Barack Obama’s election to the presidency and larger Democratic majorities in both houses of Congress have made serious health care reform look much more likely and I presume that’s what’s spurring the increase in debate on the subject. This morning James Joyner has entered into a discussion of the subject prompted by post of Ezra Klein’s on tradeoffs in medicine. James concludes:
While extremely dubious of further nationalizing our system, I agree that a UK-style system is incredibly unlikely to emerge here and we’re much more likely to have a public-private hybrid that simply leans ever more public. I’m not philosophically opposed to the idea, since health care isn’t a pure market (there’s little elasticity of demand, for one thing) and the current system is incredibly inefficient. But I do fear disencentivizing research and the provision of cutting edge resources and the general DMV-ization of health care.
This is a subject I’ve posted on quite a bit here and I don’t think I want to recap everything I’ve written over the years here. I’ve you’ve got the inclination here are some of my more signfiicant posts on the subject:
Market Plans, Healthcare Costs, and Bureaucracies
Interesting Times for Health Care
Migration of Doctors Because of Supply and Demand?
A Short History of Medical Education in the United States
How to Create a Healthcare Cartel
The Bottom Line on Healthcare
Best Care Anywhere?
Why Do We Have Universal Education? Why Not Universal Healthcare?
10 Points on Healthcare Reform
Administrative Costs of Healthcare Systems
Optimizing the Healthcare System
How Not to Discuss Healthcare Reform
Health Care Fundamentals
Issues 2008: Health Care
If you’re even less patient, I’ll summarize my position here. Serious healthcare reform is in our future—fiscal realities make that a foregone conclusion. Anybody who believes that universal coverage will solve the problems with our healthcare system has confused partisan posturing with the facts of the case since it doesn’t do enough of itself to control costs. The American people would find a fully nationalized healthcare system very objectionable. Although I’m predisposed to be a bit of a free-marketer I believe we need to go to a system somewhat along the lines of the one in France, a hybrid system but largely a single-payer system based on payroll deductions. We can’t get anything like the reductions we need and still leave the insurance companies in the picture. They already account for 30% or more of every healthcare dollar and that’s rising. Single-payer alone isn’t enough; we need to change the work rules for healthcare delivery dramatically to increase the supply of healthcare. By dramatically I mean double or more the number of med school billets with most of those new billets going to primary care physicians, train lots more physicians’ assistants, nurses, and other technicians, and broaden the scope of action of non-MD practitioners.