Last week, I brought you a video from the National Prayer Breakfast speech of Dr. Benjamin Carson. His words were heartening in many respects, and many in conservative media leaped at the notion of his political potential as a candidate. I thought at the time that it was a bit of a fad, and I was therefore surprised to see Hannity run a full hour-long show on FoxNews devoted to talking with Dr. Carson. (You can see the full video, here in parts 1 and 2.) I am glad Hannity had him on because my own caution seemed justified by something Dr. Carson said. As I listened to him address the question of health insurance, it struck me as odd that he sees an inherent conflict of interests between an insurance company seeking to make a profit and its customers seeking health coverage. When I hear such things said, I often dismiss them as the vapid utterances of mindless politicians, but since Dr. Carson has been receiving so much press, including on this site, it’s time to address the matter. What Dr. Carson the practitioner of health-care seems to think about insurance is a common misconception, and it offers one more reason why conservatives must be cautious in their choices of leaders.
Dr. Carson said on Hannity’s show that there exists an inherent conflict of interests between health insurance companies and their insured clients. This is not true. The actual conflict begins a good deal sooner in the process, and as I think you will see, exposes a wider misunderstanding of the problem. Ask yourself this: Who are the majority of purchasers of health insurance? If you said “individuals,” you’re wrong by a mile. The truth is that the largest purchasers of health insurance are institutions, including the Federal and states’ governments, and corporations. The problem here is that the people who consume the service are not the people directly paying for it. Any time you break the connection between the end user and the provider of goods and services, you effectively destroy likewise the natural market signaling that provides feedback in both directions.
As an example, imagine you are a smoker looking for health insurance. If you were approaching insurance companies directly, they would undoubtedly quote you a price many times higher than the one they propose to a non-smoker. Obese? Same thing. This would mean that as a matter of natural market forces, you would either amend your behaviors and condition, or you would bear the burden of higher prices. Insurers would naturally consider everything about you in determining what they would charge for a policy, but perhaps more importantly, you would be free to shop for insurance among many providers. This would act as a restraint upon overcharging, and would also cause them to offer special discounts if you lived an exceedingly healthy lifestyle. In short, personal responsibility would have a good deal to do with how much you pay for health insurance, as it should in a free market. At the same time, a particular company’s profitability would hinge on making consumers happy with their coverages.
What many people ignore is that if one had to pay cash for the whole bill each time one became ill, or injured, most of us would go untreated indefinitely, because few of us have the resources to pay cash for extensive or invasive health-care procedures. Dr. Carson talks a good deal about Health Savings Accounts, but such plans are more useful for mundane purposes of a less critical nature than their utility in life-threatening circumstances. While I support Health Savings Accounts, I believe insurance is a necessary hedge against calamities. If we change our focus from health-care insurance for ongoing maintenance, to a paradigm in which what we insure against are catastrophic circumstances, while letting things like HSAs pick up the slack for ordinary health maintenance, in a market environment, one would see the market begin to perform in a natural fashion. Unfortunately, this means that people would need to shop for insurance like they do any other commodity, and seek out the best deals on their ordinary health maintenance and preventative care, and most Americans have become far too complacent about such matters, expecting it all to be automatic.
The truth of the matter is that if Americans want health-care to improve markedly in the United States, while restraining the growth in costs, without resorting to some sort of death-panel or other government-mandated rationing mechanism, there is a mechanism, however imperfect: The free market. Unfortunately, since the advent of Medicaid and Medicare, and even widespread employer-purchased health benefits(prompted by government wage and price controls,) we haven’t had a free market for health-care in the United States, never mind health insurance. The government is now the largest consumer of health-care services in the country as a direct payer, by many times over, and yet there is still an illusion held by many who receive health-care services paid for or otherwise subsidized through government payments that they are in control of their health-care. They’re not.
If Dr. Carson’s criticism of corporate health insurance providers were true, then it must be even more thoroughly the case that no institution more than government would wish to avoid costs by denying care. Do you need evidence? Consider Paul Krugman, longtime leftist economic propagandist and one-note statist, quoted as follows in a piece at Western Journalism:
“We’re going to need more revenue…it will require some sort of middle class taxes as well…And we’re also going to…have to make decisions about health care, not pay for health care that has no demonstrated medical benefits…death panels and sales taxes is how we do this.” -Paul Krugman
What Krugman is saying is entirely true, but only if government becomes the source and payer for health-care, because otherwise, the free market would regulate prices in the same manner it does for virtually everything else. Some will object, insisting that “health-care is different,” just as they have insisted that every other human need is different, from food to housing to education to Internet service to cellular phones. All of these claims are equally wrong, and equally immoral. These claims all begin by demanding that some basic human needs be met, and all of them end with a gun to tax-payers’ heads. All of them.
I admire a number of positions taken by Dr. Carson, and I have no objections whatever about his participation in the public policy debate, but at some point, if he wishes to keep my attention, he will be required to offer more than platitudes and generalities about Health Savings Accounts. He devoted several lines of rhetoric to the attack of ideologues, but I am always cautious when people attack broad sets of philosophically bound principles in vague terms. I am curious to hear more from Dr. Carson, but I hope there will be a good deal more specificity. Talk of presidential runs and other such notions are fanciful and premature at best, and while I’ve heard a number of truncated statements about various topics from Dr. Carson, what I’ve not heard is a guiding philosophy that informs his opinions. Absent that, I have no grounds upon which to base any opinion of his suitability to any office, much less his qualifications to be President of the United States, and I find it unseemly that Hannity and others would talk of Dr. Carson in presidential terms given that we know so little about his positions. It may turn out that Dr. Carson is wonderful in all respects, but we already have a President who sailed into office through the propagation of vague, nice-sounding generalities, and I do not believe we can afford another.
Enough said about that.