Economic Health Care
At the beginning of this semester, I went on a Louie’s binge. At least two or three times a week, I would head over to the little store in Redifer dining commons and buy overpriced bags of popcorn or chips and ice cream with my meal points. And despite a fairly hefty eating plan for a 120 lb female, a few weeks ago, I almost ran out of mealpoints. Since then, I have been adding money on my account in small increments, and shaving off my meal costs wherever I can. I eat breakfast in my dorm, with milk and cereal bought from the regularly-priced grocery store downtown, and stuff my lunch takeout box at the buffet, which I eat for both lunch and dinner. That comes down to $3.45 per day, thanks to the student discount, plus around $3 per week for the milk and cereal. Not bad, given my previous $20 a day habits.
But what if my college meal plan worked differently? What if everyone paid the same amount of money per semester, that money would be pooled to form a university-wide fund, and everyone could consume as much food as they needed. I mean, for every jock or heavier-set boy, there would be a lighter eaters and dieting college girls to offset the consumption. Food is a necessity, and that way, nobody would ever have to worry about running out of meal points.
It doesn’t take an economist to tell you that this system could never work. Many people would adopt my attitude from the beginning of the semester: “I have an unlimited meal plan, so I can splurge on whatever food I want.” And what about the more expensive HUB dining? I know I would love to visit Panda Sushi five times a week, or that wonderful soup and salad place by Burger King. As for the milk and cereal, which I now buy for a lower price from McLanahan’s, I would probably spare myself the longer walk and get it overpriced from Louie’s. In the end, students would bankrupt the system halfway through a semester. And if university officials wanted to continue it, they would have to raise the price for everybody.
This type of thinking is something economists like to call the Moral Hazard complex, which states that people will take greater risks when they do not incur the costs of those risks. In other words, I will spend more money on food if everyone pays for meal points. But unfortunately, that is exactly how modern health care and insurance work.
As John Stossel explains in Insurance Makes Healthcare Far More Expensive, Insurance was a system designed to protect people against the costs of serious injuries or illnesses. A large group of people pay a small monthly amount which is pooled together, and if someone from that group gets cancer, for example, insurance will cover the costs of chemotherapy with the funds they have collected from everyone. And while healthy people ultimately end up losing money, people with life-threatening conditions can get the help they need without worrying about costs.
But insurance has expanded far beyond the scope of covering emergency care, and according to Stossel, this is what is driving up the cost of health care. Now, insurance covers even small things like flu shots and physicals, and consequently, people don’t “shop around” to find the lowest prices. Because people have no incentive to look for lower prices, suppliers (i.e. doctors and hospitals) don’t have the incentives to lower the costs of these procedures.
The best example of what would probably happen if non-emergency care weren’t covered is lasik eye surgery. According to Alex Tabarrok,”In 1998 the average price of laser eye surgery was about $2200 per eye. Today the average price is $1350, that’s a decline of 38 percent in nominal terms and slightly more than that after taking into account inflation.” Why has the cost declined? Because insurance doesn’t cover it! In the Stossel video, Dr. Brian Bonanni says that even $100 can make a difference between which doctor people choose for lasik. When was the last time you or your family “shopped around” for the cheapest doctor’s visits?
Furthermore, there is an incentive for unhealthy people to lie about their health problems. We all know that conditions such as smoking, obesity, or heart disease can drive up the monthly costs of insurance. Naturally, nobody wants to make these conditions known to providers, and many people hide them. However, these people are more likely to buy health insurance than healthy people, since they know there is a large chance they will need health care in the future, a condition known as adverse selection. When these people begin consuming health care for their conditions, the pool of insurance money is quickly depleted. Providers often combat adverse selection by doing three things: raising the cost of insurance for everyone, requiring physicals and other tests to screen potential customers, and refusing to cover people with serious conditions or terminal illnesses that actually need the insurance.
Costs are further raised by increases in technology. This seems counterintuitive at first, since technology is usually meant to make things cheaper and more effective. But with advances in medical technology, and the blanket of insurance to cover the costs, people end up demanding the “best” (a.k.a. most expensive) treatments there are for their problems.
From a strictly economic point of view, health care would be most efficient if there were no insurance. However, basic insurance is a good thing: it gives people a safety net in case something awful happens and they are sick or injured. But I believe that insurance should not have such wide coverage, simply because it causes people to take unnecessary risks. If we truly want health care to be more affordable an readily available, then the only way to bring the costs down is to cut coverage, forcing consumers to “shop around,” and suppliers to lower prices in order to remain competitive. I also believe that high-deductible insurance is the best approach to health care: healthy people end up paying much less, while sick or injured people are still covered when they need to be.
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