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Why is healthcare so special?

by Greg Krehbiel on 2 August 2017

A recurring meme in the national chattering about healthcare is that Congress should get the same healthcare that everybody else gets. So if Congress gets gold-plated healthcare, everybody else should, and if we have to get Obamacare, so should Congress.

Why?

Why doesn’t this apply to other perks Congressmen get? Should everyone in America get special parking privileges at Reagan Airport, the way congressmen do? Or special postal privileges, or special security, or, for that matter, Congressional salaries and pensions?

Obviously not. That would be stupid. So what is the point of this argument about Congress and healthcare?

Clearly people think healthcare is different than any other service we receive.

I have to eat, but that doesn’t mean restaurants are morally required to feed me. I need shelter, but that doesn’t mean somebody has to build me a house. But somehow we think places that offer healthcare are morally required to provide service without pay.

Why?

What is so special, so different, about healthcare?

An expensive car is usually safer than an inexpensive car. So should we insist on public funding to give safe cars to the poor?

Nutritious food is often more expensive than junk food. So should we insist on public funding to give poor people fresh fruits and vegetables?

What is it about healthcare that turns all these normal, everyday facts of life on their head?

2017-08-02  »  Greg Krehbiel

Talkback x 6

  1. Nat Whill
    2 August 2017 @ 12:00 pm

    First, let me say that I’m not among those calling for Congressmen and staffers to be forced into Obamacare; not so much because they don’t deserve it, as because they’d just figure some way around it, and they are paid enough to absorb the cost anyway.

    But to the point of your question, some of those things you mention, such as the franking privilege or special security, aren’t so much perks as as they are defrayments of the costs of doing their (largely theoretical) jobs. Other things, such as high pay, the availability of nice restaurants, hotels etc., are indeed perks, but no one is forcing the rest of us to eat at restaurants or to stay in hotels at all. Also, there is a very wide range between the most and least expensive hotels, restaurants, etc. But most of us are required by law to buy health insurance, whether we want it or need it or not. Moreover, it’s not sufficient to have an inexpensive barebones catastrophic policy, but one which covers all kinds of things that any individual policy holder is very unlikely to need.

    So for me the difference is that I don’t begrudge Congressmen or other highly paid persons the benefits that come with that. But I do begrudge their exempting themselves from onerous laws that they force on the rest of us.

  2. pentamom
    2 August 2017 @ 12:32 pm

    The interesting thing is that the ACA requires congress to participate in the exchanges. They’re outside the normal federal system, but inside Obamacare.

    So the whole argument is based on a false premise.

    http://www.npr.org/sections/health-shots/2017/04/12/523335954/what-happens-to-a-congressmans-health-insurance-if-obamacare-goes-down

    That said, I agree with Nat.

  3. pentamom
    2 August 2017 @ 12:34 pm

    And the difference with healthcare is that everybody views it through the lens of appendicitis, so to speak. You can think about which grocery stores to use in advance and shop around. Most people have several days’ worth of food stocked in their homes so if you have to take bit of time to think about where to shop, or delay it a bit to get a cheaper option, there’s margin for that. But when you have appendicitis, the health care had better be there, available to you, in a form you can afford.

    The idea that people can shop around for health care while they’re healthy so they have it when they get appendicitis does not seem to occur to them.

  4. Derek
    3 August 2017 @ 10:02 pm

    On top of all that, there is nothing in the Constitution that allows the Federal Government to be involved with healthcare.

  5. RR
    4 August 2017 @ 12:03 am

    Greg,

    Your comparison between medical services and food and shelter has some limitations. For instance, if a dentist refuses to clean my teeth because I won’t pay, I’m probably not going to die from the experience anymore than a restaurant that denies me a meal or a hotel who denies me a room because I don’t have the money.

    On the other hand, if I come into the emergency room of a hospital unconscious because of injuries sustained in a car accident or with severe chest pain, I could well die if the hospital refuses service. Moreover, in these sorts of emergency situations when time is of the essence, it isn’t reasonable to expect people to shop around for the best hospital emergency care prices as one could do with having say ones’ teeth cleaned. Nor do we want hospitals to waste time in an emergency situation checking for insurance and the like. When someone’s life is a stake and time really matters, they need to treat the patient first and figure out payment later.

    While a lot of routine medical services can be treated similar to the way we pay for food and housing, emergency medical care really is special and different. This also has a huge impact on health insurance and the price of medical care, with people who are uninsured and who can’t pay their bills driving up costs for the rest of us as hospitals have to find some way to make up the difference. A friend of mine at church is an ER doctor. He tells me that something like one-third of patients he sees are ultimately found to be uninsured and don’t pay their ER bills, even after their bills are turned over to a collection agency. That means the rest of us who have insurance and can pay pick up their tabs in the form of wildly overly inflated medical bills.

    This is why requiring everyone to have at least catastrophic health insurance would be beneficial. From an economic point of view, it would eliminate the current “free rider” problem and eliminate a lot of the smoke and mirrors and distorted billing that we currently experience. I realize that a lot of conservatives complain about the ACA’s individual mandate. They have a point that it is problematic to force people to buy a product, i.e. health insurance. On the other hand, as someone who does have health insurance and has paid wildly inflated medical bills, in essence the current system forces me to pay other peoples bills. Should I have a right not to do that?

  6. Greg Krehbiel Greg Krehbiel
    4 August 2017 @ 8:38 am

    @RR, you make a good case re: emergency services, but healthcare costs go a lot farther than that.