Friday, March 4, 2011

Health Insurance Doesn't Matter?

Surely you are joking, Mr. Feynman.

I've written about this before: the fact is that there's only been one longish-term study on health insurance, the RAND Health Insurance Experiment. The result was the same as the Folgers coffee test. No difference. Well, not exactly. As Jim Manzi says,

According to the study, “The poorest and sickest 6 percent of the sample at the start of the experiment had better outcomes under the free plan for 4 of the 30 conditions measured.”

Otherwise the study showed that the more "free" health care people get, the more they use it. That's all.

I suppose that the reality in back of health care is that, when people are sick, they use their human ingenuity to get access to health care. Humans are good that that, presumably for evolutionary reasons.

But the problem with health care is that there are two kinds: health care that makes you better and health care that makes you worse. Manzi then goes on to kick a hole in the whole approach to health care proposed by liberals like Ezra Klein.

Klein clearly has a very sophisticated take on the issue, and wrote in 2009 that health-care reform is not primarily about improving health, but in reducing how much we spend on it. As he put it, “The purpose of health reform, in other words, is to pay for health care — not to improve the health of the population.” Fair enough. But the real debate, then, would be about whether market forces or bureaucratic control would be better at reducing costs, not about which would be better at promoting health for the “poorest and sickest” or anybody else.

Oh come on? ObamaCare is all about reducing health care costs? Really? Is Ezra Klein seriously suggesting that the political hardball of 2009 and 2010 was just a decent effort to search for ways of reducing health care costs?

If there is anyone left in the world who thinks that the bureaucratic method is the way to reduce costs on anything, I've got a bridge to sell them.

The fact is that people in politics are people interested in power. They get power by winning elections. Politicians, left and right, design programs to distribute money to their supporters. Democratic politicians distribute money to their supporters with spending programs; Republican politicians distribute money with tax cuts. There are plenty of people that love the idea of free health care for them and their family. That kind of person votes for politicians that offer free health care and the politicians know it.

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