Monday, February 13, 2012

Get Back to the Spirit of Insurance

Obama 政府最近為了避孕藥搞得焦頭爛額,蠻值得一提。事情是這樣的,Obama 政府的 Department of Health and Human Services 上個月要求所有雇主都必須提供包含避孕計畫的健康保險,引起了宗教界(主要是天主教)強力的反彈。 

今年是選舉年,教會這種馬蜂窩沒有必要就最好不要去捅,最近的新聞都以 Obama 政府失分來評論。這把火越燒越大,最後終於把總統也燒出來了。Obama 改口說宗教組織雇主可以不用受到限制,不過他要求健康保險公司必須『免費』提供避孕藥給需要的宗教團體僱員。 

這讓我想到最近在看的 The Forgotten Man 這本書。作者 Amity Shlaes 借用一個遠在經濟大蕭條半世紀前的一個 Yale 哲學家 William Graham Sumner 的觀念來討論 Roosevelt 的 New Deal:
"As soon as A observes something which seems to him to be wrong, from which X is suffering, A talks it over with B, and A and B then propose to get a law passed to remedy the evil and help X. Their law always proposes to determine what A, B, and C shall do for X." But what about C? There was nothing wrong with A and B helping X. What was wrong was the law, and the indenturing of C to the cause. C was the forgotten man, the man who paid, "the man who never is thought of."
在絕大部份立法『照顧』某些人的過程中,都有 C 這個 "forgotten man" 的存在。在 Obama 的最新提案裡面,所有參與保險計畫的人最後都成為了這個 forgotten man。

保險公司提供『免費』的避孕藥?這是在開什麼玩笑。當下保險公司當然只有吞下來,不過在次年他們一定會把成本加回到保費裡面去。為了要掩蓋他們不是跟宗教組織收這個額外的成本,搞不好還會把增加的成本轉嫁到其他非宗教團體保戶去。

John Cochrane 在 WSJ 的文章更直指問題的核心,這在台灣健保的討論裡也一直看到類似觀念的運用。

WSJ, 2/9/2012, "The Real Trouble with the Birth-Control Mandate", by JOHN COCHRANE

為什麼保險要包括避孕藥這種東西?保險的目的是降低風險,使我們不至於因為房子失火、車子被撞等意外事件而承擔我們擔不起的損失。像避孕這種事情有什麼意外可言?懷孕還有意外發生的可能,避孕是自我選擇的事情,而且也不是只有女方使用避孕藥一種方式,男方也可以使用保險套,而且後者還有一些防止性病的功能。Obama 政府傾向於管太多政府不該管的事情,這剛好又是個例子。最近的討論幾乎都聚焦在宗教信仰自由上,Cochrane 把這個問題拉回來經濟自由,是個蠻有意思的討論。台灣經濟學界對於健保長期有『保大不保小』的建議,也是回歸到保險的本質來看。如果必須要動手術,有沒有保險的確差很多。拿保險去看感冒?洗牙?那最好還是花自己的錢就好了,別用保險來給付。

7 comments:

Ivan de la Isla Hermosa said...

我昨天剛好睡前讀物就是Economist對於這件事情的專文. 我直覺只是覺得有人嫌他自己票太多? 還是總統當成課長是現在全世界的潮流? :P

Publius said...

對照共和黨提名亂打一通的狀態,Obama administration 要硬打自己的自由派旗號其實對喚起基本盤或許有用。更陰謀論一點的想法,是把教會逼去支持 Santorum 或 Gingrich,或者逼 Romney 往保守黨靠攏以取得提名,對他獲勝的機率也有一定的幫助。

Ben said...

Did you know that more health insurance providers in the U.S. pay for Viagra but not birth control pill?

What a mess over there in the GOP camp! Obama doesn't deserve a second term, but looks like he will get it anyway. I sure hope that Obama brings his A game for his second term.

CCLu said...

To Ivan,

看起來更像『家長』。


To Publius,

我知道選戰策略有的時候可以推到相當極端的地步,不過殺敵八百,自損三千應該不是主動的選戰策略。


To Ben,

I didn't know that Viagra number, that is total insane.

How about this? Cut all coverage on Viagra, therefore the insurance company don't need to cover birth-control pills. If the U.S. cannot produce enough new-born babies this way, they can always import those from other countries.

Ivan de la Isla Hermosa said...

"Cut all coverage on Viagra, therefore the insurance company don't need to cover birth-control pills. If the U.S. cannot produce enough new-born babies this way, they can always import those from other countries" <==大推!! :D

Ben said...

>>How about this? Cut all coverage on Viagra, therefore the insurance company don't need to cover birth-control pills<<

That will put a lot of "working girls" out of work for sure:) We are in a prolonged recession and we need to save as many jobs as possible....

Thomas said...

關於健保給付洗牙感冒一事,有點不同意見。洗牙是預防醫學的一環,就像是牙齒塗氟防蛀牙或是吃阿斯匹靈預防中風一樣。如果健保不給付,洗牙人數減少,可能導致未來要花更多的錢治療牙周病。未治療的感冒與肺炎也常有因果關係,後者可能是攸關性命的大病,台灣十大死因中肺炎一直有重要位置。厲害的肺炎需要住加護病房和使用高貴抗生素,有時一天的藥物費用就可以開三台盲腸。健保的邏輯如果核可給付肺炎疫苗,那麼對於相同對象的感冒也是理當給付的。