From: andy@SAIL.Stanford.EDU (Andy Freeman)
Subject: Re: Bush/Quayle's Health Plan -- vouchers?
Organization: Computer Science Department,  Stanford University.
Date: Mon, 14 Sep 1992 16:30:17 GMT

In article <92257.175356DGS4@psuvm.psu.edu> <DGS4@psuvm.psu.edu> writes:
>In article <1992Sep13.195519.25265@CSD-NewsHost.Stanford.EDU> andy@SAIL.Stanford.EDU (Andy Freeman) says:
>>In article <92256.083946DGS4@psuvm.psu.edu> <DGS4@psuvm.psu.edu> writes:
>>>While I'd prefer a system financed by income taxes, I'd accept one
>>>with community rated premiums.
>>
>>Now we're getting somewhere.  I have very healthy practices.  Why
>>should I subsidize people who don't?  After all, they get the benefits
>>from smoking, drinking, driving fast, not exercising, and so on; why
>>shouldn't they pay the costs?
>
>I would ask you what you think is the most effective and equitable
>way of deterring unhealthy behaviors.  One option is to price health
>insurance on the basis of risk.  I would argue that this is both
>ineffective and inequitable.  It's ineffective because it is all too
>easy for people to heavily discount the cost of unhealthy behaviors
>which might increase their risks of being sick 20 or 30 years in the
>future.

It isn ineffective only because "we" insist on picking up the pieces
for people who do that.  That's our fault.

>It's inequitable because it requires health care workers to
>ignore the needs of those who need their services most, because they
>don't have money to pay.

Evolution in action.

>If you want people to stop smoking, to stop drinking, to stop engaging
>in unhealthy behavior

I don't want people to stop smoking, drinking, eating fatty foods, not
exercising, and so on.  I'm not a health nazi - if someone wants to
swim with sharks, that's fine with me.  I'm just saying that they
should pay the costs because they get the benefits.

>t is far more efficient to raise the direct
>price of the behavior, rather than raising the cost of health care
>(through higher ins. prem.) to deter the behavior indirectly.  If you
>want to deter smoking, and make people pay the full costs of smoking,
>then you tax it like crazy.

We tried that in the US for alcohol; it was called Prohibition.  We're
trying it with cocaine and MJ; it's called the war on drugs.  That
approach does not work, so any system that depends on its success is
doomed.

It doesn't even apply to not exercising and other PRACTICES (not
associated with products) that are unhealthy.

If society wants me to pay for the health costs of people who don't
exercise, I'm going to bring the power of the state down on people who
don't exercise.  I'm going to institute standard diets.  If you don't
want me to have this kind of control over your life, don't ask me to
pay for it.

>>So?  The training overhead of dealing with an additional form doesn't depend
>>on the frequency of use.
>
>But it does depend on the number of different types of forms you have to
>process.  Every physician in the U.S., in effect, has to have the staff
>with training to process several thousand different types of forms.  The
>number in Canada is much smaller.  Just take a look at the numbers for
>number of non-medical staff in a physician office in the U.S and in
>Canada.  They are different by an order of magnitude.

The difference will decrease rapidly if the people who believe in the
"overhead is excessive" theory are actually correct.  That's what
happens when superior producers come on-line; the inferior ones either
change or die.

-andy
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