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Who Should Decide?

Here’s a letter that I sent a couple of days ago to the Boston Globe:

In “These mandates add up” (July 30) you take a baby step toward economic reasonableness.  With that step you realize that government shouldn’t force health insurers to pay for each new medical advance simply because that advance is available.  Some of these advances, you correctly note, fail cost-benefit tests.

But your solution for addressing the need for cost-benefit tests is faulty.  You want such tests to be conducted by government.  If bureaucrats determine that a new advance is worthwhile, then, in your view, government should require all insurers to include in their policies coverage for that advance.

I have a better idea.  Just as we allow each consumer to do his or her own cost-benefit test on whether or not, say, the optional all-wheel-drive feature in a car is worthwhile, or whether or not the benefit of flying first-class is worth its higher cost, let’s allow each individual health-insurance consumer to choose which pieces of coverage are – and which aren’t – worth their costs.  Surely each person can reliably judge whether or not the cost of some particular type of coverage is worthwhile for him or her – or, certainly, each person can make such a judgment more reliably than can bureaucrats who do not know that person.

Donald J. Boudreaux

UPDATE: This letter is published in today’s edition of the Globe.