Not On the Universal Health Insurance Bandwagon

Paul Krugman’s column in the New York Times (which you can also find here, if you don’t want to pay to get past the Times Select firewall) has spurred a new flurry of concern about spiraling health insurance costs impacting American businesses.

Revere over at Effect Measure mentioned a post over at My DD by Scott Shields titled “GM Layoffs and The High Cost of Healthcare”, in which the case is made that healthcare costs for employees and retirees are a major part of GM’s financial problems, and that universal health insurance is a matter of economic competitiveness. Revere’s comment was this issue should be a no-brainer for Democrats.

What drew my attention to Mr. Shields’s post, the associated comments, nor the other blogs he cited (summarized here), was not seeing health promotion featured in the discussion. Universal health insurance may be a great bandwagon for Democratic politics, but I’m not ready to jump on if it isn’t going to address wellness, including instituting some standards of individual responsibility on the part of beneficiaries to maintain their health. Maybe there’s a trade that can be made here – workers will eat their fruits and vegetables, and get more exercise, if investors cough up some of their dividends.

For example,

Taking a cigarette break outside a General Motors (GM) assembly plant in Lansing, Mich., last week, Mike O'Driscoll admits he has problems: diabetes, high blood pressure, high cholesterol.

But his arteries are cleaned out, thanks to a $160,000 heart-bypass surgery a few years back.

"I ate too many steaks and not enough veggies," says O'Driscoll with a laugh.

For as long as O'Driscoll has worked at GM, he hasn't had to worry about health care costs. . . .

The intent here is not to endorse a moral hazard argument (Malcolm Gladwell makes a good case here that moral hazard is a really bad idea), but there’s a balance to be struck somewhere – at least the debate over universal health insurance could also encompass the role of health promotion in controlling medical expenses.

Is Mr. Shield’s post a representative cross-section of the discussion in the liberal blogosphere? If it is, then a vital public health component to addressing the health insurance crisis is absent. Phillip Longman published an interesting article in Washington Monthly a couple of years ago, suggesting that the money being used to prop up benefits in a healthcare system that is already financially unsustainable, instead be used to bribe people into acting preventively and taking better care of themselves. While possibly an unconventional approach, at least it has health promotion at its core. A political no-brainer it may be for the Democratic Party, but will universal health care really accomplish anything of value if it does nothing to address the avoidable causes of disease?

Postscript: minor editing for grammar on November 27, 2005.