The first thing that jumped out at me when I read today’s editorial in the Washington Post on healthcare reform was this:
For liberals, labor unions and others pushing to make health care available to all Americans, however, the fixation on a public plan is bizarre and counterproductive. Their position elevates the public plan way out of proportion to its importance in fixing health care. It is entirely possible to imagine effective health-care reform — changes that would expand coverage and help control costs — without a public option.
There is not a single chance that any healthcare reform plan I’ve heard discussed will “make health care available to all Americans”. Subsidizing the health insurance of those who can’t afford it won’t do that. It won’t put a single additional doctor, physicians assistant, nurse, or other practitioner into rural areas or other places in the country that are underserved. In these places there isn’t access to health care simply because there isn’t enough health care to be had.
Since the supply of health care in the United States does not respond to increased spending, giving more people access to health care in the sense that we’re subsidizing more people’s health insurance will primarily induce increased rationing.
It’s an enormous help in solving a problem if you identify what it is that you’re trying to accomplish before you start looking for solutions. I think it’s pretty clear we have a problem with our healthcare system. We need a heckuva lot more agreement on what the problems are before we start proposing solutions.
Update
This morning the New York Times has an article on how the shortage of physicians is proving an “obstacle to Obama goals”, which I find a rather peculiar diction:
WASHINGTON — Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.
The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.
One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.
Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.
I doubt that will be enough. Another alternative would be to restrict the stipends provided by the Medicare system to medical residents so that more money was provided to those in specialties more likely to be primary care providers, e.g. family practice, rather than those who aren’t, e.g. cardiac surgeons, oncologists.
I continue to believe that the real, necessary, and painful change that required is a change to the way that healthcare services are delivered that’s a lot more basic than this.
Some of that is inevitable, simply because rural areas just can’t offer the incentives on their own to attract doctors who can get more patients and money in the cities. That’s, to the best of my knowledge, the case in most countries, universal health care or not.
It depends on what type of rationing, though. The Canadian system, for example, has longer waiting lines for a number of services where the problem isn’t “urgent”, but the idea is basically that everybody can use it, even if the most medically urgent cases get first priority (that’s why they largely ban private insurance coverage of the same things covered by Canadian Medicare). That’s the theory, at least.
Right now, you’ve got rationing by price, which means that a large number of people get decent coverage via employers, a small number of people get really good coverage and access, a large number get substandard access that leaves them bankrupt if they get really sick with an expensive illness (particularly a chronic one), and a number of uninsured, which we try to patch over with public programs. Is that better?
I wonder if you could shift some of duties on to nurses or even some new type of general practitioner in below doctors, some group with less rigorous and lengthy training requirements, assuming this is the case.