But it's also wrong for someone who wants to change the status quo to ignore the unpleasant fact that there usually are costs. We have to at least review the costs to see if they're worth the change. This ultimately slides into a bit of utilitarian type of thinking, which is ok if you're trying to decide what a taxicab badge should cost or how much your property tax should be, but may not be the correct frame to use in questions of justice. For example no one, well few people anyway, will question the cost of liberating slaves or giving women the right to vote or stopping the arrest of homosexuals for being homosexual. If those things are right, then costs simply don't matter and you're probably a pretty cold heartless SOB for even bringing that question up.
So then if you want to change something but don't want people to think about costs you definitely need to frame the change as a question of justice. If you don't want change and wish to avoid arguments about justice you need to focus on costs and unintended and unforeseen consequences. We saw some of this play out in the arguments over ObamaCare. However as it turned out both sides (pro and con) strongly believed they had an excellent argument about justice (the individual mandate vs. the numbers of uninsured or the importance of universal birth control coverage) and as a result the popular discussions over the PPACA didn't really focus on costs. Rather cannily the Obama Administration and Congress set up the legislation so that most of the more unpleasant changes would arrive AFTER the 2012 election. Well that election will shortly be completed and absent an extremely unlikely sequence of events the PPACA is here to stay. As a result companies and organizations have begun to adapt to the law's less pleasant incentives. It's important to realize that these things aren't bugs. They're features.
Over the next 18 months, between one quarter and one half of Americans who get insurance coverage through their employers will pay more of their doctor bills themselves as companies roll out health care plans with higher deductibles, benefits consultants say. The result: sticker shock.
"They have huge out-of-pocket costs before they get any insurance coverage, it's a real slap in the face," said Ron Pollack, the executive director of Families USA, a health care advocacy group. High-deductible plans set a threshold for medical expenses that an individual must pay for, often in the thousands of dollars, before insurance kicks in. Studies show people on these plans are three times more likely to delay or skip care than people on traditional plans, where doctor or emergency room visits are covered by a relatively low co-payment.
These plans have been around for years, pushed by employers, insurers and industry experts who believe that consumers with "skin in the game" will drive demand for better quality care at a lower cost. It is a rationale also backed by President Barack Obama's Republican challenger Mitt Romney.
But now corporate America's adoption of high-deductible plans is accelerating, partly because of Obama's health care reform, which requires insurance plans to provide more expansive coverage such as preventive care.Several industry surveys forecast a two-percentage-point increase in the number of companies offering only high-deductible plans in 2013 to about 19 percent, and a larger jump of anywhere from 5 to 25 percentage points in 2014.LINK
The problem with this line of thinking is of course that with few exceptions no one just runs down to his or her doctor and starts requesting hysterectomies, colonoscopies or angioplasties just for the heck of it. No one looks at their health care coverage plan, sees that he only has a $250 co-pay for major procedures and promptly books himself into the hospital for a weekend dialysis session. I mean for just $250, how could you pass up that deal?
Yes you need to take this medicine and/or have this procedure done or you will die/be crippled/live in horrible pain for the rest of your life" then that's what I'm probably going to do. No one who is having a heart attack demands to be taken to Dr. X instead of Dr. Y because he has a 10% off coupon from Dr. X. Very few of us could afford to pay the true cost of a required procedure. That's why we have insurance. Delaying your car's scheduled oil change until next month's paycheck is one thing. Ignoring that new spot on your body or that cough that won't go away involves an entirely different set of consequences.
This really stinks because as an employed person I lacked real complaints about my health care coverage. And for those who didn't have health care coverage because they weren't employed or their employer refused to offer the benefit, I would have supported opening up Medicare/Medicaid for them. That would have made more sense than the PPACA but because the Administration was determined to keep the private health care industry happy it made the decision not to go down that path. So if you're employed you get to enjoy higher deductible plans and most likely higher premiums as well. Let the good times roll!!
Time will tell if PPACA was a good idea. I think not. Others may think differently. But at the very least we should all realize that it was not cost-free. There really ain't no such thing as a free lunch.