Sunday, December 27, 2009

An Item From Santa's Lap

Paul Krugman applauds the Senate health care bill for, among other things, forcing insurance companies to cover patients with pre-existing conditions. This has been a long standing point of reform: why should a family be forced to cover the expenses of a medical problem when they had no role to play in the development of the condition. It's not as if they're smokers suffering from lung cancer. And many families can't afford the very expensive treatments that come with such conditions. But insurance companies can and so, the argument goes, they should pay.

For one, I'm not sure they can, but there's a deeper point. A pre-existing condition is tragic, doubly so if burdened on a family who cannot afford to properly address the issue. But that does not translate into forcing someone else to shoulder the burden, whether the target is insurance companies, hospitals, or the U.S. government (though the last is most justified since, in theory, it works for all of us). Some believe that doesn't matter; covering such individuals is the right thing to do. But that misses the larger picture. Even if they could afford it and even if they could continue to afford it for the foreseeable future, it would be ethically wrong to force one group to shoulder the problems of another group. Yes, I know we do this a lot already, but that's hardly grounds to keep doing it.

Here's an analogy. Some people are born ugly, or stupid, or socially awkward. Such people have difficulty getting dates or maintaining friendship. While befriending a person with such a pre-existing condition just to be nice would be seen as an admirable act of kindness, no one would agree to a policy which forces people to befriend or date such individuals. It would be seen as unethical, even if the individual is not able to "afford" such loneliness (i.e. they are suicidal).

It's all well an good to ask for things but you have to think about where they come from.


Anonymous said...

In addition to being "the right thing to do," covering people with pre-existing conditions helps ensure their long-term health and maximum productivity so that taxpayers don't end up supporting them via welfare, disability, or frequent trips to the ER. I don't find your analogy to befriending people out of the goodness of one's heart to be very helpful. Yes, everyone knows that doing something solely because it's "nice" may not be a sound reason over the long haul, esp. for a hugely expensive government program. That point is obvious. But whether an ugly person has less or more friends does not directly impact the larger community the way the uninsured impact our economy. Also, do items usually come from Santa's lap? I thought kids sit on his lap and presents come from his bag...


Anonymous said...

Another obvious point on your rather facile analogy. There's a difference between forcing an insurance company to do something and forcing a person to do something. Companies do not have the same autonomy rights as individuals. The government can force a company not to discriminate. It cannot force you personally to befriend/date a person from a group you do not do like.


David said...

True, a company is not a person, but it's made up of individuals. Forcing a group to do something is effectively the same as forcing at least one individual in that group to do something. By requiring firms to cover people they won't otherwise cover, the law is increasing their costs and those costs will be felt somewhere. Premiums might rise, people might be fired, benefits might decrease. Someone will feel the cost, a cost they must suffer because of the law. Just because we don't know who it is, doesn't mean it's not there.

An efficiency argument doesn't translate into forcing a few to shoulder the burden. They get a fraction of the benefit and endure most of the cost (or some of their customers do). It would be better to make the argument that the government (and thus the populace at large) should shoulder the entire cost for covering pre-existing conditions, not a single company.

Granted, I don't know all the details of the health care bill--it's possible the government will perfectly compensate the insurance companies--but given the complexity of health care and the complexity of diseases, I'd be very surprised if this was true.