Jeff Jacoby dropped another turd in my Sunday Boston Globe, this time about how awful it is that people might spend more on health care when they have insurance than they would otherwise. Let’s start with the lesser of his two mental malfunctions first, just to get it out of the way.

Why is health insurance so expensive? One explanation is that the extraordinary gains medical science has made over the last few decades come with hefty price tags. The revolution in cardiac care, the myriad new drugs, the invention of CAT scanners and MRIs, the ability to transplant organs — these and so many other lifesaving medical miracles didn’t come cheap. It stands to reason that insurance covering the cost of such miracles doesn’t come cheap either.

But wait — does it stand to reason? Information technology has exploded in recent decades too, yet computers have never been as affordable as they are now.

Jacoby’s “one explanation” is not based on any actual facts. People who have actually studied this subject have found many contributing factors to rising health-care costs – an aging population, higher physician salaries, increased administrative costs, shifts in focus from prevention to late-stage intervention, litigation and malpractice insurance, prescription drug prices propped up by government patent and procurement policy, etc. Yes, those MRI scanners do contribute to costs somewhat, but they’re far from the driving force and their price has come down as technology has improved. Having an MRI scanner still costs more than not having an MRI scanner, though, just as having a personal computer or television costs more than not having one, no matter how much the price for all of those things might have decreased over the years. The difference is that it might be reasonable to say that someone should forego the use of the PC or TV, but denying them an MRI scan is often a bit less reasonable. That brings us to Jacoby’s more serious crime against reason.

Why does it matter whether Americans pay for medical care directly or let insurers cover their bills? Because thrift and price awareness usually go out the window when we’re spending other people’s money. Under the present setup, most Americans have little incentive to be economical consumers of healthcare. As a result, health care expenditures — and insurance premiums — have been racing upward at three and four times the rate of inflation.

Oh yes, it’s all about “thrift” isn’t it? Decreasing costs is the most important goal, right? WRONG! Very few people pursue health care as a form of recreation. When they incur those costs it’s not for fun; it’s because they’re sick or injured and they want to be well again. As economists would say, demand for health-care services is a lot less elastic than for most commodities. People don’t rush out and break a leg or catch a disease just because treatment is cheaper. Let’s put this in very simple terms. Imagine that there’s a $1000 pill that can cure some fatal disease, and insurance enables 1000 people to have that pill who wouldn’t otherwise be able to afford it. Sure, it’s cheaper to deny them the pill, but is that a better outcome? Obviously not. Despite what Jacoby and other disciples of Mammon might tell us, being cheap isn’t the only goal – not for most things, and especially not for health care. There are other measures that also apply. When Jacoby gets paid for copying other people’s work, does he spend it only on the cheapest house, the cheapest car, the cheapest food? Obviously he’s willing to forego a decent haircut, but would he be willing to forego medical treatment that he could only afford because of insurance? Remember, all insurance claims – whether the insurance is employer-provided or privately purchased – are a way of spending someone else’s money. The truly “thrifty” by Jacoby’s own definition would do everything they could to keep premiums down, even if that meant sacrifice. But, as we well know, to a conservative, sacrifice is always for other people.