Of Health Care, Horses, and Hell

Let me start discussing the questions from the weekend with Ken's pair of doozies. First of all, Ken, man, thrilled to have you around -- and when you come out, boy, you do it with a bang. I always wonder who is reading and it always surprises me when interesting thoughtful people take time to read my silliness.

First question:

"On the concept of moral hazard the economic principle that says if certain services are free, people will consume too much of them. In relation to health services isn't this totally bogus and is keeping people from the services they need. Or in other words I don't see a bunch of healthy people signing up for quadruple bypass surgery because it's "free". Your view?"

We all know perfectly well the intuition behind this principle. My grandfather used to run a belt factory and provided free soft drinks to all the workers. He was finding a lot of half drunk sodas all around the factory floor. He didn't mind giving the workers all the sodas they wanted, but he hated to be wasting the money on something that was just being thrown away. Then he started charging a nickel for sodas, well below normal market value (every trucker who came through bought sodas by the five or ten for the road). At once the sodas were all being finished. When something is free, we treat it as it it has no value and use too much of it. But when it costs us, even less than the amount we would be willing to pay and consider it fair, we treat it more respectfully.

Now, the case you select seems to me to be degenerate in the sense that you've selected an example where the free service or product is a strange one in not having a demand among the general population. No one wakes up and thinks, you know, it'd be fun to have my appendix taken out this afternoon, but it's just so damn expensive. It seems like the principle only works if the good is something that we would want or at least wouldn't want to avoid.

If you look at other parts of the health delivery system, you might see something more like it. I think this is one of the reasons for co-pays. If people pay even just a five or ten, they are less likely to go see the doctor and this saves the insurance company lots of money. This may have good or bad effects on the system. It may keep down frivolous visits, allowing doctors to spend more time with patients who really need it. Or, it may keep people from getting earlier diagnoses than they otherwise would allowing complications that might have been avoided. It's an empirical questions and the sort of thing public health researchers spend their time on. If anyone knows of any studies on this, I'd be very interested to hear. But it may be a situation where it does work because doctor visits, unlike surgery, may be desirable even if they are not needed (say, if you are looking for back issues of Field and Stream, Women's World or Highlights for Kids).

Second Question:

"I live in a horse racing town in the south and on any given weekend I will go from fishing on Saturday morning to betting the horses in the afternoon to church the next morning. I have recently taken moral flak from the wingnut's down the street for this. They don't approve of my gay neighbor either but that's a different story. So the other day I was mowing my yard and Mrs. Wingnut started her standard I'm going to hell speech when I just up and asked her the question that has been asked by every horse player I know of in the last 30 years. What is the difference between people who pray in church and people who pray at the track? The answer is the people at the track really mean it. Now the wingnut's are not talking to me. Should I apologize?"

It depends upon what you mean by "should." Did you do anything morally wrong? No on either part. A) You are doing nothing wrong by playing the ponies. It's your money and if this is your hobby, so be it. You aren't hurting anyone. there is nothing inherently immoral with gambling as long as you aren't using the rent money -- ask Bill Bennett. B) You did nothing wrong with using a joke to make your point that you were doing nothing wrong. You are not responsible for someone else having too thin of a skin. She started this argument, took it to you stridently, and to expect someone not to respond with equal zeal is absurd. Morally, you are on solid ground.

BUT...Pragmatically, the question is how much does the friction with this person make your life more difficult. This is a person who while being quite arrogant, obnoxious, and annoying, was, on some level, only trying to help. At least part of how one might understand the preaching is a legitimate concern for your soul. If it would make life easier having peace with your neighbor, approaching her would not be the worst of things. You could explain that you did not mean to be ridiculing her faith and you are sorry if you offended her, but that with your theological differences, she too has been quite offensive.

Oh, and "What is the difference between people who pray in church and people who pray at the track? The answer is the people at the track really mean it." Outstanding line.