(2007-07-26) Kling Goals Vs Assumptions

Arnold Kling, trying again to avoid Message Vs Messenger confusions, thinks we should generally assume that people we disagree with actually have Shared Goal-s with us, just different assumptions that affect our respective Design decisions.

He tries to make various assumptions explicit in the area of HealthCare Universal Coverage and use of Preventive Medicine. Many people are more convinced than I am that lack of health insurance causes major health problems, due to failure to obtain preventive care. There is an urban legend that 20,000 people die each year for lack of health insurance. The Institute of Medicine may be the original source for this claim, in which case it is based on superficial correlations, not on controlled studies that would be required in order to make a claim about, say, a new pharmaceutical. In careful comparisons of similar groups of people, it is rare to find significant differences in longevity based on levels of health care spending, which makes it unlikely that one can demonstrate a causal relationship between health insurance and longevity. The famous RAND experiment found that decreasing insurance coverage reduced the use of preventive care, but without a significant overall adverse effect on health outcomes. Another analysis, by Amy Finkelstein, showed that Medicare increased health care utilization substantially, again with little noticeable impact on health outcomes. I can believe that there is a significant group among the uninsured who take poorer care of their health than the rest of us. But I am not convinced that forcing those people to buy health insurance will make them take better care of themselves. It might even do the opposite.