Conversation Starters

• The leading cause of personal bankruptcy in America is unpaid medical bills.
• Americans spend 2.5 times the industrialized world's median on per capita health care, $5267/person.
• All the while, infant mortality is in the nineteenth percentile of industrialized countries, and the US wildly outspends Canada in expenses for medical paperwork (we're neither more effective nor more efficient).
• The death rate for someone without health insurance is 25% higher than for someone who has it.

Gladwell describes the political mess that has stymied the six historical attempts to universalize health coverage in the US (who exactly should be added to the roster of the insured that includes the wealthy and those in powerful unions? And who should pay for those who are added?) But beyond the political mess, the major impediment to expanded health insurance in America is the "moral-hazard" idea: that those with insurance will engage in more risky behavior because they know they're insured. Data supports this effect for car insurance, but Gladwell argues that health insurance is a different beast entirely. Economists underestimate how big a hassle it is to deal with waiting rooms, rounds of testing, dental procedures, etc. People have serious incentive to take care of their own health, and will not act more dangerously just because they have expanded affordable medical coverage.

It is true, Gladwell says, that putting the cost on the consumer cuts down on how much health care he consumes. The problem is that studies show he will cut down on basic, essential health services along with those that might be called "frivolous" by some standard.

And as people continue to propose treating health care like car insurance (in that you pay more or less given your medical history and risks of illness, like paying more insurance for having a sports car or being a young driver), do we want to support the idea that those in poor health or with tragic predispositions should shoulder more of the financial burden than those of us who are lucky (and isn't much of it luck?) enough to be healthy? Don't we as a society benefit from our individuals being healthy?