Letting the Sick Die on the Street
Jeffrey Miron defends his view, as recapitulated by Matt Yglesias, that government health care is not even justified in order to provide health care to those “with no money through bad luck or poor decision-making” who then “get sick [and would otherwise] just die on the street for lack of money.”
I agree with the general premise of Mr. Miron’s view. There is really no reason to treat health care from any other industry. That is, of course, unless for some reason we want to starve health care of the productive and intellectual energies of market actors and instead serve it a diet of whatever level of useful efforts a farm of government employees finds its way to part with. The trouble is that, in order to overcome the moral wrinkle that comes with the question of health care, we need to make sure that everyone is able to take responsibility for his own interests if he so chooses. That is, if someone can’t afford fire insurance on his home, those are the breaks—he probably bought too much house. But if someone can’t afford health insurance, most good folks won’t be able to assuage their guilt at the thought of him dying on the street because he happened to get sick. At the very least, we need to be able to say, “sorry to hear that, but you should have done x.”
This has mostly to do with the pre-existing conditions issue. In some instances, we can waive off this problem by arguing that so-and-so should have gotten health insurance before he got sick, or his condition was probably caused by his own behavior. This is perhaps true. But the fact remains that there are many folks who get terrible illnesses through no fault of their own. And even if they have health insurance, even one short lapse—which might occur due to a missed form, of which there are many—could forever banish them from the possibility of ever again being insured.
That is why, in my view, certain unknowns should probably be diffused across large numbers of Americans, as a matter of public policy. By this I assume that, while it just won’t wind up sitting right to make each individual take on the entirety of the risk of the calamities that nature might throw at him, it is also not right to make insurance companies take on unreasonable risk. Instead, because the health care system is one that we all want to be available to everyone who wants it—i.e., it is not like the Faberge egg industry—we might all need to shoulder slightly higher premiums so that certain pre-existing conditions do not unduly price individuals out of the market.
In this way, so long as everyone who wants insurance is able to obtain it at a relatively reasonable price, there is no reason—as a matter of social justice—to lament anyone “dying on the street” because they chose not to purchase it. As a matter of personal justice, of course, many folks will still be unable to stand idly by. But this is what charity is for. The government’s duty is fulfilled simply by making choices available. It is neither required, nor constitutionally empowered, to right every wrong doled out by fate and nature.