As I ponder an Obama Administration health care reform bill, whatever that turns out to look like, I am struck by how different the debate is on the left, where Ezra Klein and other wonks are deep in the weeds on health care policy, and the right, where objections to a greater federal role are predicated largely on a general principled aversion to interference in markets and a rapidly expanding state. I’d like to pose a few questions meant to stoke conversation between these groups, and to highlight a couple of my own (possibly mistaken) ideas about health care in America. As I’ve yet to study this issue deeply, I am persuadable on most points, and I expect some who share my opinions are too.
a) The current system is an economic drag insofar as it ties people to jobs they’d otherwise leave, discourages entrepreneurship, and otherwise lessens healthy risk-taking because people fear losing their insurance.
There is no good conservative argument for the current system, which is broken beyond repair. However, the progressive answer – a public option, alongside “keeping the insurance you have” is an expensive, doomed-to-fail proposition. The only way to really alleviate the drag created by employer-based insurance is to tax those benefits, deregulate insurance markets, and provide means-tested insurance vouchers for low-income Americans. Americans want safety nets, and it’s important to realize this, but it’s also important to realize that entitlements are extremely expensive, and adding state intervention into the economy on top of massive entitlements is even more expensive.
b) There is a moral obligation to ensure that every citizen has some minimum level of health care, in the same way that society has decided everyone should have some baseline level of food. I find it difficult to pinpoint what level exactly, but I suspect we’re currently falling short of it.
Conservatives often lose sight of the moral question when it comes to health care, which is too bad because the fact is there is simply no reason for conservatives to oppose universal health care. A combination of deregulated insurance markets and a strong push to get health vouchers to every low income American would provide universal care to every American, without the huge burden of a federal bureaucracy or the economic burden of state intervention into the markets. Most Americans will not need help paying for their insurance plans and those who do will be able to get it without having to deal with tons of government red tape.
c) I suspect the government can play a useful role pushing measures like electronic medical records that I doubt would happen absent a state coordinating role (including privacy protection measures).
This is simply not true. For years hospitals, doctors, and other health organizations have been making the switch to digital record-keeping. The field of medical records software is highly competitive and highly profitable. The benefits to patients and especially to record-keepers are huge, and can save hospitals (et al) a great deal of money. Technology adoption is perfectly suited to markets, and that is especially true in the medical field. Government involvement would effectively pick favorites in the industry, making it more difficult for start-ups to compete and creating an uneven playing field.
Conor is rightly skeptical of a public plan. A public plan, as I’ve stated before, is not the only way to provide real safety nets, or to achieve universal coverage. His points are all valid ones. I think it might be important to note, though, that we haven’t even begun to see where real innovation will lead. The state of affairs as they are, we already have a highly regulated, highly subsidized – far from “market” solution – health care industry. I’d like to see the move toward deregulation and open source.
Conor goes on:
It seems like we should train people other than doctors to perform certain discrete medical tasks that don’t require all those years of medical school — a mix of pharmacists, professional bone setters, nurse practitioners and others should be able to dole out a lot of routine examinations, procedures and cures at a lower cost.
Which is true – except I’m not sure what he means by “we should train…” The fact is, due to regulations, the medical industry has grown its own batch of cartels. These cartels create artificial scarcity and artificially high costs. As Will Wilkinson put it,
You don’t need a Ph.D. in mechanical engineering to change a muffler any more than you need a M.D. to set a broken arm. You just need to know how to change a muffler or how to set a broken arm.
We don’t need to train people to do any of these things. Just break up the medical cartels, tear down the barriers to entry for service providers (bone-setters, stitchers, etc.) and these people will get trained. And they’ll start little clinics where you can go and pay half of what you might pay at a doctor’s office. Obviously heart surgeons and other highly-specialized professions will need to be certified, but there is a big difference between operating on a spine or the brain and stitching up some-one’s eye or telling them that the cough they have is just a cough and they should drink some tea and take a nap.
Kevin Carson writes:
Imagine, for example, a cooperative clinic at the neighborhood level. It might be staffed mainly with nurse-practitioners or the sort of “barefoot doctors” mentioned above. They could treat most traumas and ordinary infectious diseases themselves, with several neighborhood clinics together having an MD on retainer (under the old “lodge practice” which the medical associations stamped out in the early 20th century) for more serious referrals. They could rely entirely on generic drugs, at least when they were virtually as good as the patented “me too” stuff; possibly with the option to buy more expensive, non-covered stuff with your own money. Their standard of practice would focus much more heavily on preventive medicine, nutrition, etc. [….] For members of such a cooperative, the cost of medical treatment in real dollars might be as low as it was several decades ago.
Conor points out some obvious flaws in conservative (and libertarian) thinking on this subject. Not enough focus is given to the safety nets Americans are demanding, and to the real economic benefits strong safety nets provide; and not enough priority is given to the moral necessity of insuring all Americans. Add these concerns and what you have is a conservative plan in which people are looked after better than they are now, but also given more of a choice. State involvement in health insurance actually shrinks, while at the same time more people are covered. Markets are given a chance to work for Americans who can afford to use them, but there is still a safety net, and lower costs, for those on the lower end of the income scale. And we save a few trillion in taxes, and a few more trillion in lost economic output, all while helping to ensure all Americans receive health care.
See also: Kevin Drum
Travis asks, in the comments:
Also, about this evil enormous government bureaucracy that would be created – what about the evil enormous insurance company bureaucracy?
The fact is the bigger the government bureaucracy, the bigger the “evil enormous insurance company bureaucracy.” The one thing that liberals and I can agree on is the problem with Big Business. I think Evil Enormous companies are a threat to healthy capitalism. Where we part ways is our belief on the origin and preservation of said Big Business. Where Big Government goes, Big Business is sure to follow – via capture, cartelization, and the inevitable bailouts. What a public option or a government-run option will do is subsidize the big corporations. That’s one reason you see companies like Wal*Mart leaping on the employer mandate with such support and glee. It is detrimental to small business, does very little good at all for citizens, and gives Wal*Mart an edge over their competition….