Steve Daines, Montana’s junior U.S. senator, has voted — again — to repeal the Affordable Care Act. He’d voted for repeal on three dozen earlier occasions so I presume that he’s against the ACA.
Which raises two questions: What’s he for? And why won’t he tell us? What he — and his party, particularly those congressmen in the so-called “Freedom Caucus” — seem to be for is a health-care system based on free-market principles, but he won’t admit it because the unintended consequences of a free-market health-care system are too gruesome to stomach.
Let me explain.
To understand free-market health-care insurance, look no further than the life insurance industry. You want to purchase life insurance. The insurer asks a few questions: your age, your gender, your physical fitness, perhaps your occupation and your avocations. These details are correlated with the insurer’s actuarial database to estimate your life expectancy.
(Older people die sooner than younger people, men sooner than women, the sick sooner than the healthy. If you’re a college professor or in retail sales, OK; if you’re a member of the police department’s bomb-disposal unit, not so much. Ditto regarding avocations: do you golf on the weekend or do you skydive?)
Once the insurer understands what is called the “risk” of insuring your life, it makes an offer: if you pay the insurer X dollars a month from this month until the month of your death, the insurer will pay Y dollars to your heirs. When the insured die, their heirs are left with Y dollars to defray the kids’ tuition or to pay off the mortgage or to pay down their debts. When the uninsured die, their heirs are left to their own resources or to charity or to God. And that’s the free market at work.
Now substitute the word life with health and you begin to understand the free-market health-care system that seems to fascinate Daines and the Freedom Caucus.
You want to purchase health insurance. The insurer asks the same questions. Age? Premiums will increase with age, so it’s best to enroll early. Gender? Women have babies, so it’s best to be male. Health? To understand the predicament of the sickly, think about applying for life insurance from your deathbed; when playing in the free market it’s best to avoid those pesky “pre-existing” conditions. And it’s best, too, to avoid those hazardous occupations and dicey hobbies.
Once the insurer’s actuarial data calculates the “risk” of insuring your health, you receive an offer: if you pay the insurer X dollars a month from this month until the month of your death, the insurer will defray the cost of your health care. (Note to self. Don’t let your insurance lapse because your “risk” will be recalculated with each resumption of coverage. You’ll be older—read riskier. You may be approaching child-bearing age—read riskier. You may have developed a “pre-existing” condition—read forget about it.)
Stay with the life insurance analogy. When the insured get sick, their health-care expenses are defrayed. When the uninsured get sick, they are left to their own resources or to charity or to God. And that’s the free market at work.
I have written elsewhere in these pages about the uninsured sick of meager means, about the accident victims and the stage-four cancer sufferers who—according to marketplace dictates—must be left to die in the streets or in their beds.
Daines and his ilk seem devoted to these dictates, although the unintended consequences are too gruesome to mention. And yet, as Shakespeare’s Merchant of Venice argues, are the uninsured sick not “subject to the same diseases, healed by the same means… . If you prick us, do we not bleed?”
Bruce A. Lohof is a native of Montana. A former professor and a retired diplomat, he lives in Vienna and in Red Lodge.