As I pointed out in my Sunday Examiner column, our current health insurance arrangements give most Americans a choice of insurance policies every year. If they don’t like the policy they have they can avail themselves of (in economist Albert Hirschman’s term) the option of exit. In contrast, if you were confined to a single government plan and didn’t like it, you would have to exercise (Hirschman’s term again) the option of voice. Exit is easy to exercise: just choose another insurance option for the next calendar year. Voice is a lot harder: you have to convince your congressman to vote for something different, he has to persuade a majority of his colleagues to do so, which means setting up lobbying groups, etc., etc.
About ten years ago HMOs became unpopular and members of Congress supported bills to create a “patient’s bill of rights.” I used the more neutral term “HMO regulation” in T
he Almanac of American Politics (of which I am co-author) to describe such bills.
The Republican leadership struggled successfully to keep them from passing despite indications of support from most members of the House. But that support in time evaporated. Why? Because people took advantage of the option of exit. As I recall, ABC News took a poll some time early in this decade and asked what people thought of HMOs. Most people hated them. But when ABC disaggregated the results by the kind of insurance respondents had, they found an interesting thing. Most people who didn’t have HMOs hated them. But people who had HMOs loved them. There is a lesson here for those who think it would be a great idea to push people into government health insurance. It’s a lesson that Rasmussen’s results indicate more and more Americans are taking to heart.
