Like most of you, I suspect, I've been having lots of conversations with angry conservatives about the Health Care bill.  One issue that's come up right away is the controversial mandate that everyone MUST buy insurance.  Those with a more libertarian streak don't much care for this provision since isn't it somebody's personal responsibility as to whether they should have insurance or not. If they want to take the risk of not covering themselves, isn't it their lookout? 

The argument for forcing people to buy insurance in order to drive a car is not completely analogous. Forcing everyone to buy insurance, you guarantee that innocent third parties will not have to bear the costs of accidents that are not their fault.  But rates are determined by people's behavior, something that can't be as effective in health insurance.  If your rates are so high that you can't afford the insurance and you don't buy it, you can't legally drive a car. If you can't afford your health insurance and don't buy it, somebody will pick up the tab down the road when you have a health care expense that you can't pay.  And if you don't see a problem with making people pay for their own choices, one way or the other, there will be some clearer innocent third party cases.  The recent S-CHIP and Medicare expansions probably cover them already but most conservatives (including myself) didn't and don't favor that solution. 

The benefit of forcing the healthy and the sick to buy insurance is that you get a lot of cheaper people in the pool to help cover those who will be more expensive. The healthy people are actually buying insurance against some catastrophe. The sick people are buying pre-paid and in some cases subsidized health care. If you want the system to be fair, this isn't a solution. It's practical but not principled.

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Senator Amy Klobuchar is promoting a measure that would fund genetic testing for women in their 30s and 40s for breast cancer.  A great thing you say? Not so much. Breast cancer in this group is pretty rare, and genetic testing doesn’t really get you very much, except to tell you whether you have a higher probability of getting breast cancer than the average person.  Family history screening (merely finding out whether you have any close relatives who had it) is a better indicator and costs far less than genetic testing. You could get tested if you have this kind of history but it would merely confirm your inheritance of a genetic marker.  Even if you find out you have a higher probability of having breast cancer, there is no real action item if you don’t actually have cancer, even if it’s you don’t have cancer yet. 

There are some women who, freaked out by a “elevated cancer risk” will go full steam into a double mastectomy and replacement surgery.  They would choose it over simply getting regular checkups, mammograms and checking their own bodies.   If they are paying for their own testing, surgery and making their own decisions, it’s hard to question someone’s expensive and painful choice.  Obviously, if the history is clear and the genetic marker is present, the choice will look a lot different. But promoting genetic testing to a general population promotes false choices.  It emphasizes testing (costly) over personal responsibility and prevention (relatively cheap). 

Senator Amy’s approach is what is bankrupting the system-- promoting tests that give most people useless information.  And with it the idea that if you aren’t getting tested, somehow you’re not taking care of yourself.  Given that healthcare dollars used in one area can’t be used in another, it’s important to question the priorities here.  A dollar used to screen women for a relatively rare type of cancer occurrence is a dollar less that could be used to make the film based (not even the more expensive digital) mammogram available to some other woman. A woman who actually could have cancer and for whom early intervention would actually be life saving, not just needless anxiety inducing.  

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