In "Frost Warning" William Voegeli offers the following summary statement regarding the debate about the boy who became the poster child for SCHIP:

[T]he New Republic ... conceded that "going without health insurance is often a matter of choice," and "it's clear the Frosts have made [a] choice to invest in property and a business, but not in private health insurance." Now that a tragedy has left their children with serious medical conditions, private insurance is prohibitive. It's mean-spirited, however, to suggest the Frosts were feckless for not securing insurance before disaster struck — that, indeed, this is the whole point of insurance.

None of this matters, though. According to Mr. Krugman, I am my neighbor's keeper, and America is one big neighborhood. It might be nice if my neighbors were not improvident about caring for their families, but it's completely irrelevant.

We will defeat viciousness by creating a society where the bad choices of the parents are never visited upon the children. In doing so, we'll fashion one where it is entirely unnecessary to go to the trouble of making good choices. The big neighborhood will be held together by sharing — specifically, families who provide for their children conscientiously will have innumerable occasions to share their wealth with the families who don't.

This is preface to a larger issue raised by Peter Huber, whether health insurance (whether private or socialized) as we know it is becoming obsolete.

Lipitor is a lifesaver for 600,000 genetically unlucky Americans who harbor a bad-cholesterol gene or two on chromosome 19, and for another 100 million victims of our supersize-me culture. Fourteen billion dollars is a bargain for problems as pernicious as these. Or is it? Let’s blame the victim. The human body is so comfortable with fat that it rarely complains about a cholesterol glut in the blood until seconds before things crash. Many who should be worried never even get their blood checked. Many who do check it fail to take their Lipitor. None of us really needs the pill anyway—just lose the ice cream, shed the pounds, stop smoking, and exercise regularly.

Call it tuning, if you prefer. Lipitor tunes our cholesterol. Anti-stroke medicines tune our platelets, antidepressants our serotonin and dopamine, heart medicines our angiotensin-converting enzymes, contraceptives our estrogen. Cancer drugs tame or kill our own mutant genes. And for every drug to suppress chemical excess, there’s another to address deficits: insulin for the underperforming pancreas, clotting factors for bleedy blood, Synthroid for the tired thyroid, and cancer-suppressing proteins to lend a hand to tumor-suppressing genes.

Medicine has never seen—nor much needed—anything like this biochemical arsenal before. When infectious germs were still ubiquitous, few people lived long enough to clog their arteries with ice cream. ... Some people are still attacked by microbes, but such assaults from the outside aren’t the big problem any more. The cholera of our times is a stew of specific, discrete molecules, concocted by genes, gluts of cigarettes, beer, ice cream, and other delicious consumables, and by whatever attitude problems we might have about eating our peas or taking our pills.

This great etiological shift—from the medicine of us versus germs to the medicine of us versus us—upends everything. Disease and its cures now depend on factors too fragmented for conventional insurance pools to contain, too costly for public treasuries to underwrite, and too divisive for public authorities even to discuss, much less manage.

Asian-American women have a life expectancy of almost 87 years; African-American men, 69 years. We have these facts on the authority of Eight Americas, a 2006 [by] Harvard’s School of Public Health. Women in Stearns County, Minnesota, live about 22 years longer than men in southwest South Dakota, and 33 years longer than Native American men in six of that state’s counties. The gap between the highest and lowest life expectancies for U.S. race-county combinations is over 35 years. Some race-sex-county groups typically die in their nineties, others in their fifties. Some are healthier than the norm in Iceland, Europe, and Japan, others sicker than Nicaragua and Uzbekistan.

What accounts for these cavernous differences? Harvard dares to name six leading “risk factors” for the population as a whole—alcohol, tobacco, obesity, high blood pressure, cholesterol, and glucose....

By 2005, seven of the world’s ten most profitable drugs owed most of their success to our foolish mouths. Two ... lowered cholesterol, one suppressed the blood’s tendency to clot on cholesterol plaques, one lowered high blood pressure caused in part by clogged arteries, two were for heartburn and acid reflux, and one was for asthma, often aggravated by cigarettes. [S]moking still causes more deaths than all other readily preventable causes combined, but gluttony is catching up. It’s now responsible for 350,000 preventable deaths in the United States every year, including about one-third of all cancers.

[B]iochemists can now disassemble glut-and-gene diseases into molecules that can be exposed long before they morph into plaques, clots, tremors, tumors, occluded airwaves, clogged arteries, and failed muscles. By scrutinizing differences in our chemistry, biochemists can now disassemble glut-and-gene diseases into molecules. Breast cancer used to be a lump; now it’s at least four genes, two of which, when paired, make a tumor almost certain. ...

Because they treat our differences, ... the new drugs cost far more than the old. Brewing huge vats of penicillin or Lipitor is quite cheap. ... A disease with four separate genetic roots probably requires four miracle drugs on the shelf. “Pharmacogenomics” fragments things further still, by tailoring drugs to patient-specific genes.

In the One America vision of things, better government would deliver better diets and also more Lipitor to all, and that would make health care, perhaps even health itself, equitable and uniform. But however clear a health problem may be, and however simple and cheap the cure, molecular medicine is riddled with lines that the nanny state just can’t cross.

[I]nsurance systems that pool health risks indiscriminately are vestiges of the past. They can’t survive what lies ahead. Insurance makes sense for risks that people can’t control. Or to put it more bluntly, socialized medicine was a smart idea back when medicine was too stupid to halt infectious epidemics, discourage suicidal lifestyles, or discern the perils in killer genes. ... But we’re now past the days when infectious diseases were the dominant killers, and heart attacks and lung cancer seemed to strike as randomly as germs. And insurance looks altogether different when your neighbor’s problem is a persistent failure to take care of himself. Many people willing to share the burden of bad luck eventually tire of sharing the cost of bad behavior.