An odd little thing that came to Your Humble Blogger’s attention—the big health-care cost-sharing study Free For All? Lessons from the RAND Health Insurance Experiment, (Cambridge: Harvard University Press © 1993), which made a big public-policy impact in the eighties, seems to have concluded that people who pay more for health care (on a pay per service system, think of HMO co-payments and such) receive fewer services, but don’t, on the whole have worse health. That is, most people who get less health care because they choose not to pay for things aren’t less healthy than they would be if those things were free and they got them. This is based on an experiment run in 1980 or so, and is interestingly complicated, but that’s the gist.
The important exception, though, is that poor people who get free health care are significantly better-off (in terms of chronic health problems particularly) than those for whom free care is not available. In other words, free care benefits the poor, but not the non-poor. So, have one system for the poor, and one system for the non-poor, and do your best to figure out which is which. Thus, our employer-based system makes some sense; people who are employed, and thus not poor, get one system, and those who are unemployed, and thus poor, get a different one.
Oops. Employment doesn’t lift always people out of poverty, nor does getting laid off always plunge people into it. Well, and we approximate. We model. Using employment as a proxy for non-poverty more or less works, right? Anyway, it makes some sense.
OK, so why does our system work so badly? Two possible answers are (A) it doesn’t, but like your local Registry of Motor Vehicles, all the anecdotal evidence of awfulness hides the fact that it works very well indeed; or (2) having employer-based health care introduces problems of its own, which are not accounted for in the system. I think it’s 2, but I honestly don’t know. And that sort of shallow analysis is all you’ll get from Your Humble Blogger for a couple of weeks I’m afraid. Anybody want to help me out here?
Redintegro Iraq,
-Vardibidian.