POLICY: Me. A loony libertarian?

Not exactly but I am up at Cato Unbound with a piece replying to Arnold Kling’s fascinating essay "Insulation v Insurance." Read his first, then read mine. It’s called Abundance Is Insulated from a Crisis–For Now.

In his insightful book and in this interesting essay, Arnold Kling
has made several leaps forward from the pack of “America-first free
marketeers." If you want to see them in action, take a look at the comments page
of any blogger who dares to suggest that spending nearly double what
its economic competitors are spending on health care—primarily because
it is paying its providers more for more or less the same volume of
services—may mean that the U.S. is not getting too good a deal.

apparent to any serious student of health care that the impact of
medical care on overall raw measures of health is not sufficiently
important that differences in spending here or there makes too much
difference to health. The somewhat pedantic arguments over life
expectancy and infant mortality, and the slightly more real ones over
the appropriate treatment of predominantly elderly people with serious
diseases, are all massively less important than the political and
medical culture in which the health care system exists. So there is
broad agreement, I believe, among most rational observers that the
activities Kling describes as "premium medicine" are far more in the
interests of providers and suppliers (including those middlemen who
mark up the price without taking on much risk) then they are in the
interest of patients&mdash, and certainly of society as a whole. Continue.

BTW before the brickbats start flying; “loony libertarian” is a term of affection. Actually most of the Cato guys are very sensible libertarians whom I agree with on almost all social & civil liberties issues.

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Tom LeithAlexPCBBarry Carol Recent comment authors
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Tom Leith
Tom Leith

I second Alex’s comment. Matthew has hit a grand slam. I am glad that the word “correct” can still be used with respect to values at least in some places. I hope that the definition of “correct” has something to do with “truth” understood in the Aristotelian sense. > If you want a real “insurance” market you’re going to > have to let them suffer. If you want a social > insurance model, you’re going to have to subsidize > them. Quite so. One distinction I think may be made has to do with who or what is being subsidized.… Read more »


That’s the best essay you’ve ever written.
I think the answer to you’re free-meketeer question is pretty straight forward. If you want a real “insurance” market you’re going to have to let them suffer. If you want a social insurance model, you’re going to have to subsidize them. Given that we have decided, correctly, that we don’t want people to suffer, the decision for conservatives seems to be whether they want to retain any free marker for health care or take Medicare for all when it their other options fall apart.


A couple points of interest from Kling’s piece: —- “The MRI exam that I had when I hurt my back moving furniture was pointless—the treatment would have been rest and anti-inflammatories, whatever the exam showed. My doctor’s referring me to a nephrologist for microscopic hematuria (blood in a urine specimen not visible to the naked eye) was equally pointless—like many people, I have this symptom sometimes, and then it mysteriously goes away.” — In most cases it is pointless. Rarely, however, that MRI or hematuria workup will find something serious. When the doctor waits for it to “mysteriously go away”… Read more »

Barry Carol
Barry Carol

I agree with the thrust of Arnold Kling’s argument about insulation vs insurance. To help consumers better understand this, I think it would be helpful if the cost of an insurance policy were unbundled into a catastrophic coverage piece (say, 100% coverage after the first $5K of expenses) and the “insulation” piece (the first $5K of charges – with or without modest co-pays). Perhaps even Medicare could be repackaged into one comprehensive policy as opposed to the current Parts A, B, and D. Beneficiary premiums could be reset to cover, perhaps, 50% of the cost of the insulation piece and… Read more »