Health Care Reform – The red herring of the pre-existing condition

Posted by Jason | Posted in Economics, Government, Health Care | Posted on 17-10-2009


Earlier this week, I posted a two part series on how to fix the health care crisis. The solution was to get rid of third party payer in respect to the purchase of health care and insurance. Immediately, I got and was glad to have received the red herring question of the pre-existing condition.

Let me start off by saying, that I have a child with special needs. My 9 year old son has cerebral palsy and has gone through years of physical therapy and occupational therapy to be able to walk on his own. He still wears braces on his legs. In additions, my niece has a severe case of autism, so bad that she is fed through a feeding tube. I say this because I know personally what parents have to deal with when it comes to pre-existing conditions.

With that said, free markets and freedom in general are principles on which this country was founded. Principles are meant to be applied in all circumstances, because they prevent us for choosing the wrong path. Our founders knew this. It is by veering off these principles that we are in the mess we are in now. Just because there is a hard issue to be addressed, doesn’t mean we throw away our principles. We don’t teach our children principles to guide them through life, just to have them toss them aside at the first circumstance that challenges their principles. Principles are meant for the hard issues. The are not meant for the easy issues.

“OK buddy. Enough preaching already.”

Agreed! We must start off this topic discussing the morality of government health insurance. Then we will move on to the economics of the issue.

In Thomas Paine’s great work “Common Sense”, he lays out how and why governments come into existence. He describes a civilization with two people, and how with two people you do not need government. Those two people can discuss their problems and come to a solution directly. As more and more people come into this society, they can no longer work out their disagreements directly. There are just too many of them, and they have other duties that require their attention and time. This is when government comes into existence. They decide to appoint select members of the society that they believe will represent their best interests. Those representatives will then setup laws and rules that protect all members of the society. What are they protecting each member of society from? They are protecting them from each other. They are making sure that one member doesn’t use coercion on another member. This coercion can be in the form of theft, fraud or even murder. This is how government is supposed to function in a free society. I think we would all agree that the government that functions in this manner is a just and moral government.

If we all agree to that, then we must acknowledge that coercing someone against their will directly or through the government is an immoral act. This is why the free market is always moral, and all other systems are immoral. The free market allows people, in pursuit of their own interest, to peacefully without coercion come to an agreement on trading a product or service between themselves. Both parties in the transaction walk away from the transaction better than before.

As soon as the government becomes involved, with the exception of preventing coercion (contract law, prosecuting fraud and extortion, etc), they then become the coercive power. Just because they may be acting on something that the majority agrees with doesn’t mean that coercion is now moral. I’m sure the best case of this was slavery. The majority approval for the government coercion did not make slavery moral. Immoral acts are always immoral.

What I am leading up to here is having the government force any individual to pay for another individual’s health insurance is immoral. Also, forcing an individual to buy his own insurance is immoral. In a free society, people are free to pursue their self interest. They are free to be miserly, charitable or neither. They are free to be successful, and they are free to fail. This is a just and moral society. As discussed earlier, this is a principled society. As soon as you veer away from this principle, no matter what your intentions, you then cannot say that another act of coercion, say Wall Street millionaires taking our tax dollars, is immoral.

I know this may sound like great theory, but the truth is life would be much better if we stuck to the principles of our founding fathers. I think we all know and agree to that, but then for some reason we immediately find that this special circumstance is different. It isn’t different. Our founding fathers had many reasons and opportunities to take the path we are now taking. They decided to take the principled stand. They decided to take it for us. George Washington could have easily been a king. He could have setup a monarchy that would have passed from generation to generation. Read history, and you will find how easily he could have done this. People were begging him to be king. Instead, he stood on the principles they professed during the revolution, and he stepped down after two terms.

Now, enough of my moral argument. Morals are great, and we’d all be better off if we lived by them, but how will the free market address the question that prompted this blog?

