Blood and Money

People need to have the freedom not to have insurance if the marketplace is to function properly, [Michael Cannon, head of health policy at the Cato Institute.] says. "Because if they don't have freedom, if the government is requiring them to purchase health insurance either from a private company or the government, then the government gets to define what health insurance is, and that stifles a lot of innovation in the health insurance and health care delivery markets, and we're suffering under that sort of regulation right now," he says.
GOP Says Coverage For The Uninsured Is No Longer The Priority

I get the Gospel of the Free Market thinking that goes into a statement like this. Let people go without buying a good or service, and the companies that provide that service will innovate in the service of attempting to entice those holdouts into signing up.

But, in the case of health insurance, does it really work that way? Someone who thinks of themselves as healthy enough to not need insurance is unlikely to be swayed into purchasing something that, in the best-case scenario is a complete waste of money. After all, if you pay 50 years of premiums and never make a claim, you can't receive a reimbursement. They money either goes to people who do file claims, or it goes to the profitability of the insurer. And there is the other angle to consider. While a serious illness or injury may require expensive care, you are, likely as not, going to get that care regardless of your actual ability to pay. Okay, so you may have to declare bankruptcy, and liquidate a number of assets to pay your medical creditors. But you'll receive a basic level of medical care, and if you can't pay for it, someone else will.

Between them, the idea that the workings of the free market are a socially ideal solution is a pipe dream. In a more indifferent society, the story would change. If we were willing to allow people to die, when they could be saved, because they lacked the means to pay for care or the expectation that close relations would ride to the rescue were not there or we were okay with the idea that children with serious diseases were solely the responsibility of their parents or medical debts were un-dischargeable and/or we were okay with hospitals shuttering because of too much uncompensated care, then the free market in health care and insurance services would be more desirable, as the risk/benefit analysis would have much more real consequences. But that's not the society that we live in. Pretending that it is doesn't make any sense, and fosters an attitude that "conservatives," "libertarians" and/or whatever other labels free market boosters attach to themselves, are knowingly relying on others being soft-hearted to allow themselves to avoid paying into a system without having to see the consequences.

The way in which we regard health issues means that health care is less an issue of finances than it is one of mores. The social contract rarely concerns itself with costs and this is precisely the way that many people want it. We'll all be better off if we make the effort to engage with it that way.

(Of course, this leaves out the fact that most people's choices are limited by what their employers do, or do not, offer. We'll save that one for later.)