In all the hullabaloo about Romney’s little bit on “I like to fire people” one of the aspects that has been missed, is that even taken in context about health insurance, his comments are just plain stupid. I was going to write a post explaining this, but, in catching up on Jon Cohn today, of course I discovered that Cohn had already done this. So, I’ll take the easy way out:
But this points to the underlying problem with conservative dogma on health care, oneAaron Carroll points out today. Conservatives have great faith in competition to improve health care, by driving up quality and driving down costs. And while liberals like myself think conservatives put too much faith in competition, I think most of us would agree that competition has at least some value.
The problem is that true competition can’t exist without regulation. Insurers would use that freedom to avoid enrolling sick people and to make whatever coverage decisions would increase their profits…
Many individuals have few choices and those with serious pre-existing medical conditions may have no choices at all.
Carroll sums it up nicely:
The real issue, unfortunately, is that very, very few people have the luxury that Gov. Romney is endorsing. Let’s say that you are self-employed, and lucky enough to have found a company to provide you with health insurance. Then, let’s say you develop cancer. You suddenly find out that your insurance company stinks. So you fire them, right?
Of course not. You’re screwed. Now you have a pre-existing condition. There’s not an insurance company out there that wants to cover you. So you don’t fire them. You scream, and curse, and cry, but you’re stuck. Only healthy people have the luxury of picking and choosing…
The lesson here — and this doesn’t apply to exclusively to health care — is that sometimes you need regulation in order to make a market work. And while there’s a very legitimate debate between left and right over how far that regulation should go, I believe the best evidence we have suggests it takes a lot of regulation, and some money too, to really make the market for health insurance functional.
Romney should know this as well as anybody, since the law he signed in Massachusetts did exactly that.
And, of course, I suspect he does know this as well as anybody. Yes, plenty of politicians say pretty much whatever they think will best get them elected, but Romney truly seems to take this to a level beyond any modern politician. It seems to me that he will be haunted by the “I like to fire people” comment more than he should be, but when you consider just how wrong he is on this comment in his intended context, it seems like appropriate karma.