At a party in Somerville on Saturday night, we were talking about the constitutionality of the federal government’s proposed requirement that everyone buy health insurance (see The Dirty Dozen book review). A woman of about age 30 said “I would be dead without health insurance.” She explained that she had required a two-day stay in the hospital not so long ago. I pointed out that she had paid at least $60,000 in health insurance during her lifetime and that, aside from this one incident, she had never required anything more than routine care. Surely she could not have run up $60,000 in charges in two days?
After paying out all claims, health insurers have enough money left over to pay nearly half a million employees (source; UnitedHealth is a typical example) and still declare consistent profits. So it should be obvious that the average consumer of health insurance does not come out ahead. Premiums for a single 30-year-old here in Massachusetts are approximately $3600 per year (source; ever since Massachusetts passed a law requiring everyone to buy insurance we have had the highest insurance rates in the U.S. (and therefore the world; source)). Even a “catastrophic” $100,000 illness can be paid for with 30 years of premiums, or fewer years if you assume that you were able to earn interest or investment returns on money set aside.
Our almost-always-healthy young woman was unconvinced. I asked her if she would be better off with her employer (a university-affiliated research institute) paying her $3600 more every year rather than buying insurance for her. “No, because if they didn’t have to buy insurance for me they would just pocket the money; they wouldn’t pay me anything extra.”
I thought about arguing that in a classical free market, employers relieved of the burden of paying for health insurance would have more money to spend. With more money, they’d bid up the salaries offered to workers. Since her salary was already above the minimum wage, it was clearly being determined by some sort of competition among employers.
However, I reflected that classical Economics tells us that in a free market there can be no involuntary unemployment. Looking around in the U.S., this is not exactly what we see. Mancur Olson has some persuasive explanations, but it is not exactly clear how to apply his theories to the question of what would happen if the U.S. ended the employer-paid tax-exempt health insurance experiment that we began during World War II.
Perhaps the reason that we can’t sort out health care policy is that so many of us think that we have gotten something of tremendous value from health insurers. We don’t want to keep paying 500,000 Americans to work at health insurers but we still want the benefits that we think these folks have bestowed upon us.
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