Talking About Health Care Reform

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

That should get you started. If you’re impatient read Market Plans, Healthcare Costs, and Bureaucracies, How to Create a Healthcare Cartel, and 10 Points on Healthcare Reform.

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.

4 comments… add one
  • Larry Link

    I was thinking about our health care problem again today, it is complex and very political like so many of our issues, but it seems to me that most of our dialog on the health care issue is about access to, types of care, admin cost, quality, etc…Most of this dialog appears to be centered on the issue of the business side and the actual administration of care…as a nation, we seem to be missing an important debate in the health care issue and that is about life and death issues..I’m not going to express this well, but shouldn’t we be having a discussion on death, end of life issues. Should we be trying to continue life at all cost no matter the cost because we can, because we have the technology to prolong a life in cases where the out come ends with poor quality of life issues and with prolonged and extremely expensive treatments that in the end only do just that, prolong life but give back little in the quality of life area…Do we have an issue with death and that we’ll do everything we can no matter what the cost even when the outcome of extending life is pretty low, negative at best.

    Are there numbers out there somewhere where medical cost are high and the outcome is minimal at best..on this issue…

    Should we also be having a dialog on dying, end of life, when would it be better to let our selves go, or let someone we love pass on rather than to spend who knows how much in medical cost to society?

    I’m not sure how or what I might do in my own case. My father is in a situation where he and I have talked some on this issue, mostly coming from him…he had a sudden and serious illness six months ago, his life was saved, with all kinds of modern medical technology and highly skilled medical professionals, but his quality of life these past months has been pretty poor at best. He will most likely pass on soon…I have seen him suffer mentally and he has expressed his wish that things had turned out differently, that he often wishes he had just past on. I can’t tell you the cost that all this, in dollars, the mental cost for the surviving family is unmeasurable…I now often think about my own end of life and what I will do when my time comes..but I do know that the cost is staggering in the dollar sense…

    As a nation we say we value life…we certainly have advanced the technical side of health care…but at what cost and for who’s benefit in some cases?


  • Tom Strong Link


    Your take on health care is the most sensible and fact-driven that I’ve seen. It really needs to get lifted into the political dialogue, and soon.

  • Brett Link

    I’m with you on this, Dave – we’re probably going to have to go to some form of single-payer combined with strong incentives for medical modernization (plus a focus on prevention) and to increase the supply of medical personnel (particularly in certain areas, like general practitioners).

    What concerns me are two things. One of the reasons why I like Canadian single-payer is because I think it fits into a federalistic political framework that is closer to the US in nature than to the heavily centralized French political system. The system is administered through the states, who negotiate fees for services with the doctors.

    But how do we incorporate that into the American model? I guess what you’d have to do is have the states give out “Universal Health Care” cards for that state (like Drivers’ Licenses now), then charge fees when somebody from out of state uses the system except for emergency care.

    I’m also concerned about what to do with the private health insurance companies. I don’t exactly have a lot of sympathy for them, but we’re probably not going to get the political will to do what the Canadians have done, where they actually ban the sale of private insurance for services covered under Canadian Medicare because they believe it allows the rich to jump ahead in line and undermines the system. In America, the real obstacle with them will probably be trying to keep them from poaching the healthiest workers with ultra-cheap bare minimum plans (although I guess it wouldn’t matter in the long-run, since those workers would still have to pay the taxes to support the health care system, and they could always go back to the public plan if necessary).

    Either way, we need to get as far away as possible from the employer-health-care model as we can. We don’t live in a world anymore where someone can expect to work at the same job for the same company for 30 years unless you’re either in one of the few remaining big union jobs, the government, or a university. The Employer Model is poorly suited for the new employment environment, and I’m sick of these bad compromises that try to keep it alive on life support.

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