I’ve been delayed this morning by debating with a commenter in a comments thread at WSJ. The commenter believes that Medicare and Medicaid should be abolished and a free market be established for healthcare in the U. S.
Whatever your political or economic views, you should understand there is no prospect whatever for that happening. It’s politically impossible for one thing. It could not get enough votes.
We have not had a free market healthcare system in the U. S. for 120 years and maybe not even then. Government at all levels is so embedded into healthcare that if federal support were withdrawn the entire system would collapse.
I recognize that such realities trigger anarcho-capitalists but that is the nature of the world in which we live.
That is not to say that our present system is beyond reform. It is in serious and substantial need of reform but the reform will need to be from within the system and gradual rather than radical. I believe it will reform because events will force it to reform. It’s like Winston Chruchill’s wisecrack: “The Americans can always be trusted to do the right thing, once all other possibilities have been exhausted.”
FWIW, Hammurabi in his Code, set fees for medical services and punishments for malpractice. Then there’s the convents that long provided medical care subsidized by the local nobles and Crown, the City/County poor house, government owned asylums for the tubercular, lepers, hospitals, clinics etc. Btw, read your state constitution. many specify the county as being responsible for the care of the ailing poor. Medicine and government have been long tied together.
Setting aside the political impossibility of ending it, Medicaid is really just a flat out part of the social safety net. It needs reform, but it must exist.
Medicare is a much more Rube Goldberg contraption consisting of payroll taxes, private insurance augmentation, ABCD options and so forth. I wonder if this individual you cite is really just trying to convey that free market aspects might rectify some of these issues.
The fund will be insolvent soon; it needs something.
Well, if words have meaning, “abolish” kind of ends that notion.
“My view is….”
I’m not sure there is any other viable approach at this point. It retains the realities of a social safety net need, and recognition of the irresponsibility of some to not provide throughout life for their elderly care needs. Yet, it puts a throttle on things. Without that throttle costs will run wild. But it will be a political nightmare.
I am not opposed to trying to increase the use of markets in medicine but we have no models anywhere in the world where markets have been used successfully to contain costs. There is a pretty strong correlation between the larger the size of the private sector and the higher the costs of medical care in countries around the world. Doesnt mean it cant work but it does mean no one has figured it out.
Steve