Arnold Kling  

Pragmatic Health Care Reform

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From my latest essay:


Overall, I am not persuaded that socialized medicine will prove more efficient in the United States. However, I am not a big fan of the insurance industry as it operates today, and I think that it would be interesting to see an experiment with single payer at a state level.

As it stands, none of the leading Presidential contenders is advocating single payer. Instead, some candidates propose additional government mandates and/or subsidies, while keeping our existing private insurance systems intact. It seems unlikely that this will reduce the cost of providing insurance.


The essay itself is a summary of what I think government can and cannot do about health care. So it is hard to summarize.

The point is to look at the issue realistically. There is a difference between government and a fairy godmother. With fairy godmothers, when you have a problem, all you have to do is wish real hard and the problem goes away. Government does not have that same bibbity-bobbity-boo.


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COMMENTS (12 to date)
David N. Welton writes:

Great article! I very much appreciate the emphasis on the practicality and feasibility of different approaches, as well as a focus on several goals, and not just "access for all" or "the best service for those that can afford it" or whatever is popular with each ideological faction. Thanks!

Matt writes:

If government wants to do something, then government should roll up its sleeves and do it like true socialists.

My proposal is also an experiment, an experiment with a uniform portion of "medicine", a part of medicine with defined ins and outs, where socialist blundering does the least damage.

Let's federalize the emergency room services across the U.S. Let the socialists run that whole enterprise on a national level, even a North American level!

Floccina writes:

Our Government spends more per capita on healthcare than France does. Healthcare is highly regulated and providers are highly licensed by the government, so how is it not the Government's fault. Why can’t we demand that our politicians they cover everyone for the money that they are currently spending? Democrats seem not to want to call for this but for more funding for some reason. Some Democrats actually seem to want higher taxes just to lower the wealth of the rich.

Amanda writes:

I agree, Government is not listening to anyone who is trying to voice their concerns about their health care. Many people live on a fixed income and paying insane premiums is not an option. AARP has set up http://www.thisissoridiculous.com
so that we can sign a petition to make our voice heard. They Also make it easy to e-mail your congressman to let him know how you feel. As well as great info and videos.I'm working with AARP to support better medicare.

Randy writes:

Government "can" do whatever it wants to do with healthcare. That's the problem. Once nationalized, the government will raise the cost however high it finds necessary in order to make the system work. If what the government finds necessary is a 20% payroll tax, mandatory community service, a draft of medical personnel, draconian health responsibility ordinances, or whatever, then that is what it will do.

Chuck writes:

Randy,

The thing is, in all the other countries where governments do run health care, it is actually cheaper than here, and just as good.

Arnold,

That was the longest platitude I ever read.

Randy writes:

Maybe, Chuck... and maybe not. I've heard stories both ways. Either way, I don't trust the government. I believe they will take a 10% cut of all the money taken in and keep raising the rates over time to ensure that the system remains profitable - for them.

wafranklin writes:

[Comment removed for crude language and pending email address confirmation.--Econlib Ed.]

Randy writes:

See, that's what I'm talking about, Chuck. If healthcare is turned over to the government, people like wafranklin here will be running it. I'd say that a bit of pessimism is in order.

Fly Fisher writes:

Evidently, Arnold, your essay is easier to summarize than you think. wafranklin did it with only 414 words, and, it appears, without bothering to carefully read and consider what you wrote.

Dr. T writes:

I would like to opt out of the health insurance system, since I have adequate financial resources. But, doing this is more expensive than it should be. Over the past 30+ years, providers have been padding their list charges because insurers often paid a percentage of the charges. The aggregate of charges (usual and customary for the region) are used by the government and insurers to set payment rates.

When Joe Uninsured goes to a physician, the charge often is very high. If Joe asks for a discount for immediately paying the bill in cash, the physician must say no to avoid hassles from insurers and government. Joe Uninsured probably will have lower medical costs if he buys a high deductible policy and takes advantage of the 20-50% discounts negotiated by his insurer.

I believe we need a law allowing reasonable discounts to self-pay patients. After all, the provider is saving money by not having to file insurance claims and then bill for deductibles and uncovered charges. Without this change, most of us will be stuck with the current, inefficient health insurance system.

Punditus Maximus writes:

Isn't Vermont's system more or less single-payer? Certainly Vermont keeps showing up at the top of health lists.

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