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The “Uniqueness of Healthcare” Argument April 17, 2012

Posted by geoff in News.

The constitutionality of Obamacare rests largely on the argument that health care is a unique commodity:

Moreover, the market for health care is distinctive (if not entirely unique) in several key respects. Virtually all of us will need and obtain health care at some point, but we often cannot predict when or in what ways we will need it. And for the vast majority of us, direct payment for the health care services we obtain would be prohibitively expensive. Yet not obtaining needed medical care can be the difference between life and death.

I guess that sounds compelling to some, but to me it’s an argument that cheats by jumbling together a lot of different situations and cherrypicking facets of those myriad scenarios to support itself. Here’s what I mean:

Is all healthcare both critical and unaffordable?

Certainly not. Wellness visits, mundane ailments, routine dental work, optometry, many prescriptions – these are all affordable for “the vast majority of us.” And this is the sort of medical expense we most commonly encounter. Most people don’t need help covering these sorts of costs, and the entire system would be improved if these costs were addressed outside of the insurance system.

But the constitutionality argument conflates these common health care costs with catastrophic costs, i.e., coverage of conditions such as cancer, heart disease, major surgery, AIDS, emergencies, etc. We all need routine health care, but not everybody will need health care for major problems. And among those with these types of conditions, not all patients would choose to pay for treatment.

There is also a huge set of conditions which lie between the routine and the catastrophic: pregnancy, joint surgeries & replacements, and other optional but expensive treatments. Is it fair to ask someone else to pay for your elective surgery? How many pregnancies can you justly ask the childless to pay for?

So how can one use the catastrophic circumstance to justify the constitutionality of an insurance mandate to cover the routine and the elective? How can one use the “life or death” argument to rationalize the whole enchilada?

The answer is, I believe, that you can’t. Everybody needs health care, but not everybody needs unaffordable, life-saving health care. Forcing people to help pay for all care by claiming that they are eventually likely to need unaffordable, life-saving care is not a logical or just construct.

Finally, I doubt that anybody who wrote this line:

“And for the vast majority of us, direct payment for the health care services we obtain would be prohibitively expensive.”

is truly a conservative, as the fellow who wrote the excerpt above claims he is. If the “vast majority” of us cannot pay for healthcare, then who do you expect to pay for it? If most of us are going to need this expensive treatment, and most of cannot pay for it, then the wealth transfer from the young to the old is exposed as a Ponzi scheme.

This fellow is no conservative.


1. Mrs. Peel - April 17, 2012

There’s also the conflation between health care and health insurance.

2. kevl - April 17, 2012

Someone is making money on this racket. By and large I don’t think it’s the docs. It’s the insurance companies.
I pay thousands a year in premiums for a family of four, yet none of us go the doc for illness or have any prescriptions, there’s your Ponzi scheme.

3. daveintexas - April 17, 2012

It’s risk pools, same as auto insurance. The larger the pool, the lower the cost and expense.

Most plans have a “maximum lifetime expense”, like say, a million bucks, but that’s misleading because they carry additional insurance that begins to pay above that (however astronomical the number is). It’s a different kind of pool.

The government had effectively controlled almost half of the market anyway, with Medicare and Medicaid. And drive the prices up through overregulating and underpaying.

Price controls do not work (to lower cost). Competition works.

4. geoff - April 17, 2012

Mrs. Peel!

5. BrewFan - April 17, 2012

Hi Mrs. Peel! *waves*

6. Sobek - April 17, 2012

There’s also a conflation between congress-critters and sentient beings.

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