Arnold called for a real health care debate between him and Daniel Callahan and quoted from his book. Actually, some of that debate has already happened in my review of Callahan's book. Here's what I wrote on one of the issues Arnold addressed, namely his judgment about which procedures should be covered. After quoting Callahan, I wrote:
On some of these coverages, Callahan is right for the wrong reason. He seems to make it a moral issue: some things "should be" covered and others "should not be." But really, what is wrong with insurers covering these things if people are willing to pay for them with non-tax advantaged dollars? I predict that some of these coverages would go away if the government did not give preferential treatment, under the U.S. tax code, to employer-provided health insurance and if governments did not require coverages such as mental health. But because Callahan seems unwilling to take yes for an answer, he never draws on his allies in the health economics literature whose analyses would buttress some of his point.
One thing that doesn't come across in Arnold's post is just how extreme Callahan is in his willingness to prevent old people from using their own money to pay for their own health care. If you want to see just how extreme, check out my review or at least this graf:
That leads to Callahan's third option, which he seems to favor. He would have the health care system emphasize "health promotion and disease prevention" (he calls this "the carrot") and have "fewer expensive technologies with tougher eligibility standards for their use" (he calls this "the stick"). The problem here, he writes, is that we "will continue to find clever technological ways to keep people alive when they finally get
sick." Oh, the horror! Solving this "problem" without rationing,he writes, "can best
be done by not having the technology readily available in the first place." How would
he enforce this? A few pages later he advocates forbidding certain "marginal" benefits,
which he admits could be life-saving, to be covered -- not only by Medicare, but
also by private insurance. Again, to prevent private insurance from covering these benefits would require coercion.