Cui Bono?

Not only does a proposal’s making objective sense not particularly make the proposal more likely to be adopted, it’s practically a guarantee it will not gain much support. That was my reaction to William Hazeltine’s Fiscal Times op-ed on healthcare reform for the United States, based on Singapore’s model:

Singapore teaches us that patients must understand that health services cost money and that they should pay a portion of those costs. It teaches us that hospital and doctor incentives must encourage them to provide the best service at the best price. Government can create a framework of rules that does that. And it does not have to be a cold-hearted solution. The framework must also assure that people have the ability to pay, and it must provide a safety net for those who cannot. Lastly, all health costs and outcomes should be transparent to the patient and the payer.

Who would support such a plan? Not healthcare providers. The sad reality is that any healthcare reform plan that actually reduces costs necessarily means that providers get less money.

Certainly not the elderly. Higher co-pays, even for the wealthiest elderly, will be fought tooth and nail if only on a slippery slope basis.

Not most Americans with employer-supported healthcare. For most Americans, employer-supported healthcare comprises a hefty and rising proportion of their total compensation. Making them pay more or receive less necessarily means demanding that they take a pay cut.

A lot of the increase in costs in healthcare are necessary to support healthcare’s growing bureaucracy. Anyone who owes his or her job to inefficiency isn’t likely to demand its end. And, as I’ve mentioned before, bureaucracies do not scale linearly. The medical bureaucracy for a country of 300 million won’t just be 60 times larger than one for a country of 5 million souls. It will be closer to 100 times the size or larger. That’s a lot of inefficiency.

I guess the bottom line is that it’s a lot easier to implement a sensible plan in a relatively small, authoritarian polity than it is in a large boobocracy.

7 comments… add one
  • sam

    “I guess the bottom line is that it’s a lot easier to implement a sensible plan in a relatively small, authoritarian polity than it is in a large boobocracy.”

    Jeepers. The Republic in a nutshell.

  • Sam

    As the insurance gets more and more expensive, I’m seeing this shift to higher co-pays anyway, at least with my employers. This would likely happen on the individual market as well – eventually the math just doesn’t make sense (pay an extra 5k in premiums, vs. just a chance to have to pay 5k). Medicare, well, the only hope there is probably significant immigration.

  • Sam

    Another data point:
    My company offers two plans: one with higher deductibles and higher copays, and one with higher premiums, lower deductibles and lower copays. Not one employee took the second option. In general we’re not a young company, but I think there are offsetting factors (more money to cover potential large expenses, but less healthy than a younger company might be)

  • Comrade Icepick

    Speaking of bad proposals, turns out even the CBO thinks the “immigration” “reform” bill is going to hose American workers.

    But what the Hell, we all know that all the pols and everyone that voted fro Obama hates American workers more than anything else in the world.

  • Remember that the CBO works at the pleasure of Congress. If a Congressman asks them “show how more immigration will help us economically”, that’s what they’ll do. In other words, the CBO report is sugar-coating it.

  • jan

    Will Obamacare hurt jobs? It’s already happening says one poll.

    Steven Friedman, a lawyer specializing in employment law at the firm of Littler Mendelson, commissioned Gallup to do this poll. He was quoted as being “startled” by it’s results:

    Forty-one percent of the businesses surveyed have frozen hiring because of the health-care law known as Obamacare. And almost one-fifth—19 percent— answered “yes” when asked if they had “reduced the number of employees you have in your business as a specific result of the Affordable Care Act.”
    The poll was taken by 603 owners whose businesses have under $20 million in annual sales.

    Another 38 percent of the small business owners said they “have pulled back on their plans to grow their business” because of Obamacare.

    If at all possible people just don’t fall into line with what they see as governmental unfairness or strong-arming their rights. For instance, In Brazil a 10 cent bus fare increase was the straw that apparently broke the people’s willingness to go-along-to-get-along with other simmering fiscal disagreements they had with their government. The same happened in Turkey over the intrusion of government in taking over a park, underlining their discontent with government leaning on other aspects of their lifestyle. Over here, dealing with healthcare, there will also be repudiating circumvention by the people, when at all possible. For instance there is already a creeping alternative, in bypassing medical insurance noted in an increase of cash-only doctors, now accounting for 6% of family physicians, as compared to 4% in 2012..

    As an aside, I think Jim Comey is one of Obama’s best appointments so far, as FBI Director. He seems independent and, importantly, apolitical.

  • Comrade Icepick

    In other words, the CBO report is sugar-coating it.

    I thought that was understood.

    The amazing thing is that Congress and the President can act so blatantly to crush average Americans with no consequences whatsoever. (The NYTs seems to be making the case that Obama is much more involved than has been otherwise revealed.) Seriously, how can these people actively work to ruin employment and wage prospects for Americans like this and get away with it? (Rhetorical question, doesn’t need answering.)

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