Remember the health care debates of the 1990s? Defenders of the status quo, or more market-oriented versions thereof, placed their hopes in HMOs and managed care. Managed care did show promise in lowering costs, but few people liked the idea that mainstream institutions would simply say "no" to patients.
Democrats pushed a plan for national health insurance, based on a Hillary-led modification of the German health care system. Health insurance would be detached from specific jobs, reorganized into regional cooperatives, and new taxes would finance universal or near-universal coverage. For all its flaws and complications (and no, I do not support the idea), this idea still makes more sense for the American context than do the single-payer plans. They put all those smart Democrats in a room way back when, and there is a reason why they came up with this. It not only had some chance of passing, but compared to the single payer model it was more consistent with America’s decentralized, federalistic, corporate interest-heavy ways of running government.
Sadly, current debates on health care have yet to reattain their status in the 1990s. I know full well why both ideas failed and lost popularity. But still, if we wish to debate health care today, we probably should be taking two steps backward.
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Maybe your contention is one of those “we never had true socialism” lines, but hasn’t the HMO, “more-market oriented” line been an abject failure?
Most health care plans that have been seriously proposed of late–see Massachusetts, the Wyden initiative, the John Edwards campaign–don’t sound worse to me than Clinton’s plan, although they are certainly not without problems. I do not think single payer is much more likely to be enacted than it was in the 90s, if that is the concern.
The “single-payer health care” idea just needs snappier marketing, like “HMOs and the DMV: Together at Last!”
How well does “voucher HMO” fly, as a market-hybrid? Does any country do that? Or does modeling suggest any level of success? (lazy web)
” would rather have the limitations be the result of a societal decision than a profit-making decision. But, I may be crazy.”
First: false dichotomy
Second: Yes, you are.
Allan — It’s very likely that the profit-making decision would be more “societal” than one made by government. The government decision would be made by a bureaucrat following rules established partly by Congress and largely by agency fiat (subject to non-binding public comment). Feedback from society regarding the bureaucrat’s performance and the efficacy of the rules would be indirectly felt at best and greatly dulled by the various layers coming between the agency and the voters. By contrast, the profit-making decision would be made by a private bureaucrat whose employer will feel it directly in the pocketbook whenever a customer decides (as he is free to do) to take his business elsewhere. The profit-making decider will therefore be *more* sensitive to what “society” (its customers and potential customers) wants.
How can we really say the U.S. system is “private” or “free market” health care? You have a handful of government-approved insurance providers, with the largest provider being SS, a system that is pretty much micromanaged by state and federal governments, and where the government per-capita spends more on health care than countries like Canada.
Isn’t it more fair to say that the debate is between non-monopoly socialized medicine (as practiced in the U.S.), vs. monopoly socialized medicine (as practiced in say Canada)? If you call the U.S. system a “free market” system, you can call pretty much anything a free market system.
To end the post. So long as we view health care as an essential right, I do not think there is any advantage that a private system would have over a government system.
“In a free market, the improvements are assumed to occur because the customers have freedom of choice to change vendors if they aren’t satisfied. In the health care/insurance industry, this tends to not be true.”
Scott — I don’t know what your basis is for asserting that it “tends to not be true.” However, even assuming that it is true, how can we conclude from the current system what improvements would occur in a truly patient-driven system? Currently, tax incentives (primarily, the exclusion of health benefits from taxable income) cause the customer to be, in most instances, the patient’s employer, which chooses what coverage the patient will get. The service providers don’t really answer to the patients, since the patients aren’t paying them more than a tiny fraction of what the employer’s insurer pays. Insurers likewise respond to their customers, the employers, rather than to the patient.
If we switched to a system in which health benefits were taxable compensation (i.e., a nearly 1-to-1 trade-off with salary), and where high-deductible insurance was the norm for all but the very poor (who would get government-subsidized care), then the incentives pushing service providers to innovate would change drastically, for the better. (This is Arnold Kling’s proposal, BTW. See his short, excellent book “Crisis of Abundance.”)
I think we should run our health care system like they do in Sweden. Over there the goverment pays for everyones health coverage. This way everyone from the rich to the poor could get equal coverage. Yes this would increase taxes but if you ask me it would be worth it. But if everyone had equal health coverage it would increase the waiting time at health care facilities. But if “all men were created equal” we should all have the same oppurtunity for equal health coverage.
Private sector does not enjoy any liberties and benefits as compared to the govt sector.
Money spent on health care will not directly go in the favour of individuals as long as the bureaucrats will not understand what is good for people nad not them.
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well health care policy is a good idea if enforced in a regular and truth daring fashion.
hi great article …would love to read more about it..keep up the good work.
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