August 28, 2009
Weekend Health Insurance Reading

If you want to understand our health cost problems, you should read this Atlantic article by David Goldhill.

Here's the heart of his argument:

I'm a Democrat, and have long been concerned about America's lack of a health safety net.  But based on my own work experience, I also believe that unless we fix the problems at the foundation of our health system—largely problems of incentives—our reforms won't do much good, and may do harm.  To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy.  We will need to reduce, rather than expand, the role of insurance; focus the government's role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.

As I mentioned in this post, I have made similar arguments over the years, but I have never put them together in one big post.

By the way, you don't have to take just my word that this article is worth reading.  On today's Gang of Four show, David Horsey recommended the article and said, though not in these words, that it had made him rethink his support for the current Democratic health insurance "reform" proposals.

Because the article is so long, and because I want you to think about it, I'm going to close the comments over the weekend.  On Monday, I will either open up the post, or put up a brand new post just for comments on the article.  (Later next week, I will put up a guest post by a person who favors the current Democratic proposals.)

Posted by Jim Miller at August 28, 2009 11:49 AM | Email This
Comments
1. I think the article has some very good points on where our health care should be at!!

1. The customers (us) can drive the cost if they are responsible for paying their primary care

2. The customers would have a special post tax savings account for primary care that once it had the basic saving in it could also be used for other purposes.

3. Health insurance would be for catastrophic problems.

We would not have an unworkable 'single payer' system.

Posted by: Tim on August 31, 2009 09:00 AM
2. Thanks for pointing out that great article.

I see now that health-care has not been a "free market" in the way we usually think about markets. Imagine if a grocery store negotiated different prices for bread based on customers' ability to pay (uninsured versus insured) and that they were required by law to give bread to those who couldn't afford anything, and that their biggest customer (Uncle Sam) basically dictated a low-ball price he was going to pay! Who could accurately pinpoint the "market value" of a loaf of bread under such conditions? Who could blame the grocer for overcharging other paying customers in order to stay in business?

What profit margin is reasonable for health care? And how does that compare to aerospace, software, oil, or other business sectors?

I don't know all the answers. Nor do I necessarily agree with the author on every point. But it has given me a lot to think about.

Posted by: Doug King on August 31, 2009 09:04 PM
3. Obamacare is bad.

We need ROMNEYCARE.

Cap and Trade is bad.

Uh, sorry I mean cap and trade is GOOD.

Forgive me it is so hard to keep up when as a Movement Republican my core values must change suddenly all the time without notice.

Posted by: Beth on September 1, 2009 09:11 AM
4. This is the point I try to make with my liberal friends. The "System" that is broken is not the actual part that heals the patient. It's the part that pays the doctor. Most doctors have to have a high staff to physician ratio just to do the paperwork. Add on high insurance rates to protect against lawsuits and it gets expensive. Less involvement by third parties is what is needed. Medical savings accounts would do that. Get the deal making back to a "buyer/seller" relationship and watch the costs shrink. Just like you drive past the high priced gas station, you can do the same with doctors. Whether it's his price or his patient load or maybe you just don't like him. When the customer exercises his choice, costs go down.

Posted by: scott on September 3, 2009 01:59 PM
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