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Health care reform

Column: Do you want your goat scruffy or shiny?

Glenn Harlan Reynolds
  • "A goat owned in common always starves."
  • This pithy phrase captures a key truth of human behavior.
  • You can also see this phenomenon in medicine.

According to a West African proverb, "a goat owned in common always starves." This pithy phrase captures a key truth of human behavior: People are a lot better about taking care of things that belong to them than they are about taking care of things that don't.

That's a lesson that applies to more than goats. At the beach place where I'm staying right now, there are some "community" bicycles. They're "free," in the sense that the cost is just built into your rent, so that it doesn't cost any more to use them a lot than to use them a little.

A goat owned in common always starves.

You just get a key from the front desk, and return it later -- or not. And, of course, the complex doesn't make any more money whether they're used a lot or a little.

The result is that there are a lot of bikes locked up to the "community" rack, but the front desk doesn't have any keys -- they're all out with people who aren't using the bikes, but keep the keys anyway. Why not? It doesn't cost them anything.

The bikes are also kind of scruffy. They work, but there's a lot of rust and wear. Why not? The complex wouldn't make any more money if they were nicer.

These "free" bikes make an interesting contrast to the shiny and abundant Schwinns that rent for $10/hour down at the beach. Why are they so shiny and abundant? Because the people who rent them out make more money by keeping them nice, and available -- and because the renters have an incentive not to keep them longer than they use them, because keeping them costs money.

You can also see this phenomenon in medicine. The dermatology office where my family goes has two sides. One does the work that's covered by insurance: Stuff that's mostly "free," in the sense that it's largely paid for by someone else.

The other side does the stuff that's paid for out of pocket and isn't covered by insurance. Guess which one is nicer? Guess which one makes it easier to get an appointment? And, most interestingly, guess which one has the newest, and fastest-advancing, technology? Thanks to ObamaCare, we're heading toward the world of "scruffy bike" medicine. Is that where you want to go?

On the one hand, the scruffy bikes are free, sort of. At least, you don't have to cough up any cash each time you use them. But you pay in other ways. First, they're, well, scruffy. Second, they're not always available, meaning that you have to wait, or do without. Waiting is a kind of payment, too, since time is money. (Time is probably more important, actually, when you're waiting for a hip replacement, or chemotherapy, than when you're waiting for a bike).

Third, since there's no charge for using them (or might as well be no charge since someone else pays), there's a temptation to overuse them: Why not hang onto that key, since you might want a bike tomorrow? It may keep someone else waiting, but it doesn't cost you anything. (The longer people wait, the stronger the tendency for insiders to find a way around the waits. Taking money from someone feels like stealing in a way that jumping the line doesn't. But you're taking time, and everybody has only so much of that.)

Of course, health care isn't the only goat that we own in common. Everything the government does is like those community bikes, while the free market is more like the shiny rentals. (P.J. O'Rourke once visited a strip joint in then-communist Poland and remarked that under communism, even strip clubs have the ambience of a post office.)

Which do you prefer? Shiny? Or scruffy? Decision time is in November.

Glenn Harlan Reynolds is professor of law at the University of Tennessee. He blogs at InstaPundit.com.

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