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Kemp shocks me by pushing a project near and dear to my heart--switching America's government provided insurance to catastrophic income insurance, rather than the current screwed up system. My proposal is that the government should pick up the tab after you've expended 15% of your annual income.

Goolsbee responds by saying that consumer driven health care helps you on the price side, but then you get less on the preventative care side. This is fair. But something that isn't emphasized enough is that a lot of preventative care can be iatrogenic. Drugs and treatments have side effects; people die on operating tables. There are some diseases where preventative care has overwhelmingly clear benefits--diabetes management, for example. But diabetes patients spend enough on insulin and needles to quickly pop a catastrophic cap--at least, if they're poor enough to need the money, they do. And compliance is a far, far, far, far, far bigger problem with diabetes than cost. People don't eat too much and ignore their insulin because they can't afford a doctor's visit; they do so because dieting and injecting yourself with insulin is extremely unpleasant.

Indeed, it's possible that consumer driven care would improve preventative care for some conditions--if you have to pay $1,000 for an emergency room visit when you get slack on your asthma management, you might get a lot more motivated.

More broadly, I'm suspicious that a shift towards preventative care is going to save tons of either lives or money. I don't object to it, exactly. But I think its advocates make far too many claims for its grandeur.

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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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