Arnold Kling  

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I attended this Cato forum on health care reform options. Speakers were Sally Pipes, John Goodman, Jeff Lemieux, and Robert Kuttner. A few notes:

Best one-liner belonged to Kuttner: "The hardest job for a liberal is to defend the D.C. public school system. The hardest job for a conservative is to defend free-market health care."

Most important point belonged to Goodman. He pointed out that "equal access" to health care is a chimera. Government health care systems play favorites. Moreover, the poor are just as lacking in political clout as they are in economic resources.

Best overall presentation was by Lemeiux. He argued persuasively that the Right (represented by Pipes and Goodman) and the Left (represented by Kuttner, tend to talk past one another. The Right does not address the left's fears that market-oriented health care will leave the poor without access to health care or that the insurance market will break down. The Left does not address the Right's fears that national health insurance will lead to bureaucracy and the stifling of creativity and innovation.

I was very disappointed overall in that the other panelists demonstrated that Lemeiux, of centrists.org, is correct. The other panelists attacked each other with sound bites, rather than reasoning with one another.

UPDATE: See Tyler Cowen's post:


If we don't understand why private health insurance functions so badly in our mixed system, we won't understand how to fix things.

That is the sort of question that Sally Pipes and John Goodman failed to answer at the panel discussion, which is why I was disappointed.

For Discussion. Try taking one side and answering the fears of the other side.


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The author at Division of Labour in a related article titled Free-Market Health Care? writes:
    From Arnold Kling: I attended this Cato forum on health care reform options. Speakers were Sally Pipes, John Goodman, Jeff Lemieux, and Robert Kuttner. A few notes: Best one-liner belonged to Kuttner: "The hardest job for a liberal is to... [Tracked on October 2, 2004 2:11 PM]
COMMENTS (9 to date)
nathan writes:

centrists.org link is broken

Thanks, nathan. It's fixed now.

Lawrance George Lux writes:

Consensus starts with a statement to the Conservatives that both a bureaucracy, and the free market solution, are wrong approaches to the problem of health care. This must be followed by statement to the Liberals that though Univeral Care might be a goal, universal levels of health care can never be realized.

Basic health care must be provided to All, and at a price which society can bear. Subsidiary, or extraordinary care, must be financed by the Individual if he has the assets to expend.

Basic health care will have to include Preventive Care, Corrective Care for Accidents and Injuries, Limited Cost Care procedures, limited price-regulated Drug supply, and Hospice Care. Subsidiary Care can include anything the Individual can afford, whether personally or through an unsubsidized insurance policy probably costing four times the current issuances, when denuded of Basic Care premium payments. lgl

John Thacker writes:

One first does have to question the apparent automatic assumption that rising medical costs must mean a failing system. It's quite obvious that the pace of medical technology and research increases extremely quickly; care now is not the same as care 40, 20, or even 10 years ago. What's more, one can get the standard of care from 20 years ago very cheaply.

Rising medical costs are partly from very high demand for the best medical care, combined with expensive new discoveries and general rising incomes and rising life expectancies.

Unfortunately, I'm really not familiar with any good way to correct for this.

shamus writes:

Congress could go a long way toward helping people purchase insure by opening the federal employee's insurance program to all Americans and letting small business form cooperatives to purchase insurance. Most of the problems in our health care system were caused by ill-considered government policies. Government could fix most the problems by adopting better policies.

Lawrance George Lux writes:

Shamus,
John Thacker was quite right in stating the health care from twenty years ago can be acquired cheaply. A Basic Health Care insurance policy can be mandated covering this exact type care (all Insurance companies must supply such a policy to be licensed by Federal act). The exact cost of such a policy cannot be determined, but I am thinking in the range of $700-1200/year, and $1500-2000/year for a family of four. lgl

quan nguyen writes:

I do not believe anyone in this country can obtain "the health care from twenty years ago". The regulations, the medical practice environments we have at present simply prohibit such care to be provided. The medical care is no longer the business between a doctor and a patient, but is supervised by many third parties (insurance companies, regulators, licensing bodies, lawyers, just to name a few).

Practically speaking, the "basic health care" will mean different things to different groups, hence different prices. The moment some one suggests one set of "basic health care", many other groups will pick it apart for including or not including certain life-saving but costly procedures.

One solution would be "tiered basic health care plans" which can be financed by or for each group dependent on health risks. This concept however defeats the purpose of "insurance" being the vehicle of spreading risks and liabilities.

Jason Ligon writes:

Defining success correctly is critical to avoid talking past each other. As mentioned, equal access, and for heaven's sake 'universal' access, are not attainable and don't measure anything like success. We should aspire to more than a bandaid on every booboo, and government rationing is not obviously superior to rationing based on price from any reasonable moral perspective.

It seems to me that what matters is lives saved and misery prevented over time. A policy that advances access to current care at the expense of development incentives should be approached very cautiously, because development is the only way to save lives and reduce misery due to existing untreatable conditions. If you foresake development, you are accepting a baseline of misery that will not budge.

I know, we are not talking about eliminating development altogether, but are choosing to increase access at the expense of current development levels. Does that make sense in the context of reducing misery and death over time? It depends on how you view the value of each development. If you believe that a cure for diabetes is possible, the value of development of the cure is gigantic in terms of important measures.

By contrast, how much misery and death are we actually avoiding by rationing by government instead of by price?

mcwop writes:
Shamus, John Thacker was quite right in stating the health care from twenty years ago can be acquired cheaply. A Basic Health Care insurance policy can be mandated covering this exact type care (all Insurance companies must supply such a policy to be licensed by Federal act). The exact cost of such a policy cannot be determined, but I am thinking in the range of $700-1200/year, and $1500-2000/year for a family of four. lgl

What will that cover? Per capita health care spending in Canada is around $3,000. That equates to $12,000 for a family of four. $1,200 in premiums hardly covers that.

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