Buce Explains Health Care(But it Won’t Make You Happy)

Getting ready for tonight's PBS special on health care (cf. link)--somebody must have thought of this, but I haven’t seen it elsewhere so I will make the point now. That is: when we talk about “health care,” we are talking about two rather different problems, not solvable in the same way (if solvable at all).

One is the problem of catastrophic loss. Only the unlucky few of us will run up hundreds of thousands of dollars of health care bills. It’s the kind of risk that can (and should) be “socialized”—spreading the loss over the lucky and the unlucky.

But quite apart from catastrophic loss, there is the general problem that we just think health care is too damned expensive and that somebody else—well, call it “the government” should pay. It is far from clear to me where “the government” gets that kind of money, except from us. We send the money out in a boomerang and get it back encumbered, as George Stigler liked to remind us, with the price of a round-trip ticket.

There probably is a distributional issue here: some people are “too poor” to pay for health care. Okay, make some wealth transfers (and yes, I am perfectly willing to stump up a share). Maybe "welfare stamps," like "food stamps"--one fairly successful, effective public program. But it can’t be that 100 percent of us are “too poor”—kind of a reverse Lake Wobegon, where all the residents are below average.

I'm all for finding ways to make health care cheap, or at least cheaper. There's got to be a reason why we pay, relatively, so much for our health care--and the reason cannot be our great results, because we don't have great results.

Oh, and another thing. “We”—a lot of us—want “open borders,” and we want government provided health care. Assume for the moment that both are worthy goals. Still, you can’t have both at once: you can’t at the same time offer everyone government health care and make it open to the whole world. Either you have to cut down on the level of government support or you have to limit immigration, legal and illegal. There’s no third way.

There. Everything clear now?