Marginal Revolution | Tyler Cowen | A Christian Scientist’s guide for opting out of MedicareI see parallels of extending the ability of members of recognized Peace Churches to apply for conscientious objector status to the current Selective C.O. system.
You will find it here (pdf), and the broader set of links is here, some of the key material starts at p.10. There is some general background here. You can’t get your “money back,” but you can have the payments transferred to a qualified Christian Science care facility. In other words, Medicare will pay for prayer. A few points:
1. It would be easy to generalize this idea, and also easy to give people — whether or not they are Christian Scientists — some of their money back in return for forgoing higher levels of care.
2. American society recognizes the right of Christian Scientists not to pursue traditional forms of Medicare. Can not that principle be extended, and in a way which saves money?
3. There is no public outcry about the horrible life outcomes, and endings, suffered by older Christian Scientists (there is a justified outcry about foregone treatments for the children). It is not obvious that they have worse or less dignified deaths. [...]
4. In any case I see no obvious moral repugnance, or public unacceptability, to giving people more money, in return for the equivalent of Christian Scientist health outcomes at later ages.
5. That said, taking the money instead of the Medicare does not (at all) require you to consume zero subsequent health care. [...]
I think the most important thing to keep in mind in this discussion is that the current all-you-can-eat system is not sustainable no matter what. Someone, somewhere, will have to get less medical resources provided for them at no cost. Maybe it's higher eligibility ages, means-testing, rationing by commissions or trade groups, market-allocation, etc. but something absolutely must give. Bearing that in mind, why not make this sort of option available to people who are willing to take it?
To address the problem I discussed yesterday (the inability to to credibly commit to letting people who have opted out of the system go without care) I would propose a paternalist modification to the to the option Cowen offers. Rather than giving people a lump of cash in exchange for withdrawing from the program, I would give them some cash along with a catastrophic insurance plan (i.e. actual insurance against low frequency, high impact events, and not the insulation scheme posing as "insurance" we have now).