Low Signal-to-Noise Ratio

“Keep government out of Medicare!”

Lots of us have posted articles, editorials, and analyses discussing the health-care debate. Clearly, it is something about which many people have passionately-held beliefs. Lost in all the noise, in my view, are the underlying principles that gird this debate, so I think it is time to return to first principles.

Behind all the talk of a “public option”, “death panels” (puhleeze), etc., is a fundamental fracture point that seems to cleave us all. Either you believe that health care is a fundamental right, or you don’t. For those of you who don’t believe in the existence of this right, our conversation is over. There is nothing to debate. But if basic health care is not a right belonging to every American citizen, why stop there? Why should Americans have a right to expect clean water? As this article describes, we have been failing to take care of each other in this regard as well. We should be ashamed of ourselves.

For those of you who still hold this pithy-yet-simplistic view that the government that governs least governs best, come visit me in the country where I am currently living. Everywhere you look, you will see consequences of this myopic view: children playing in standing water contaminated with fecal coliform bacteria (and worse), grinding poverty and ignorance (the phrase doesn’t do justice to the reality), infant-mortality rates as high as two out of five, life-expectancies as low as 45 years, weak legal structures, randomly-enforced laws, minimal access to credit…the list goes on. Now, I am not saying that government is the answer to all these problems, but if you want to see what a total absence of a Social Contract looks like, my door is always open. (Oh, wait, that’s right—it’s not, because here people don’t give a shit about each other, and will steal anything that isn’t nailed down. I’ll make sure the guard lets you in.)

For those that do believe that access to affordable health-care should be a right accorded to all Americans, the debate shifts to a more interesting plane: how to get there from here?

To the ideologues, I say, please, take the scales from your eyes, and see the world as it really is, as it really works. Think about what it means to be human, to be an American citizen. I too have read all the great works of economists; I have profound respect for the invisible hand (though as this book review points out, even Adam Smith saw the need for regulation.). Free markets are powerful information-generators.

However, they are not always (or maybe even ever) perfect. Economics as a field is recognizing this fact as it re-examines the Efficient Market Hypothesis and the whole notion of the individual as rational actor. There are simply too many exceptions to this rule (the asymmetry of gain and loss, to cite but one example) to make it useful for every situation. Hence the rise of behavioral economics.
Returning to the health-care so-called debate (which currently is really nothing more than shouting past each other), I would like to remind those opposed to Obama’s efforts a few things:

The President is not mandating “socialized medicine” with the so-called public option. For those who are privately insured, they are absolutely free to keep the policies they have. For those of us (myself included) who cannot afford health care, there will now be an option. Are you cross-subsidizing me? You bet—thanks a lot. I know you care. As a childless adult, I cross-subsidize some of your behaviors too, like helping to educate your children. (No, really; it’s my pleasure. I recognize that I have in interest in ensuring that your kids aren’t ignorant. Believe me, with the absolutely staggering ignorance I see every day here, even among the intelligent and somewhat-educated, it is not hard to make the calculus: spending on education versus the cost of ignorance. It is also, as I see it, my duty as a citizen to help pay for the education of those who cannot afford to do so on their own. Again, “non-zero-sumness”, as the author Robert Wright called it.)

The idea is that private insurers will have to compete against a public option. (You’re not afraid of a little competition, are you? And from the government, of all entities? ) If the private insurers are doing such a bang-up job, consumers will make their choice and go this route; at the limit, everyone will chose a private option.

A friend recently posted an editorial from Forbes magazine regarding the health-care debate on his Facebook page. One quote in particular struck me:

…Obama promised Americans would get eternal health care "security and stability." To deliver that, he would of course ban insurance companies from denying coverage to those with pre-existing conditions--tantamount to forcing fire insurance companies to write coverage on a burning building.

…except that it is not. We are talking about human beings here, not buildings. Mothers, fathers, sisters, brothers, neighbors, fellow citizens.

So please, let’s talk about what it means to be a citizen. I have given up my right to punch you in the nose whenever I feel like it in order that you too abrogate that right. There are many other ways in which the Social Contract manifests itself—let’s not forget that. And, again, if you need a reminder, come visit anytime.