Of helmets and healthcare

Joe Paduda had an interesting post the other day on the limits of personal choice:

There are few issues that do more to crystalize the balance between personal freedom and personal responsibility than motorcycle helmet laws.

Twenty states require motorcyclists to wear helmets.. . Opponents of helmet laws see it is a personal choice and often claim wearing a helmet decreases visibility and situational awareness. Could be.

Proponents of mandatory helmet laws note that….falling off a bike onto one’s head without a helmet is likely to cause a more serious head injury than if one was wearing a helmet.

…there is an ongoing back and forth debate… but ultimately wearing a helmet is a personal decision, until you get a traumatic brain injury, whereupon it becomes a societal issue.

Exactly. Because all of us, either through insurance or government programs, will have to take care of someone with terrible injuries. In other words we may be disinclined to interfere with someone engaging in risky behavior because, “hey, that’s their choice”, but if their bet turns out bad, we all bear the cost. So we all have an interest in what kind of risks people take. Thus, motorcycle helmet laws.

Paduda says it would make more sense to impose high insurance premiums on people taking risks instead of mandating helmets. Maybe so. But I would like to point out an even more destructive example of choice run amok: Consumer Directed Health Care.

Conservatives believe that the problem with our healthcare system is that people don’t have to make enough choices. Third parties pay for everything. What’s to stop people from going to the doc every five minutes with a hangnail if it’s free? That’s the reason for the terrible overspending on healthcare, they say, and therefore we need high deductibles and Health Savings Accounts that will force people to pay docs and hospitals themselves. That’s when costs will come down!

Maybe. But, what actually happens when healthcare consumers are given more choice?

Here’s report on high deductible health plans as quoted in the Register-Guard today:

“Health insurance plans that require enrollees to pay up-front deductibles before coverage kicks in have an alarming side effect, according to two studies released Tuesday by health policy researchers at the University of Oregon.

People enrolled in these plans were two to three times more likely than enrollees in other types of plans to quit taking drugs to control cholesterol and high blood pressure, said Jessica Greene, professor of health policy in the UO’s department of planning, public policy and management.

She and Judith Hibbard, a professor in the same department, were co-authors of the papers, which were published in the peer-reviewed journal Health Affairs.

Cutting back on antihypertensive and lipid-lowering drugs may result in higher long-term health care costs, Greene said. “These consumers may be making shortsighted, cost-saving decisions that may have higher-cost and unfortunate health ramifications,” she said.

Oops. Giving people more choices in healthcare makes it more likely that they will engage in risky behavior (not getting screenings, going off meds) that will very likely impose large costs on all of us–eventually.

Great. Another gigantic deferred cost imposed on our society by conservatives under the banner of personal choice.

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