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Politics : View from the Center and Left -- Ignore unavailable to you. Want to Upgrade?

To: Alastair McIntosh who wrote (106011)	3/12/2009 10:56:30 AM
From: Mary Cluney	Respond to of 541877

<<<Perhaps you could explain.>>> Just the term "moral hazard" scares the beejesus out of most people. And if you combine that in the same sentence with "single payer system" people just freak out.

To: Alastair McIntosh who wrote (106011)	3/12/2009 3:28:28 PM
From: Lane3	Read Replies (1) \| Respond to of 541877

Unless you are referring to the uninsured, how is moral hazard greater with a single payer system? I am referring in part to the uninsured and the less than grandly insured, which would be the majority of Americans. Simply by adding more people to the system you have more opportunities for practicing moral hazard. Add more benefits than what is provided by one's current insurance and you have a second set of opportunities. I take your point about the employer provided insurance assuming for the purpose of isolating key factors that there are comparable levels of coverage. I do think there is some difference there in mind set. People wouldn't have so much of a mind set that medical care is "free" and plentiful when they're using an insurance policy to pay for it, even if they didn't pay the premiums on the insurance themselves, as they would when it's been established by the government as a right and the actual cost transaction is remote and murky because insurance and government benefits are different paradigms. For example, it would never occur to anyone to be judicious in the use of highways. They're "free," after all, and everyone has a right to use them. No matter that added use creates incremental costs to the taxpayer. I would expect that same thinking to seep into the use of health care over time. I may be wrong, but that's what I would expect. The other application of moral hazard is not individual overuse but a more collective overuse via interest-group centered political extension of what is covered. Currently we cannot personally influence what our employer-provided coverage covers but political lobbies can and do run up benefits. That's why insurance in some states is so much higher than in others--those states have mandated coverage of things that insurance companies wouldn't offer on their own because there is a lobby of practitioners or suppliers, such chiropractors or reach-tool manufacturers, trying to drum up business by getting their stuff covered or a lobby of users, such as those with tricky backs or little people, trying to get their expenses covered. It seems inevitable that under a national system those pressures would continue. In opposition would the the pressures to keep costs down. Hard to tell where the fulcrum might be but there's a huge upside risk on costs via expansion of non-critical benefits. I know in my case I would go for years without seeing a doctor I think that there is a lot of personal variation in this. It varies from individual to individual, culture to culture, and age to age. Surely you have seen people who stuff their pockets and purses with take-home from the all-you-can-eat buffet, food that is unlikely to survive the trip or ever be eaten. Some people take whatever they can get their hands on whether they can use it or not. When stores put giveaways on the sidewalk, the stuff flies away uninspected by the takers. All they know is that it's free. When they get it home and find they can't use it, they can always throw it in the trash, after all. You may not be inclined to over-use. I know a lot of people like that. My dad and his siblings are all like that--go to the doctor only when it's critical. I consciously over-use although not close to the extent that someone who would steal from a buffet likely would. I take every diagnostic test I can wheedle and I visit my doctor unnecessarily just to get her some easy income. People are different and have different motivations and mores and understanding. I know women who have had hysterectomies who demand PAP tests annually because they were conditioned to expect them back when they had a cervix and were sexually active. Ever since I had my hysterectomy some twenty five years ago I've been offered one. The system pays for that. Consider today's kids who weren't conditioned as we were that if you want some music you save your money, then go to the record store to buy it. They think music is free for the taking, copyright or no copyright, and they take oodles. And many/most will continue to do that when they are middle aged. I don't see any reason to expect that kids raised with "free" health insurance would grow up to be any different. Not all of them, for sure, but enough to put big demands on the system.