Our punitive health care system

[KT2000]

Malcolm Gladwell wrote an essay for the New Yorker in 2005 the describes the theory behind our current system of health care - moral hazard. This means that insurance can be used to control the behavior of people using the insurance.
Listening to the testimony before Congress yesterday, it is obvious that we have moved into a punitive system and are about ready to hand the insurance companies even more power. It's a great essay and helps explain why we are not being heard when we have expectation for a health care system that actually delivers health care to those that need it.

"Policy is driven by more than politics, however. It is equally driven by ideas, and in the past few decades a particular idea has taken hold among prominent American economists which has also been a powerful impediment to the expansion of health insurance. The idea is known as "moral hazard." Health economists in other Western nations do not share this obsession. Nor do most Americans. But moral hazard has profoundly shaped the way think tanks formulate policy and the way experts argue and the way health insurers structure their plans and the way legislation and regulations have been written. The health-care mess isn't merely the unintentional result of political dysfunction, in other words. It is also the deliberate consequence of the way in which American policymakers have come to think about insurance.

"Moral hazard" is the term economists use to describe the fact that insurance can change the behavior of the person being insured. If your office gives you and your co-workers all the free Pepsi you want—if your employer, in effect, offers universal Pepsi insurance—you'll drink more Pepsi than you would have otherwise. If you have a no-deductible fire-insurance policy, you may be a little less diligent in clearing the brush away from your house. The savings-and-loan crisis of the nineteen-eighties was created, in large part, by the fact that the federal government insured savings deposits of up to a hundred thousand dollars, and so the newly deregulated S. & L.s made far riskier investments than they would have otherwise. Insurance can have the paradoxical effect of producing risky and wasteful behavior. Economists spend a great deal of time thinking about such moral hazard for good reason. Insurance is an attempt to make human life safer and more secure. But, if those efforts can backfire and produce riskier behavior, providing insurance becomes a much more complicated and problematic endeavor."
from New Yorker archives

http://www.malcolmgladwell.com/2005/2005_08_29_a_hazard.html

[Warpy]

1. Moral, my ass

I've been punished by those leeches because I got sick in my teens with something that has absolutely nothing to do with lifestyle or any voluntary behavior. They did nothing to improve my morals, such as they were. They have undoubtedly shortened my life.

Sickness is punished, not morals.

As for being insured leading to more risky behavior, what a crock of shit! I don't know anybody who goes out looking for a broken leg, they hurt.

This is the stupidest argument against universal insurance I've ever seen, that it will make us less moral, less careful.

Only a healthy young male who has never experienced pain or illness could possibly think universal insurance would give people a reason to seek either out.

Asshole!

It's obvious his tenure at The American Expectorator has taught him how to be callous and selfish. Perhaps he should restrict his pop psychology to, well, pop.

[KT2000]

2. Did you read the essay?

Gladwell does not agree with the "moral hazard," he is informing us that the politicians, think tanks, insurance companies et. al. do believe in this and keep it to themselves. This is the awful premise upon which the insurance system is built.
The moral hazard is not about one's life behaviors, it is their behavior in using insurance and health care they are concerned with. They could give a crap if someone is sick - they just want to discourage people from seeking healthcare through co-pays and large deductibles. Of course insurance co's take it further with their denials and cancellations.
It is a system cooked up by economists - apparently sociopaths.

Gladwell also tells us that there is no other country that subscribes to this horrible system.

He is telling us that we are conducting two different arguments - most politicans DO NOT WANT easy access to health care, period.
The people do want access to health care, period.

He is trying to wise us up to what is really going on so we can actually call them on their crap and make progress.
It was NOT an argument against universal health care - it is an argument FOR it.

[madaboutharry]

4. But it is really sociopathic on several levels, not just

among insurance companies and the economists who advise them.

Hospital corporations that most likely own the hospitals in your city do not give a crap about the quality of care you as a patient receive. The care about revenue.

And a vast majority of the doctors in this country couldn't care less about you. They care about RVU's and how much money they deposit into their bank accounts. They are not healers. They are bean counters. And if that means you get an unnecessary procedure so that the can meet productivity expectations, well..tough shit on you.

The entire system is corrupt from one end to the other.

[KT2000]

5. Yes - exactly

the AMA, hospital associations etc. put forth bogus arguments against single payer - or even having the public option.
The argument must be "access to healthcare fo all" and we can rightfully accuse them of being satisfied with the corrupt system the denies access.

[surrealAmerican]

3. The whole "moral hazard" argument collapses ...

... when you're dealing with health care because some things matter to people more than money. Most people would rather be healthy than save money, virtually all would rather stay alive even if they spend "too much". This is precisely what conservatives have so much trouble understanding. Money is not the ultimate value in life.

[KT2000]

6. I believe that is why

other westeren industrialized countries do not have that system. I think they would be ashamed to espouse such lack of values.

[Kat45]

7. Very interesting article.

It's a fascinating explanation of why our systems is a fucked up as it is. I bookmarked and plan to share it; unfortunately those I share it with will probably not want to bother reading it.