Who gets sick or injured is a lottery. (We may exclude from consideration all those medical problems that people have a role in bringing on themselves through their own behavior. So, we’ll exclude a smoker’s getting lung-cancer, etc. In practice it is often impossible to judge what contribution a person’s behavior makes to their illness, but this is a thought-experiment we’re engaged in.) If you’re born with a bad set of genes, you’re unlucky. If you happen to be in a car that gets hit by a bus, you’re unlucky. If you happen to get colon cancer, you’re unlucky. None of these things is your fault. So, like I said, it’s basically a lottery.

But tied to this lottery is another feature, being financially responsible for the necessary medical care to treat these misfortunes. Since having the misfortunes in the first place is a lottery, so is being financially responsible for them. But because the two lotteries are tied in this way, if you lose, you lose twice. Not only do you get sick; you have to pay for the treatment too (or your insurance has to).

So, here’s a proposal. Uncouple the two lotteries. When someone gets sick (through no fault of their own), somebody else is picked at random to pay for it (or to have their insurance pay for it).  Everybody’s total risk stays the same but it would be spread more evenly. And if you got sick, you wouldn’t also have the misfortune of being financially responsible. (People who get sick should be excluded from the random process employed to chose who will pay for them.)

As is already the case, one can buy health insurance or not, as one chooses, and buy better or worse grades of insurance with higher or lower premiums, co-payments, etc. If you buy insurance which is cheaper because it excludes organ transplants, for example (a common exclusion), you’ll be fine if you get stuck paying for someone else, unless you get stuck paying for an organ transplantation. And so on.

My proposal is (if we iron out a few inevitable kinks) just a fairer version of the current system of insurance. But I’m guessing no-body will like it. The alternative? A national health care system.

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