It’s increasingly likely that serious healthcare reform will pass by the end of the year, and even include some form of public option. This is great news for America, but bad news for Republicans who have been pinning their hopes on defeating the measure.
Yet many problems will remain, primarily healthcare’s ever-increasing costs. The final bill will likely improve efficiency, increase and improve preventive care, and decrease abuse and fraud. Nevertheless, costs will continue to rise if Americans don’t radically improve their health. Obesity and diabetes are skyrocketing, and preventable deaths from cancer and heart disease are still near historic highs.
If people were truly rational and not as susceptible to addictions and misinformation, the disincentives associated with sickness—pain and suffering, lost wages, shorter lifespans—would be sufficient to encourage Americans to stay in relatively good health. Unfortunately, in areas related to health, people are often highly irrational, cravings and addictions are extremely powerful, and knowledge is abysmally low.
If government is going to either provide healthcare for free or highly subsidize it, then it’s only right that it enact policies that try to incentivize good behavior and minimize long-term costs.
Some of the policy options in this regard are non-objectionable: better prenatal and early childhood care and nutrition, healthier school lunches, and a ban on candy and sodas in school vending machines. Other policies, such as “end of life” counseling, have stirred up a great deal of controversy. Such counseling could save lots of money, since a disproportionate share of healthcare dollars are spent in the waning months of life; yet, if consulted beforehand, many people would prefer not to have many of these procedures. Unfortunately, when they’re old and infirm, people are often incapacitated and unable to inform their healthcare providers of their true preferences. It’s one of the great scandals of the healthcare debate that a reasonable and sensible “end of life” policy was portrayed as a diabolical scheme and labeled “death panels” by unscrupulous Republicans.
Another policy that would go a long way towards promoting healthier lifestyles would be an end to agricultural subsidies for commodity crops, which act to artificially deflate the price of corn syrup, meat and dairy products. Unfortunately the agribusiness lobby backs many powerful legislators, both Republicans and Democrats; they hold tremendous sway, particularly in the Senate, despite the relatively low populations of the states they represent.
Better healthcare could also be encouraged by charging different premiums based on individual behaviors, e.g., diet, alcohol and cigarette consumption, and exercise. If people were charged higher premiums for engaging in unhealthy lifestyles, this would likely be viewed as too harsh by a majority of the public. But the same outcomes could be achieved by rewarding people who engage in healthy lifestyles with lower premiums, which is intuitively appealing.
Even with all of these policies in place, there may still be a need for either higher taxes or additional healthcare rationing. But those tough choices can at least be minimized, and the overall population will be a lot healthier, the sooner policies along these lines are put into effect.
Jason Scorse