Once there was a country called Jamerica. In Jamerica, people drove cars, and those cars… Once there was a country called Jamerica. In Jamerica, people drove cars, and those cars rolled around on tires. Sometimes the tires slid out of control or blew out. And when a tire failed, lives were lost.

Not every tire carried the same risks, though. Premium tires didn’t fail as often as standard tires, but they cost more. Also, wear and tear raised the risk of tire failure.

Socially, there were problems with this situation. Some Jamericans couldn’t afford periodic tire replacements or premium tires. When a seemingly fine tire wore out unexpectedly, the driver would have to drop a bunch of money on a new tire, which just didn’t seem fair.

So far, Jamerica mirrors America. Here’s the difference: Jamericans decided to do something about the tire situation. The Jamerican government announced it would pay for new tires whenever necessary.

This new program was popular. Taxes rose a little bit, but no one minded because tire failure killed fewer people.

After a while, though, things began to change.

Change one: Whereas, before, Jamericans sometimes bought the standard tires and other times bought the premium tires, with the deal in place they began to only pick out premium tires. In fact, standard tires were suddenly considered unsafe — even though almost everyone had bought the standard tires in the past. Premium tires were suddenly considered necessary.

Change two: New types of tires came out on the market. They were more expensive than what had previously been considered premium tires, and they were a little safer. The tire manufacturers had always been able to make these new tires, but, before the tire replacement program, they knew that not many drivers would be willing to pay extra for the small boost in safety. Pretty soon, every sensible Jamerican got the new tires. And once everybody had the new tires, they too were suddenly considered necessary.

Change Three: Drivers started replacing their tires more often. Tires don’t just go from “perfect” to “bald.” There is a gradient. And as you move down that gradient — even from “perfect” to “very, very good” — the chance of failure takes one step up the staircase of statistical risk. So tire installers just started telling everyone to get their tires replaced whenever there was extra time to do the job. And once everybody started getting their tires replaced moreoften, changing your tires frequently was suddenly considered necessary as well.

Like waves in the ocean, the three changes started to pile up and reinforce each other. But this piling up was so slow that ordinary Jamericans never perceived any change at all. In fact, when ordinary Jamericans thought about the old days before the new policy, they didn’t even remember that tires back then were more dangerous and that drivers changed tires less often.

The combined cost of the three changes strained Jamerica’s federal budget. At first, the government raised taxes. But, after a point, the Jamericans rejected tax hikes. So, Jamerican politicians cut other government programs — education, public parks, conservation efforts, scientific research and other programs not essential for survival.

But as the cost of tire replacement climbed even higher, Jamerican politicians had to cut programs that saved lives — food stamps, police protection and even maintenance for the roads beneath the Jamericans’ tires.

One politician proposed a solution: An expert panel would use cost as a criteria to decide if the government paid for a given tire replacement. The horrified Jamericans voted him out, because they didn’t want any “death panels.” This unfeeling politician dared to put a price on life, which is priceless.

Jamerica went bankrupt. Jamericans died en masse from crime, hunger and collapsing bridges.

THE END

This parable relates to health insurance — government health insurance, specifically, but it could cover private health insurance if you substitute “insurance premiums” for “taxes.”

Notice that no Jamericans do anything wrong: The government keeps its promises. Consumers keep their families safe. Tire manufacturers keep the market supplied. Everyone involved thought everything they did was “necessary.” Nor are there any equivalents for our scapegoats: Illegals didn’t use up all the tires. Tire replacement companies didn’t gorge on profits. Fear of malpractice suits didn’t drive unnecessary tire replacements.

But, somehow, the result was disaster.

Americans have painful realities to face. Newer, pricier medical treatments come out every month. Some treatments (like the polio vaccine) are cheap and world-changing, but others (like some cancer drugs) cost a fortune and only lengthen a life by a few weeks in many cases. The condition that insurance only covers what’s “necessary” is no condition at all, when the definition of necessary is endlessly elastic.

E-mail Lewis at [email protected].