« Journal Watch: Utilitas, 21/4, December 2009 | Main | That oldtime utilitarian economics (no, thank you) [UPDATED AGAIN] »

November 24, 2009

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Thanks for posting this, as I'd missed Brooks' column. Overall, I think he's right. But in posing the trade-off as between security and vitality, Brooks misses two points:
(1) that health insurance security will allow workers to migrate more easily between jobs and to start their own companies; and (2) that public health problems (e.g., contagious illnesses) will be better controlled if insurance is extended to those most at risk. So "vitality" cannot simply be measured by explicit costs within the health sector itself.

More importantly, perhaps Brooks is wrong and we should talk about costs. Is it ethical to spend 50% of all health funds to preserve the lives of terminally ill patients a few more months? Would it be ethical to offer patients a choice of treatments? (Take $150,000 cash to leave to your heirs and we'll give you lots of pain meds but no heroic treatments; or, we'll spend $300,000 on heroic procedures that are painful and will make your last months hell.)

Three comments in reply, Jonathan:

1) Your point about worker flexibility is very important, but could be achieved by severing the link between employers and health insurance.

2) Contagions can be dealt with by case-specific measures (universal innoculation programs, for instance) - there is no need for universal health insurance to cover this, since the innoculation itself is insurance.

3) Let me put your question about costs another way: is it ethical to make individual persons' and families' health care choices for them? There is no reason for "us" to talk about costs; in a just system, each person, along with his or her family and doctor, would decide what costs they choose to bear for which treatments, operations, or long-term care, based on their unique circumstances, constraints, goals, concerns, and priorities.

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