What Kind of Health-Care Paternalism Do We Want? – Pacific Research Institute

What Kind of Health-Care Paternalism Do We Want?

Steven Burd, CEO of Safeway Inc.,shows that companies can use incentives to reduce health costs on a voluntary basis (“How Safeway Is Cutting Health-Care Costs,” op-ed, June 12). He wants the federal government to reduce its burdensome regulations on self-insured health plans so that Safeway can charge higher premiums to employees who engage in unhealthy behaviors. How disappointing that he also calls for “coverage for all Americans” which would expand government’s control.

The exciting part of Safeway’s health benefit plan is the voluntary program, with incentives that are successful but would be even more so if government got out of the way. The unexciting part is the “insurance” that is a standard benefit, driven by a tax code that classifies it as a nontaxable benefit.

Instead of calling for the federal government to impose “coverage for all Americans,” Mr. Burd should be advocating reforms that build on his success by increasing Americans’ choice of our own health benefits.

John R. Graham
Director, Health Care Studies
Pacific Research Institute
San Francisco

To claim that 80% of cardiovascular disease and diabetes and 60% of cancers (excluding skin cancers) are preventable is not only irrational but dangerous, and to claim significant results in as little as four years is even worse.

Abraham Yurkofsky, M.D.
New York

I fear that a policy of personal responsibility may be incongruous with political popularity.

Insurance that does not cover desperate and costly measures for end-of-life care would surely be more affordable. Spending hundreds of thousands of dollars to briefly extend the life of the terminally ill consumes a disproportionately large amount of health-care resources.

More humane and affordable options, such as hospice care, would dramatically reduce these costs, and would reduce the moral hazard dilemmas that are presented by end of life care for the fully insured. For such a program, it would be essential to distinguish between “terminally ill” and “really old and unlikely to live more than a couple of years.” Only the terminally ill should be treated as such.

Insurance reimbursements for physicians should not be greater for curative measures than for preventative measures. If patients are encouraged through employer incentives, as well as by their physicians, to make healthy choices, they will be more likely to do so.

Steve Francis
Sammamish, Wash.

My hackles get raised whenever I hear arguments in favor of paternalism like Safeway’s policies. But Mr. Burd is right when he argues that the “nanny corporation” may be superior to the “nanny state” in trying to improve individual behaviors, like smoking and overeating. Paternalism is inevitable in a world (like ours) where other people pay for the costs of individual behavior. The question is not whether intrusion into personal choices is justified, but who is the most efficient nanny?

Many states forbid companies from basing policies on off-duty conduct, including smoking. Firms that have tried to reduce health-care costs by encouraging healthy diets or not smoking have also faced lawsuits for invasion of privacy. Government is not only an inferior nanny; it discriminates in favor of itself at the expense of the superior one.

M. Todd Henderson

Printed in The Wall Street Journal, page A14
Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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