An Allegorical Tale

Imagine for a moment that the following story is true:

Someone very close to me has been experiencing an incredible run of bad luck. Every day for the past few years my friend (let’s call him Paul) gets mugged. The robbers punch him then take his money but they leave his wallet. He’s not hurt enough from these muggings to go to the hospital, but he is sore for the rest of the day. He can never predict when these muggings will occur, sometimes it’s early in the morning, other times early evening or the afternoon, but strangely enough he’s never been mugged twice in the same day. He’s tried altering his route to work, taking a self-defense class, and in general doing everything he can to make himself a less appealing target, but nothing helps. He has found though, that if he has no money in his wallet he gets beaten up badly so he’s taken the tactic of keeping $20 in his wallet just to appease the robbers.

By and large Paul has gotten used to it. He keeps a supply of pain meds at home and his office and he goes out of his way each day to keep his wallet supplied with a $20 bill. Minor inconveniences to be sure, but he figures he’s losing about $6000 each year to these muggers and once a week heads to the police office to lodge a complaint.

The police tell him they’re doing all they can to catch the robbers, but they’ve had no success. Nevertheless they’ll keep trying. On his most recent trip to the police station, one of the inspectors, we’ll call him George, made an interesting proposition. It would cost the police $80,000 per year to have a policeman following him around all day long. And even that won’t guarantee success at stopping the mugging when the police weren’t around. So the investigators would rather focus their investigation on the larger community and not just on him. But to compensate for his monetary loss the police department would like to pay Paul $100/week while they pursue the true culprit. Sure the extra money won’t quite cover Paul’s losses (he’s frequently robbed on the weekends too) and it won’t compensate him at all for the pain and suffering he experiences by the light beating he endures during each mugging, but it’s better than nothing.

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Now lets modify our basic story by a little.

One time during his weekly trip to the police station Paul hit on an idea. He’s going to suggest to the inspector that they compensate him for the money he’s losing. After all it is the responsibility of the police to keep him safe. Over the past 3 years he’s lost about $18000 and he sees no reason why he should bear this cost when there’s nothing he can do to avoid being mugged. He wants as normal a life as possible and losing $6000 of his discretionary cash each year just doesn’t seem right. When he proposes this to the inspector, George at first thinks it’s a good idea but needs to check something on his computer first. When George returns he has bad news for Paul. Turns out that the muggings started before he became a tax payer so he’s not eligible for victims compensation since it’s paid for by tax dollars.

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While the above story is fictitious, I know someone who lives with a very similar run of bad luck. He has type-1 diabetes. Unlike type-2 diabetes which is related to factors people can control, namely diet and exercise, type-1 diabetes is an auto immune disease that strikes without warning regardless of your lifestyle or other controllable factors. He figures that he spends about $20/day in diabetic supplies, needles, testing strips, insulin. His insurance company covers some but not all of these expenses. And, of course, he tests himself (finger poke) 4-6 times a day and gives himself 3-5 injections per day. The analogies to poor Paul above should be clear. Fortunately my friend had insurance when he got diabetes, but in the US if he didn’t have insurance he’d personally have to pay for all his medical care and furthermore he’d find it difficult to find insurance afterward.

Poll: Does it make a difference?

I’m not going to run a poll on whether your opinion is changed based on the situation being crime or health care. (If you have an opinion, please leave a comment.) Instead I’ll share my opinion which is both blatant and nuanced.

Health insurance isn’t some form of a deferred savings plan designed to allow you to pay your own medical bills. Many people run their entire lives with low total health costs, others are afflicted with a chronic disease relatively early in life or for many other reasons have large medical bills. Health insurance is there for risk mitigation, everyone pays the average amount so that those with above average expenses can have those paid for by those with below average expenses. Everyone pays, everyone is eligible, no one can be denied coverage.

As a society, we have the ability and compassion to help those who are affected by a disaster to get back on their feet and resume as normal a life as possible. Folks from the US and around the world help those affected by flood, hurricane, tornado or earthquake rebuild their homes and resume their lives. Of the industrialized countries only America denies this sort of aid to those experiencing catastrophic disease or injury.

Of course, if you make something free or low cost or fixed cost people’s behavior will change from what they would do if that same thing had a variable cost based on their actions. This axiom may even apply to health care. However there is a key difference between this and say “free housing”. Poor health is a cost in and of itself, while the dollars to treat diseases may be free, everyone would rather be disease free than to be disease ridden but have those diseases treated freely. Even with free health care there won’t be a sudden increase in people playing Russian Roulette.

But Russian Roulette is an extreme example. More realistically, some smokers may chose to continue to smoke with free health care while others (those who currently aren’t regularly seeing a doctor) may choose to quit. Some people may indeed choose to abuse the system. The question isn’t whether there will be some abuse, but will there be too much abuse. If even one person tried to get a free ride from free health care would that make you be against it?

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