So, as promised, more on the Gladwell piece. Gladwell is not, as my previous post might have suggested, opening up a can of whoop-ass on America's health care system. Instead, he's digging into a cultural cause of our recalcitrance to move to full coverage -- the perception that the uninsured deserve what they get, and that insurance generally isn't what'll help these irresponsible souls.
Gladwell calls it by its economic name, moral hazard, which is the theory that insurance changes the behavior of the uninsured. If you get all the health care you want for free, you'll use a ton of health care, much of it, according to conservatives, unnecessary. If you have to pay a significant copay, the amount you use will go down, as your bank account will feel each doctor's visit. If you are uninsured and have to pay the whole cost, you'll only go when you need it.
That's all true, so far as it goes. The problem is, individuals aren't good judges of what counts as necessary care. They first cut back on dental care, which leads to lost dental disintegration and all manner of socioeconomic consequences (folks missing teeth, for instance, are rarely given jobs where they'll interact with the public). But more to the point, they'll forego obviously necessary care. A RAND study from awhile back gave different groups different deductibles. The highest deductible group simply ignored their high blood pressure, leaving them 10% more likely to die and significantly more likely to suffer heart attacks and other ailments that cost the system much more than blood pressure maintenance.
