Wednesday, April 30, 2008

Market-Driven to Insanity


I like the thrust of [John McSame's] market-driven approach, but by allowing insurance companies to deny people insurance for pre-existing conditions, and undermining the employer-based insurance system, the risk to people already dealing with medical issues is enormous. I'd love to be able to buy my own health insurance and keep it from job to job. But I'm HIV-positive and no one would sell it to me. And McCain's plan would leave people like me stranded.
Read this and marvel at how Sullivan contrives to treat "market-driven approach" as though it contrasts with "allowing insurance companies to deny people insurance for pre-existing conditions." These don't contrast at all -- for insurance companies, denying coverage to people likely to make claims is the quintessence of market-driven behavior. Exposing people with imperfect health to the full force of risk is the heart of treating health care as just another service for sale.

The market-driven approach to health care stands on the timeless wisdom that health care is something for which a rational consumer may develop a demand: he may wake up one morning and decide that it's finally time for that kidney transplant, or to do something about that exploding appendix, or to ask some pointed questions about the fainting episodes, or apply a splint to that nagging broken limb, or learn more about the three-year-old's persistent coughing and vomiting. Or he may choose instead to seek a different service -- the advice of a stock broker, the attentions of a masseuse, the know-how of a drywall installer. Who's to say what a choosy consumer might decide upon a morning? Surely not government!

The "market-driven approach" to health care is, and always has been, amenable to a two-word summary: get rich. Get rich and then you'll be able to afford whatever the doctors, hospitals, and pharmaceutical companies wish to charge for their expertise and service. For that matter, get rich and you can afford to hire your own personal physician and/or buy your own hospital and/or start your own pharmaceutical company. Amass a gigantic pile of money and you can be assured of affording all the medical care you'll ever want or need, pre-existing conditions notwithstanding.

That's John McSame's answer, which is and always has been the Wide Stance answer for health care: get rich. If you find you can't afford insurance or otherwise afford the health care you need, then get richer, because that's a clear market signal that you've failed to amass a large enough pile of money. Any questions?

In conclusion, I repeat: health care is not funny.

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