Some people believe the Fourth of July grants them liberty to disturb the night with their firecrackers. My pursuit of happiness is in conflict with theirs and I want them jailed. We all gladly infringe on the liberties of others while in pursuit of our own happiness.
For example, should motorcyclists wear helmets? Yes, if all of us expect to pay their hospital bills (through higher premiums) and maintain them on disability after they have head injuries that might be avoided by wearing helmets.
But if we did not expect to pay the costs of injuries realized by helmet-less motorcyclists, would we limit their liberties and impose helmets on them? That is, would we restrict the behavior of others if their actions had no consequences for us? Do we have concern or compassion for others, no matter how foolish and thoughtless they may be with their motorcycles or firecrackers?
Today, we limit smoking because it harms the smoker and others. But is our chief complaint that we bear (through our insurance rates) some of the medical costs resulting from the smoking of others?
Now, some firms seek to control or influence what we eat and how much we exercise. A local hospital chain proposes to reduce biweekly paychecks by $5 for people who smoke or have high blood pressure, high blood sugar or high “bad” cholesterol; $10 per paycheck would be deducted for high body-mass-index scores. Hit the jackpot and it will cost you $780 per year.
For most of us, health insurance is paid in full or in part by our employers. For others, the government picks up much of the tab. Those who pay these bills want to see them reduced. It is likely that, if each of us paid for his/her own health insurance, we would see less interference with our choices. Private insurers would certainly impose higher premiums on those whose behaviors proved to increase health risks. But the relationship would be between individuals and insurers.
Why not convert health insurance to a totally private system? First, an antiquated tax code encourages employer-sponsored health insurance plans. Second, we want everyone to have good, if not superior, health care services and we are willing to pay to care for the indigent, the elderly and the young. We believe that, without good health care, life, liberty and the pursuit of happiness are not feasible. But we are concerned that a private system would price the poor out of the market.
Would health care be such a big issue if it were less costly? Is our medical system expensive because we have not organized the delivery system efficiently? Are too many patients treated in the wrong facilities by too many specialists? Does virtually universal insurance subsidize the demand for medical services and guarantee suppliers high incomes? Mandatory statewide or national health insurance would not improve this situation.
Medical costs are increased by drug companies, hospitals and others who advertise extensively. How many patients have been scared into believing that indigestion is a heart attack? How many of us diagnose our aliments and suggest remedies seen on TV to our doctors? Do surgical centers and other specialist facilities exist mainly to boost the income of doctor-owners? Why do hospitals compete to make birthing a luxury experience?
These views do not reflect a callous indifference to the disadvantaged. But we should recognize that health care is not inherently different from other highly desirable goods and services. As a society, we do not provide every citizen with quality housing. The state does not guarantee the quality of education, an adequate income or access to quality, low-cost transportation.
Until we come to our senses about health care and health insurance, we will continue to tell others what to do and to limit their liberties in order to protect our own pocketbooks.
Marcus taught economics for more than 30 years at Indiana University and is the former director of IU’s Business Research Center. His column appears weekly. To comment on this column, send e-mail to [email protected]