Let’s look at a range of opinions about the proposed health-care reform bill. First, columnist Steven Pearlstein defends the proposal, accusing Republican critics of “lying” about the program:
There is no credible way to look at what has been proposed by the president or any congressional committee and conclude that these will result in a government takeover of the health-care system. That is a flat-out lie whose only purpose is to scare the public and stop political conversation.
Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals.
The centerpiece of all the plans is a new health insurance exchange set up by the government where individuals, small businesses and eventually larger businesses will be able to purchase insurance from private insurers at lower rates than are now generally available under rules that require insurers to offer coverage to anyone regardless of health condition. Low-income workers buying insurance through the exchange — along with their employers — would be eligible for government subsidies. While the government will take a more active role in regulating the insurance market and increase its spending for health care, that hardly amounts to the kind of government-run system that critics conjure up when they trot out that oh-so-clever line about the Department of Motor Vehicles being in charge of your colonoscopy.
OK, though I don’t understand how we will be able to purchase insurance at lower rates when the companies will not be allowed to deny coverage to anyone and will have to cover pre-existing conditions. Won’t that make insurance companies have to charge more? What I don’t understand is how the proposals will BOTH insure everyone AND lower health-care costs. Perhaps someone can explain that to me.
Here is a criticism, along with an alternative proposal, from the right. Charles Krauthhammer, a medical doctor (a psychiatrist), suggests this:
Strip away current inefficiencies before remaking one-sixth of the U.S. economy. The plan is so simple it doesn’t even have the requisite three parts. Just two: radical tort reform and radically severing the link between health insurance and employment.
(1) Tort reform: As I wrote recently, our crazy system of casino malpractice suits results in massive and random settlements that raise everyone’s insurance premiums and creates an epidemic of defensive medicine that does no medical good, yet costs a fortune.
An authoritative Massachusetts Medical Society study found that five out of six doctors admitted they order tests, procedures and referrals — amounting to about 25 percent of the total — solely as protection from lawsuits. Defensive medicine, estimates the libertarian/conservative Pacific Research Institute, wastes more than $200 billion a year. Just half that sum could provide a $5,000 health insurance grant — $20,000 for a family of four — to the uninsured poor (U.S. citizens ineligible for other government health assistance).
What to do? Abolish the entire medical-malpractice system. Create a new social pool from which people injured in medical errors or accidents can draw. The adjudication would be done by medical experts, not lay juries giving away lottery prizes at the behest of the liquid-tongued John Edwardses who pocket a third of the proceeds.
The pool would be funded by a relatively small tax on all health-insurance premiums. Socialize the risk; cut out the trial lawyers. Would that immunize doctors from carelessness or negligence? No. The penalty would be losing your medical license. There is no more serious deterrent than forfeiting a decade of intensive medical training and the livelihood that comes with it.
(2) Real health-insurance reform: Tax employer-provided health-care benefits and return the money to the employee with a government check to buy his own medical insurance, just as he buys his own car or home insurance.
There is no logical reason to get health insurance through your employer. This entire system is an accident of World War II wage and price controls. It’s economically senseless. It makes people stay in jobs they hate, decreasing labor mobility and therefore overall productivity. And it needlessly increases the anxiety of losing your job by raising the additional specter of going bankrupt through illness.
The health-care benefit exemption is the largest tax break in the entire U.S. budget, costing the government a quarter-trillion dollars annually. It hinders health-insurance security and portability as well as personal independence. If we additionally eliminated the prohibition on buying personal health insurance across state lines, that would inject new and powerful competition that would lower costs for everyone.
Krautthammer says these reforms are unlikely to happen since Democrats are in thrall to the trial lawyers and taxing benefits was John McCain’s idea that Barack Obama condemned. Michael Kinsley criticizes the proposal from the left. He is bothered that the measures will enrich the insurance companies and seems to favors a Canadian-style “single payer” system where the government just pays for everything:
Trying to stop insurance companies from behaving like insurance companies creates other perverse incentives. When people talk about “gold-plated” health care, they mean the insurance, not the care itself. There is only one level of care that everyone wants and that reform is supposed to provide: the best. But there can be differences in how much care insurance plans will pay for. You should not be surprised if people who expect to have more medical expenses are attracted to plans that pay more of your medical expenses.
If there are multiple plans (as some of the reform bills require), healthy customers will drift toward the cheaper plans and sick or potentially sick customers will drift toward expensive ones. This trend will feed on itself. The cheap plans with healthy customers will be able to get even cheaper, while expensive plans, burdened by hypochondriacs in the mood for an MRI body scan as well as with the truly sick, will get pricier. To prevent this “death spiral,” some of the reform legislation calls for a sort of tax on lucky insurers, with the money going to the unlucky ones.
If the government requires insurers to accept all customers and charge all the same price, regulates all aspects of their marketing to make sure they aren’t discriminating, and then redistributes the profits to make sure that no company gets penalized unfairly, in what sense is the industry still “private”? And as long as the forces inherent in medicine — such as your natural reluctance to haggle over price with the doctor who will be conducting your brain surgery tomorrow — haven’t disappeared, in what way will health care resemble a “free market”?
But thank goodness we won’t have socialized medicine.
Which side do you think makes the best case?
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