The free market operates in this manner. Individuals need many things for survival and pleasure. Because they cannot meet all their needs by their own action and invention, they offer what they are best and most efficient at creating and delivering for something they need that someone else is best and most efficient at creating and delivering. This is what is known as the division of labor. For society to benefit the most from everyone’s production, this must be voluntary and with out compulsion. When voluntary, people will seek to offer what they can create better and in more supply than everyone else. They do this based on their self interest. The more value they can create the more they will be able to get from others through trade. When government bureaucrats decide who should do what, you end up with people producing things that they are less efficient at producing. This results in a lower quality of life for us all.

This is apparent even in the most obscure products and services that are offered today. Do you think in government controlled economies, people with a fetish for purple, prince garbed, frog figurines could ever find the product they seek? In the free market, even products and services that seem so obscure that they wouldn’t be worth producing are produced. They are produced because there is a need, there is someone who can produce it, and there is a price at which both agree the product is worth producing and purchasing.

In the market of pre-existing medical conditions, this type of innovation would undoubtedly take place as well. There would be entrepreneurs that see a need that needs met. Typically, these entrepreneurs have experience themselves with being on the needing side of the tracks. They found that they couldn’t meet their own need through the market, so they say “Hey, I see an opportunty here. Why don’t I offer this to society. There has got to be many more people out there with the same need.” As we know, this happens every day, and this is why we as Americans progress so quickly. This is why the internet in a very short time went from bulletin boards to what we have today, where you can make video conference calls across the globe for FREE!

That is not to say you would not have some progress under a government controlled economy. The problem is you would only have progress in the areas that some bureaucrat, special interest or the majority believe should be pursued. If your child suffers from a less common ailment, you are out of luck.

With the free market, you will see innovation so much faster, and you will see prices of those innovations quickly drop. How much did a little 20″ LCD screen cost just 10 years ago? Politicians love to blast the rich, but guess who will fund that new medical treatment your child or you need? When it is first developed in the free market, it will be expensive. That is because of all the research and development costs that went into innovating the product or service. The rich will be the only ones who can afford it. There are only so many rich people, and eventually the manufacturer will have to figure out how to make it cheaper to gain access to a larger market. In this process, all the other companies that participate in the creation of the product will also be pursuing reductions in production costs. This will create a butterfly effect, which will result in rapidly declining prices. I know people think it isn’t fair for the rich to be the only ones who can afford it at first, but under the government controlled market or a market with out the rich, the innovation wouldn’t have taken place.

As I said previously, when you remove the third party payer from the insurance purchase, you will quickly see incentives to live healthier. According to the CDC, chronic illnesses that are caused by life style choices account for 75% of all health care expenditures. It would be a far stretch of the imagination to believe that this number would not be drastically effected if those life style choices were punished via higher premiums. A large decrease in chronic diseases would undoubtedly reduce insurance rates, and it would reduce the cost of health care in general.

Also removing the third party payer from the day to day health care purchases would drastically increase competition and lower prices for normal health issues. This would help those who have pre-existing conditions by allowing them to get the regular medical care at a fair price. Personally, this was my major issue when searching for insurance. My son’s pre-existing condition prevented him from getting even catastrophic care. The reason being is they assumed there would be a large amount of day to day care. I wasn’t concerned with day to day care. My concern was catastrophe. I needed coverage for the care that you can’t plan for. With the decrease in the cost of day to day care that would result from paying out of pocket and increased competition, you would see insurers more inclined to cover those who have pre-existing conditions. One can easily imagine an insurance company running a new marketing campaign stating that is is the “Only insurance company to offer coverage for children with autism”. That is a market that needs served, and they would be the first to tap into that market. Quickly competitors would step up to the plate, and prices would be driven down. Doctors who specialize in a particular affliction would compete for the dollars of potential clients by offering the newest and best treatments. These are the circumstances in which the market shines best.

