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:

Islaballena 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.

Islaballena 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。