In response to Ryan's comment from "Looming Health Care Crisis"
btw, thanks for the comments
1) right; health care is not a public good.
But, there are other market failures besides the markets for non-rival and non-excludable goods, that warrant government intervention, even by conservative economists' standards.
In particular, private information (hard to verify claims) hamper market transactions; whether a worker's back really hurts and he needs time off, or whether a used car salesman's car has some glitch somewhere.
Consider 10 used car salesmen, one of which is selling a lemon, but consumers are unable to discern which. All salesmen then must lower their price below fair value to deal with the customer's belief that their car might be the lemon. Introducing an independent verification service, as long as it costs less than the price reduction from having the lemon in the market, would make the good salesmen better off.
The problem is, with the health market, health diagnosis are not confident enough to stand by a verification service at this point, so the government is legitimately offering to stand in. Even as a minimal interventionist, this makes sense to me. The human body is still too complex relative to an automobile.
As an after thought, another market failure besides 'public goods' and 'private information' that could warrant government intervention in markets is 'market power', when firms don't act as price-takers. In this situation, the firms profit maximizing behavior can differ from a benevolent social planner's behavior when maximizing consumer surplus (total value added by market transactions).
2. I do think adverse selection is a real problem.
Sure, among financially well off individuals, most are buying health insurance as to insure against unforeseen risk. But, in less well off social circles, where money is tight, many individuals prefer to spend their money on more tangible commodities until they begin to believe that they might be afflicted with a very costly condition.
3. Last, health insurance is comparable to car insurance for just the reason you point out, the potential costs on others. Many people would find it objectionable to someone afflicted with a treatable emergency condition to die on the front steps of a hospital. And, since we wouldn't let that happen to those who don't pay for it, we shouldn't make anyone pay for it. Unforeseen emergency afflictions should be covered by a pool of small contribution from all who want to participate.
Sure, if you don't want to be pooled for this cheap coverage, you can wear a tag that either says "don't help me, I chose not to be pooled" or "help me, I don't have the pooled coverage, but I have been verified to have the financial resources to cover this emergency operation up to the level …"
Honestly, it would probably be just as cheap to include both 'those who want pooled coverage on emergencies' and 'those want to forego the coverage', since then insurance companies would not have to do any screening at all. They wouldn't have to worry about any adverse selection (people more prone to emergency, more likely to buy insurance) because everyone would be getting it. So, basically, we'd cover those who don't want it for free.
In conclusion, this is a great and timely conversation. In the wake of a severe implosion to the Republican Party, it reminds us of how the virtues of fiscally conservative policies should be considered in even the most Democratic agendas such as Health Care in order to get the most cost effective coverage with the least government infringement on our individual freedom of choice.