The last wonder of the free market that would help those who really struggle financially is charity. Historically, charity has always been the way the poor was able to receive the services that they need but could not afford. Americans are the most generous people on the planet, and it would be almost a guarantee that with the government out of the market you would see increased prosperity. With that increased prosperity, you would see more charitable donations. Insurance companies and doctors would donate time and dollars to take care of the less fortunate. One must ask what would happen with charity under a government run health care plan. If the government turns you down, it would almost certainly be illegal or at minimum be detrimental to the doctors relationship with the government if he performed a procedure out of charity.

As I write this, I get super excited as a parent of a special needs child thinking of the innovation that would be unleashed in a completely free market. Unfortunately, we have already let the barbarians in the gates, and they are not going to leave of their own accord. The likely hood that we will drive them out and take back our economy and country is slim. It involves the unknown. It’s easier to accept the mediocrity of the known than it is to trust in what we know is truth but seems so far from where we currently are. I beg you not to fear. Can you imagine what fear our founding fathers, who never knew what life was like without the protection of the Royal Crown, must have felt? The amount of courage that it must have taken just amazes me, even as I write this. I’m sure we can all agree, thank God that they did. Let’s remember life isn’t only about the here and now. It isn’t just about take care of me, and the future be damned. Now is our turn to take the principled stand. It’s our turn to make the tough decisions for posterity. If we do the right thing, one day, our children and grandchildren will say, “Thank God that they did.”

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Comments (5)

so what you’re essentially saying is that in our Utopian Free Market, instead of pre-existing conditions being a bad thing, holding people back and preventing access like it does now, it would become a marketing opportunity, a way for companies to stand out from their competitors. I like it! I guess it’s like the shady car loan commercials you see on TV: No Credit, Bad Credit??? No Problem!!! If there’s a need, the free market will find someone to fill it.

One thing that leaves you contradicting yourself though is when you discuss morality… specifically you note that the gov’t forcing you to pay for the insurance of someone else is immoral. Under that mindset, insurance itself would be immoral, so how can it exist in the free market? We both know insurance works by pooling your risk with others’. The people with lower utilization are paying for the insurance of the people with higher utilization. If your premium was based solely on your risk, the cost to insure you would inevitably be much higher.

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John, I am not saying the free market is a utopia. I am not saying the free market makes all our societal ills go away. I am saying the free market without gov’t coercion is the most just, moral, and efficient system to address or societal ills.

If the amount of money that goes into insurance shrinks because people are now buying their own, they are covering day to day health care out of pocket, and they are addressing life style illness, the insurance companies would get extremely competitive. They would need new markets to tap into in order to grow. Companies never say “I have enough business. We’ll just stay the way we are.” How many care insurance commercials do you see compared to health insurance commercials? That is the competition between car insurers playing out before our eyes.

As far as the contradiction, there is no contradiction at all. The immoral act is the coercion by the government. There is no coercion in the purchase of health insurance by the individual. You are buying in voluntarily to insure yourself against unplanned catastrophes. You are paying rates based on your personal choices and how those choices affect your risk level. The insurance company in is spreading the risk between all customers, but the riskier customers contribute the most.

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You may not be saying the free market is a utopia, but I am… I’d love a system like you’ve been discussing since you started this blog. To me, that’s utopia. The thought of an uninhibited system of free trade is enough for me to explode at the current thought of our gov’t screwing up our future and then blaming capitalism/free market.

After I re-read your article and then my comment, I missed the part where you note that it’s only immoral if you are FORCED to purchase. Voluntarily purchasing is not immoral.

A little bit of a tangent, but why do you think no republican (at least none that I’ve heard) has proposed any similar free-market system? If there have been some proposals made, they’ve done a bad job letting that be known.

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Their are some, but the media lambastes any politician who speaks of the free market. Unfortunately, people take the medias word on topics that the media has no clue about.

With the state of education in this country, the vast majority do not understand economics and the free market. They believe silly claims like the New Deal got us out of the Great Depression.

Since the public doesn’t understand it and falls for the Democrats propaganda, the Republicans play along to get elected.

I say we take our message out there and educate as much as we can. If enough people do it, there will be Republicans advocating it.

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My answer to this:

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