Being unlucky (I'm a bleeding-heart libertarian)

I like Megan McArdle's proposal for health care reform:

I'd like to see the government pick up the tab for expenses that total more than 15% or 20% of annual income. There's certainly also a case for providing basic care and treatment for certain chronic conditions to the poor, though even in that case, I'd like to see us at least try to handle the problem with a combination of catastrophic insurance, and better income supports.

The government supposedly already pays for basic care and treatment for the poor through the Medicaid program. I say "supposedly" because in many places it is tough to find doctors who will accept Medicaid patients.

I found it disheartening that the recent health care debate the main talking point from the left was "insuring the XYZ million uninsured." We're failing Medicaid patients now, adding millions more won't fix the problem, it will just make it worse.

And I found it equally disheartening that the main talking point from the right seemed to be "no socialized medicine." Our current half-socialized system is the worst of both worlds.

I think I'll start calling myself a "bleeding-heart libertarian." "Bleeding heart" because I believe that we have a moral obligation to help people who, through no fault of their own, get sick and cannot afford to pay for their health care. "Libertarian" because I realize that there's no free lunch-- health care is a limited resource, and like any limited resource there are only a few ways to figure out who gets it.

I like McArdle's proposal because it is a natural, market-driven way of identifying the truly needy. If you make $40,000 per year and are spending more than $6,000/year on health care then you're either a huge hypochondriac (but they're so rare I don't think we need to worry about them) or you're really sick. If we all paid out-of-pocket for run-of-the-mill health care that would provide powerful incentives to keep costs down. The average person spends about 15% of their income for food; it seems perfectly reasonable to expect to spend an equal amount on health care.

Especially since we're already spending that much on health care, we just don't realize it because the costs are hidden from us.