Charles Krauthammer proposes what I suspect is very much along the lines of what the Congressional leadership will eventually do with respect to healthcare reform. It has six components:
- Forget the public option.
- Jettison any reference to end-of-life counseling.
- Soft-pedal the idea of government committees determining “best practices.”
- More generally, abandon the whole idea of Obamacare as cost-cutting.
- Make health insurance universal and permanently protected.
This would result in our paying significantly more for healthcare overall than we do now. Consistent with the United States’s previous experiments with healthcare reform, it would carefully preserve most of the worst features of our present system. These bad features aren’t, as many would have it, that people go without healthcare insurance coverage.
No, it’s the perverse incentives. There are virtually no incentives at any level for controlling costs. Unfortunately, since we already pay nearly twice as much for healthcare per capita as an other OECD country and in this form healthcare reform would do nothing to change that, that would all but certainly result in stunting the growth of every sector of the economy other than healthcare which employs fewer people per dollar spent than most other sectors of the economy do (that’s what it means when you say that pay is higher in one sector than in another). See my previous post this morning.
Sigh, the only part that should be kept in any bill is end of life counseling. Anyway, I have never thought that health care was the topic on which Obama was most interested. His primary goal was to increase coverage as far as I can tell. I think that he will settle for a modest program similar to that described. There will be no serious attempt to cut costs by either party until things get worse, which will probably come sooner than most realize.
Steve
Eh?
The uninsured aren’t the only problem, or even the main one, but saying they’re not a “bad feature” of the system is rather . . . unusual.
There are only two ways I could see costs (potentially) being controlled: the various government plans that have been described, where you get market leverage from the rate-setting, or a true free market system with no intermediaries between the buyers and producers of health care. I’m not entirely confident in the latter’s possibilities to cut costs, either – if you remember the late 1990s, costs actually stabilized for a few years due to HMOs heavily cracking down and doing cost-cutting behavior (like restricting people to certain networks, etc). That turned out to be highly unpopular, so they backed off a bit from that.
I suppose that would be a good excuse to heavily crack down on immigration. After all, if you cut off or weaken external sources of growth in the population, you’d end up with a smaller workforce over time, which would make up for the lower amount of jobs in the burgeoning health care sector (assuming you’re right about that, of course). They’d be more heavily taxed, though, to pay for the large non-working population.
@steve – exactly. Even if I thought end of life counseling was death panels, I would think real conservatives would want death panels on public medicine since people would be more likely to buy private insurance because private sector death panels are more palatable.
You are missing the major point I’ve made elsewhere. Its the cost. That’s it. If you don’t reign in the costs then the provision of universal coverage is a cruel joke. Yes you have health insurance, we just don’t have the resrouces to treat you. Yes you insurance company would likely pay us, but we don’t have the beds, the doctors or the other medical resources to treat your problem. Now, go home.
You will not solve this problem by controlling immigration. Again, its a side show. Its the costs. Really, that’s all there is to it. Problem is no politician wants to take cost cutting measures because it will make them look like they want to kill grandma.
Remember that animation of Bush pushing an old person in a wheel chair over a cliff? You think the Democrats want the Republicans doing that to them?
You’re right, Brett. It was a clumsy choice of words. What I was trying to say is that the incentives problem is a more serious problem than the insurance problem (although the insurance problem is still a problem). That’s because of causality.
If incentives were properly aligned, healthcare would be cheaper than it is now, healthcare insurance would be cheaper than it is now, more people would be insured, the problem of the hardcore uninsurable would be smaller in scope than it is now, and, consequently, more politically approachable.
It strikes me that if you add one bullet to Krauthammer’s prescription for Obama 2.0 -> converting the system from employer-based to individual-based selection of Healthcare Insurance (a la Wyden-Bennett) – you introduce an incentive to control costs. this makes it salable, and holds out at least a hope of being fiscally responsible.
I understand that pushing Wyden-Bennett is seen as tilting at windmills, but, the beasts are out there Pancho. Might as well take a run at them.