Fortunately, the government can handle this problem without spending trillions or heavily regulating the insurance or medical industries. All it needs to do is provide a means-tested subsidy to make private health insurance more affordable for those who need it most. The subsidy should be based on income, wealth, chronic health status – and, given Balan's focus on the deserving poor – on past and current behavior. People who engage in voluntary risky behaviors – smoking, drinking, over-eating, mountain-climbing, violence, etc. – should receive a smaller subsidy, or no subsidy at all. The same goes for people who failed to buy long-term insurance when they were healthy and employed, then ran into health or financial troubles.
First, I am worried about a governmental process which first judges the "deservingness" of each poor person before setting the proper subsidy. Do they videotape your life as you go along, or do they convene a Job-like trial when you submit receipts for reimbursement?
Second, causality is so often difficult to determine in medicine. Say a poor guy had a heart attack but he ate grilled meats for thirty years. Was that irresponsible behavior or not?
This is a fundamental tension in Caplanian thought, namely the desire to promote intuitions of both meritocracy/desert and facts about heritability. Bryan can't have it both ways.
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