The Corner

Politics & Policy

Jacob Hacker’s Case for Health Insurance

Jacob Hacker, a left-wing political scientist at Yale, writes in opposition to conservative views of health insurance.

Senator Rand Paul (another surgeon) and House Speaker Paul Ryan have claimed that the affordability of Lasik eye surgery — generally not covered by health insurance — shows that a much freer health care market would be much less expensive. Their idea of “reform” is to cut back public and private insurance so consumers have “more skin in the game” and thus shop more wisely. . . .

The fact is that people need insurance for the highest costs they face. They may be able to pay for Lasik, a nonessential, nonemergency procedure for which consumers have plenty of time to shop around. But the biggest-ticket items — cancer care, cardiac surgery, organ transplants — are beyond the reach of all but the richest, and not so easy to shop around for when they’re needed. Just as we shouldn’t blame the idea of mortgages for the financial crisis, we shouldn’t blame the idea of health insurance for the health care crisis.

The second paragraph I’ve excerpted makes a case that catastrophic health insurance is valuable. (Liberal attempts to defend their views on health insurance end up arguing for catastrophic coverage surprisingly often.) That view is entirely compatible with the conservative view that the widespread use of insurance to pay for routine health expenses has made health care less efficient than it should be. But if what you mostly want from health-insurance policy is a system where everyone can have (at least) catastrophic coverage, a lot of conservative ideas make more sense than Obamacare does.

Ramesh Ponnuru is a senior editor for National Review, a columnist for Bloomberg Opinion, a visiting fellow at the American Enterprise Institute, and a senior fellow at the National Review Institute.


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