Wednesday, October 21, 2009

Health Care Debate: Personal Responsibility vs. Patronizing the Insured

The health care insurance debate seems often to pose the question of whether we should have government intervention or rely on the "free" market. More specifically, which of the two, the question is framed, is more "efficient" and more likely to provide wider coverage effectively?

Hidden beneath that debate is where I think the real issue lies. That issue is whether we will trust people to make their own health care decisions, requiring them to live with the consequences, or whether we will not trust them to do so and therefore devise a system where others make the decisions for them (but again requiring the citizen to live with the consequences, not the bureaucrat who makes the decision).

An article in the Herald business section today exposes that hidden issue. According to the article, Blue Cross Blue Shield of Florida, which offers a variety of plans to its customers, requires its own employees to accept a plan that calls for high deductibles and an "HSA" or "health savings account." The article states, in part:

Critics of HSAs say that their problem is that they assume consumers can make intelligent decisions about their health care when it's often difficult for most people to judge the costs and benefits of complex medial alternatives.

Think about other decisions that citizens are called upon to make that are complex. For example, what about the decision to get married, to have children, to buy a car, to change jobs, to go to this church or that, and even to vote. Shall the government (or some giant corporate institution entrenched in Washington to which we are forced to pay tax-like premiums) make those decisions too? I am amazed at the patronizing tenor of at least part of the debate we are hearing on whether to adopt a national health care system.

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