A Thought Experiment
Watching the health care summit Thursday, I came away with the strong impression of two sides who each honestly and passionately believe: (1) there is a problem; (2) their solution will make things somewhat better for the American people; and (3) the other side's solution will make things worse.
Yuval Levin has nicely summarized why point three is so crucial. Democrats (other than Pelosi and Reid, who came across as nothing but partisan hacks) think that a better-regulated system will reduce the inefficiencies; Republicans think a freer market will do so. The two goals are inimical to one another. I tend to agree with the former because I mentally analogize health care coverage to fire department protection -- most people would opt out of "firefighting insurance" if they rented or didn't have much home equity, unless and until they had a neighbor or friend suffer a catastrophic loss from a fire and got scared. But they all would prefer their neighbors bought firefighting insurance. Health insurance similarly works better for everyone if everyone participates, rather than just those with a lot to lose and higher risks. In other words, it's a market where there may be a strong disconnect between your individual interest and the group interest. That makes it a situation where government can be usefully involved. Not that it must be, but can be useful. Also, I see no market-based way to get around the multiple disconnects between insurers who pay for medical care (and profit from less), doctors who order medical care (and profit from more), and patients who benefit from medical care but do not have enough information and knowledge to rationally balance the first two parties' interests. Freer markets will do nothing to address those information and incentive asymmetries.
I'm not sure I see a way to compromise between those directly contrasting views of what is the right thing to do. Odds are we'll have to try one and see if it works. If not, we'll go the other way. Hopefully not too late, as the costs are just going to keep getting higher in the interim.
posted by QueensGuy @ 7:12 AM
15 Comments:
The trouble with "trying" a nationalized, top-down system is once it starts, there's no turning back. I have no trouble with different states trying different systems, but let's not jump into taking over 100 problems at once with a system that's entirely unproven.
The trouble with trying it on a state-by-state basis is that so much of the funding is federal. Impossible to align the incentives without a top-to-bottom redesign. And it's not like we don't have the experiences of about 49 of the other top 50 industrialized nations to work from.
That's the excuse I expected. No, we don't have experiences from other countries that we can rely upon. Or if you really want to talk about them, we can see how it would hurt our health care.
So this argument comes down to "we're going to take over one sixth of the economy, and it won't work unless we get it all at once and can never turn back, so trust us despite all your experience, and don't expect us to be able to do it in any small measure, or even get rid of any fraud and waste until you've signed over all your power forever."
"Not too late" for what?
There are no useful lessons to be learned from any other country's system, eh? I'm sad to say that's exactly the response I expected as well. I think we're both amply demonstrating one of the underlying problems -- everyone's convinced they know much more than they really do.
Anon 3, I submit that waiting for it to grow to 1/5 of the entire economy is not a solution. I'm also curious if you're aware of how precisely your statements mirror those made in opposition to social security.
What about me, lowly anon 4?
And you are pitching Social Security as an example we should follow? I'd rather say that proves anon 3 is exactly right--it's a catastrophe that can't be avoided after the fact, so you'd damned well better avoid it before the fact.
Ah, sorry, thought the "grow to 1/5" part addressed you too, anon 4. "Not too late" for the point where an accelerating cost curve makes promised expenditures completely unsustainable, bankrupting states (which shoulder much of the Medicaid burden) and leading to "emergency" fixes that are just band-aids. And if you think social security is a bad idea, I would submit that you are exceedingly unlikely to consider any but market-based health care reforms, no matter the details. More to the point, you also are in a distinctly small minority of the US citizenry.
Let's be clear--we're in a fiscal crisis, with unsustainable costs, and Social Security and Medicare are what put us there. The programes are popuolar, as any welfare that people get used to will be, but they are ruinous, and all but impossible to reform in any significant way. Supporting the health care reform before Congress is saying you want more of the same.
A4 here. Yes, indeed, I am exceedingly unlikely to support any but market based reforms. As to being in a tiny minority, I think there might be a plurality who recognizes it's bankrupt, they just don't want to face the implications. If your point is nothing can be done without a majority behind you, maybe so, but Obama sure doesn't seem to think so, so I presume you support that approach. If so, I don't know why the same approach wouldn't work for me. ("Go ahead, pass it. The idiot rubes will come along later. Or we'll shoot them.")
I love the excuse that we can't let government take over 1/6 of the economy -- what are we supposed to do-- wait until it's half the economy?
"If your point is nothing can be done without a majority behind you, maybe so, but Obama sure doesn't seem to think so, so I presume you support that approach."
I think Obama believes that a majority of Americans want health care reform, and when they're informed of the details of the actual plan, rather than the generic spin of it, they approve of it in far greater than a simple majority. Just as a thought experiment -- that's where the original title came from -- put yourself in the place of someone who actually believes that, as well as my original points (1) and (2). Would you use reconciliation and every other technique within the law? Ascribing evil motives to your opponents makes them harder to understand and defeat, in my experience.
Even if it gets to be half the economy, who cares, so long as the people choose it to be half the economy.
People don't chose this -- it happens to them. And if you don't care, I guess we'll have to wait to see if you care when you can't afford your healthy insurance anymore. ("They came for the Jews, but I was not a Jew, so I said nothing . . .") Or when the insurance company screws you after a catastrophic problem.
On the idea that most people are happy with their insurance plans, actually, we have coverage from an employer who has always striven to be generous with benefits, and our costs between higher premiums and extra copays, etc, has tripled in recent years. This is without a catastrophic problem of any kind, and in fact, a very healthy family. This may seem incremental, but the constant rises in excess of inflation (ususally double digit) are not sustainable. I'm not happy with these changes at all, and don't choose them. Please don't choose them for me by eliminating all possibilities of reform. In this arena, the "free market" has been a joke.
Er, right. Failing to socialize is a Holocaust. No justice, no peace, baby.
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