The state of Oregon accidentally performed a very interesting experiment in biology and social science. They held a lottery and gave 6387 previously uninsured people Medicaid, basically free medical care. They also, by the nature of a lottery, didn’t give free medical care to a bunch of other, still-uninsured people. After two years, some scientists compared the health of the people who received the free care with those who didn’t.
What do you think they found?
Well, they found a lot of interesting things, but in summary, the people who had access to free health-care were sicker. Not a lot sicker, mind you, not even statistically significantly sicker, but nonetheless sicker. Which is pretty much the opposite of the effect medical care is supposed to have.
What went wrong?
As regular readers of my blog, if they existed, would guess, it’s the Chubby Blonde Hypothesis all over again. People with more health-care can make a choice: they can enjoy greater health, or engage in riskier behavior at the same level of health.
And, to a slight but noticeable degree, people chose the latter path. Mostly they smoked, but I’m sure they were also ate unhealthful-but-tasty food, drove too fast, neglected to exercise, and so on. Of course.
It used to be they had to balance all the benefits of those fun things with all the costs, and one of the costs was the cost of the doctor to fix you up. Remove that one cost, and the balance point, the equilibrium between all those benefits and the remaining costs (lung cancer is not that much fun even if the chemo is free), naturally moves.
So the results shouldn’t have been particularly surprising, even though most people are going around acting surprised.
And it doesn’t affect the economic calculus at all. All these smokers and eaters are happier with their lives now then they were before, which was supposed to be the point. If you give a beggar a dollar, it’s because you want him to be a dollar better off. If the beggar buys a bottle of Night Train with the dollar, instead of a sandwich, it’s because that’s the way he thinks he’ll be better off with the booze. We shouldn’t complain about his choices.
We shouldn’t, but we do. We somehow think the beggar “ought” to have food. That’s why we gave him the dollar, not because we thought he was short of “value” in some abstract sense, but because he lacked what we (but not he) regard as a necessity.
Similarly, the taxpayers paying for Medicaid for those 6387 people didn’t really want them to be better off by the recipients’ own lights. The recipients apparently felt Marlboros and speeding were more important to their lives, would make them happier, than just being healthier.
It’s important to remember that you and I are no more qualified to speculate on what makes another person happy than to tell him what foods taste good or who he should want to date. If he think something makes him happy, it does.
To give someone money so that person can be happy — with a bottle of cheap fortified wine or with treatment for heart disease — is charity, but to give him money to spend our way isn’t really giving at all.