Healthcare as the responsibility of the State?

Last updated on: July 22, 2013 at 10:48 pm by Jane the Actuary

Healthcare as the responsibility of the State? 2013-07-22T22:48:00-06:00 Jane the Actuary

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OK, so I said in my last post that “the State has the ultimate responsibility to ensure that its citizens’ basic needs are met” which I guess means that I’m not a libertarian, though I would prefer, in general, that the State meet that responsibility in the most prudent manner, in the way that best meets the need while minimizing the apparatus of the State.

And now I’m thinking about the different kinds of human needs and how the State meets those needs (and whether I think that’s the right way or not).

Food: food stamps, of course. Everyone on the left laments that the food stamps are insufficient and point to the demand for food from food pantries as evidence. (Or, as the Trib featured, summer food distribution programs for kids who are accustomed to free school lunches during the school year.) I don’t know — even though I’ve only seen anecdotal accounts of food stamp fraud, rather than solid statistics, if everyone on food stamps could barely feed themselves with their food stamps, then it would seem rather improbable for there to be any food stamp fraud at all. And the sums given for monthly food stamp benefits don’t look that outrageous to me — though I suspect that part of the problem is that families who qualify for partial benefits, still expect the food stamp allotment to cover all their food costs.

Anyway, the question I ask myself is: is this the best approach to helping the hungry? Should we just have government food distribution centers, where anyone with income below a certain level gets an allotment of rice and beans and a couple boxes of powdered milk?

I suppose the food stamp program would be somewhat analogous to the subsidized exchanges (though not to single-payer Medicaid). In principle, people can use their food vouchers to buy the food that best meets their own needs — that’s almost a free market approach, right?

Second human need: education. For tertiary education, we’re perfectly happy with a voucher system (e.g., Pell Grants) for the low-income. But for elementary/secondary education, we give it away to everyone, whether poor or not. Imagine if education were like food, and only the needy got vouchers while everyone else had to pay full price: certainly, many upstanding citizens would pay their tuition, but others would conclude that even though the government’s formula told them they could afford to pay a given amount of tuition, they would believe that the cost was unaffordable and refuse to pay the tuition bill or (assuming there is no compulsory education in the thought experiment) decline to enroll their children in school in the first place, or withdraw them after they learned the basics of reading and writing — and as a society we believe that it harms society to have uneducated children, who ultimately grow into uneducated adults.

Right now, people are generally OK with the notion of the State providing healthcare to the poor in the same way as we provide food to the poor (though there’s no consensus, in either case, on what to do with the “voluntarily poor”, those who aren’t actively looking for work). But I’m inclined to think that healthcare is more like education — that the system of the government providing healthcare benefits only to those who meet very narrow income cut-offs just leaves too many people deciding for themselves to forgo insurance coverage.

Enough for tonight — I’ll try to elaborate on this later. (Remember, I’m still working this out!)

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