Mickey Kaus says there are “three obvious problems” with my case against universal coverage. Luckily, there are also three obvious answers. His first criticism is that direct subsidies to people with pre-existing conditions–something I posited as an alternative to universal coverage–would come with all kinds of bureaucratic pitfalls. He’s right! But I think that the need for these subsidies would be a lot smaller than people think and that any such program would end up being transitional, since in a free health-care market people would have a strong incentive to buy cheap, renewable policies at an early age.
Kaus’s second point is that such policies would tie people to their insurance companies: they would be stuck with insurers they dislike rather than with jobs they dislike. I’d say that’s an improvement in itself. But the assumption might not be right. John Cochrane has argued that if restrictions on the emergence of a robust individual market were repealed, insurance for a change in health status could easily be decoupled from health insurance that covers your big medical expenses for the next year (or some other time period). In other words, you could have an effectively renewable policy without being glued to one company. See here for more.
Third, Kaus says that it’s wrong to speak of not buying health insurance as a kind of “freedom” since it’s just a way for people to offload their costs onto other people. My first response: That’s not always true. There are people who pay out of pocket, and there are people who don’t buy insurance but never incur large medical costs either. Second: The non-buyers aren’t the ones who established a legal obligation to give care to anyone. (Note that I’m not calling for the repeal of that obligation.) Most people would say that the ability to eat whatever you want is an aspect of freedom even if it leads to higher Medicare costs down the road, right?
Update: I don’t mean to suggest that the trade-off here would never justify restricting freedom. Maybe there’d be a sufficiently good case to justify grabbing that Ho Ho out of your hand. But lost freedom would be a cost of that policy, to be avoided unless we have a really strong reason.