Bismarck and Healthcare Insurance: DeLong and DeShort of It

Brad DeLong at The Health Care blog makes these assertions:

• Bismarck created the world’s first national health insurance system 130 years ago because he wanted to make the German people healthier.
• The rationale for national health insurance in the U.S. today is the same as it was for Bismarck.
• People can’t pay for expensive care without health insurance and without health insurance they can’t get health care.
• “So, unless we adopt the view that those without ample savings who fall seriously ill should quickly die (and so decrease the surplus population), a country with national health insurance will be a wealthier and more successful country.”

Hmm. It’s hard to know where to start.

• It’s doubtful that anything Bismarck did 130 years ago made anyone healthier. In those days doctors probably did as much harm as good.
• But that wasn’t his purpose anyway: Bismarck created social insurance in order to tie the self-interest of the individual to the state. He wasn’t trying to strengthen individuals. He was trying to strengthen government.
• There is precious little evidence that insuring people increases their life expectancy. Amy Finkelstein, for example found that the establishment of Medicare did not improve the health of the elderly.
• You cannot give people as a whole more medical care unless you have a plan to use idle health care resources or unless you have a plan to create more providers. ObamaCare doesn’t do either of these things. (Also see my book, Priceless: Curing the Healthcare Crisis.)

[Cross-posted at Psychology Today and John Goodman’s Health Policy Blog]