Malcolm Gladwell delivers a lengthy polemic. He favors some form of national health insurance, but is this the correct conclusion? A few observations:
1. He is correct that "too much insurance" is not the problem. Health savings accounts are not the answer.
2. Many of the current uninsured are linked to immigration, or voluntarily uninsured. This is not pure institutional failure.
3. Gladwell downplays moral hazard, arguing that the fully insured wealthy do not forgo their golf games for superfluous doctor visits. But the real problem comes from the other side: doctors overbill or perform unnecessary procedures.
4. The U.S. health care system probably is the world’s best for some class of people, namely the well-off and I don’t mean just the super-rich. Trying to extend those benefits — however this might be accomplished — is a better approach than nationalizing the sector.
5. Much of our excess spending is to make people feel they have done everything they can for themselves or their relatives. It is partly voluntary in nature. Socialized systems don’t allow many of these options to reach the menu in the first place. We need to think long and hard about the right answer here; it is not useful to simply call these expenditures wasteful.
6. The whole debate is emphatically not about "a few simple questions," as Gladwell suggests at the end.
7. No one has a good plan for socializing American medical care or insurance.
8. Much European health comes from diet, walking, and tighter social networks of friends. Don’t expect European healthcare policies to produce the same level of well-being in the United States.
Thanks to Mark LaRochelle for the pointer.