seek the services of auto mechanics want car repair, not "auto
care." Similarly, most people who seek the services of medical
doctors want body repair, not "health care."
We own our
cars, are responsible for the cost of maintaining them, and decide
what needs fixing based partly on balancing the seriousness of
the problem against the expense of repairing it. Our health-care
system rests on the principle that, although we own our bodies,
the community or state ought to be responsible for paying the
cost of repairing them. This is for the ostensibly noble purpose
of redistributing the potentially ruinous expense of the medical
care of unfortunate individuals.
But what is
health care? The concept of reimbursable health-care service rests
on the premise that the medical problem in need of servicing is
the result of involuntary, unwanted happenings, not the result of
voluntary, goal-directed behavior. Leukemia, lupus, prostate cancer,
and many infectious diseases are unwanted happenings. Are we going
to count obesity, smoking, depression and schizophrenia as the same
kinds of diseases?
would willingly pay for insurance to protect them against the
exorbitant cost of treating their own leukemia. But how many Americans
would willingly pay for insurance to protect them from the expenses
of treating their own depression?
recognizes that the more fully we wish insurance companies to
defray our out of pocket expenses for our car repairs, the higher
the premium they will charge for the policy. Yet foregoing reimbursement
for trivial or unnecessary health-care costs in return for a more
suitable health-care policy is an option unavailable under the
present system. Everyone with health insurance is compelled to
protect himself from risks, such as alcoholism and erectile dysfunction,
that he would willingly shoulder in exchange for a lower premium.
is professor of Psychiatry Emeritus at the State University of New
York Health Science Center in Syracuse, New York. Visit