for their coverage. It costs a lot, as it should. There are countries with super Draconian DUI laws (don't get caught driving sauced in Sweden), and I don't really argue with them.

The basic principle is that the people who are likely to cost more should pay more - and there is an opportunity for people to change their risk profiles and thus reduce their costs. I cost the system a lot of money last year, about $30,000 if I remember correctly. This amount far exceeds the medical benefit I've ever incurred as an adult, probably by an order of magnitude. I engage in risky behavior (bicycle racing) and this risk caught up with me. In a more logical system, I would have gone from incredibly cheap coverage (excellent health profile, all other factors stable, nonexistent claim history) to somewhat more expensive coverage. I overpaid for years (or, more correctly, overpayment was made for years on my behalf) and I'm probably underpaying at the moment.

The best analogy I can make is to compare obesity to DUI. Obesity costs us in a zillion ways. Treatment of the downstream effects is a staggering cost. Productivity is lost due to illness and general physical inefficiency. I went to college close enough to Harvard to believe in the whole "mens sano in corpore sano" rigmarole. Entire systems are needing to be reworked - take a look at an elevator certificate sometime; recent certs divide the acceptable weight load among fewer occupants now. The ripple effect is huge. I'd like not to be one of those sanctimonious shitheads who heaps scorn upon everyone with a BMI of more than 20, but there is a good long freaking way between "a bit of a paunch" and what I see waddling around. You see some 280 pound lady throwing back Krispy Kremes like she was eating Tic Tacs and washing it all down with the Ultra Super Mega Gulp which contains enough corn syrup to monopolize about 6 acres of prime farmland for a year, and think "holy shit, enough's enough."

Maybe your parents didn't love you enough, maybe you got some hyper wedgie in third grade and you're still swallowing the shame, I don't know. The fact is, you're going to get Type 2, you're going to have crap quality of life, you're going to be on meds until you get fitted for the size XXXL pine box you're going to wind up in far sooner than you should have, and all of these things are your choice.

The bullshit about healthy food being too expensive is just that - bs. Our household grocery bills average about $110/week for two adults, plus we average about $60/week eating out. Take out the $60 and throw another $15 if we decided to economize that $60 out of the picture and you've got $125/week. There's probably $15/week average in non-food stuff in there (shit tickets, dish soap, laundry detergent, batteries, etc) in there so the food cost probably really is $110. I do the shopping and generally spend a lot more time in the healthy sections than I do in the ice cream section but if we were really militant, $10 in "not good for us" could go at no nutritional loss. So we're down to a hard net of $50/person/week. We eat a LOT of salad, a bunch of chicken, yogurt, etc. I pack a sandwich almost every day. Per meal cost is about what $2.50? You can't buy a Happy Meal for that.

So if we are going to legislate the amount that skilled medical providers can charge for the procedures that they spent multiple years and hundreds of thousands of dollars learning, why can we not also legislate against the proliferation of assinine life choices that place terminal burden on the health care system? Or why can't insurance providers simply charge more for those people who are placing themselves and the economics of the system at enormous (literally), preventable risk? Obviously one big hurdle is that the beneficiary's contribution is almost never very correlatable to the expense incurred in providing for that person.

Maybe life insurance is a good teacher? I know you get spanked on life insurance rates if you use tobacco.

Next up: unpopular opinions about immigration!


Jim said...

I'm okay with some risk pooling but frankly the insurance companies should have to fight it out with agribiz over who gets to control our wastelines and what we shove in our gullets. It's not a very libertarian position to cede control to the govt in particular, and maybe not to a business that has Market Power in any given market (such as a state with 4 insurance companies in that regulated industry).

BTW, one reason that your health insurance costs a lot more than your car insurance, is because it doesn't cost you $500 every time you want to visit your doctor. It does cost you $500 every time you claim on car insurance, and maintenance items - oil changes, checkups, lube jobs, gas additive to make it run better - aren't covered.

Chuck Wagon said...

Oh, I'm definitely not talking about the expense of health care relative to car insurance. More that the slope of the curves could be similar.

The main point is that we have people who, from the standpoint of their cost to the insurance system, display behavior that is substantively negative but they bear no brunt of that. Other people display markedly better behaviors yet receive no benefit vis a vis insurance.

Agribiz supplies us with what they've convinced us we want. If insurance providers had a mechanism for punishing people who buy what agribiz is selling, then maybe people would make a better decision.

Umbrella point - when your actions are untied from your consequences, you get shitty results. See also TARP.

Do whatever you want but pay the consequences.

My word is sycle.

Jim said...

Seems to me that if you federalize it and say "don't worry about pre-existing conditions" (many of which are caused to some extent by behavioral factors) then you're subsidizing bad behavior. I think the term is "moral hazard."

Chris P. said...

I just read this. It's pretty close to my feelings on the whole mess that I haven't really articulated myself. So I say, bravo.

word verification: ovestly, which sounds oddly similar to "obese". I swear we're being mocked here...