Why markets can’t cure healthcare
Judging both from comments on this blog and from some of my mail, a significant number of Americans believe that the answer to our health care problems — indeed, the only answer — is to rely on the free market. Quite a few seem to believe that this view reflects the lessons of economic theory.
Not so. One of the most influential economic papers of the postwar era was Kenneth Arrow’s Uncertainty and the welfare economics of health care, which demonstrated — decisively, I and many others believe — that health care can’t be marketed like bread or TVs. Let me offer my own version of Arrow’s argument.
There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.
This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.
This problem is made worse by the fact that actually paying for your health care is a loss from an insurers’ point of view — they actually refer to it as “medical costs.” This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care. Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems. And since there’s a widespread sense that our fellow citizens should get the care we need — not everyone agrees, but most do — this means that private insurance basically spends a lot of money on socially destructive activities.
The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. (”I hear they’ve got a real deal on stents over at St. Mary’s!”) That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.
You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don’t trust them — they’re profit-making institutions, and your treatment is their cost.
Between those two factors, health care just doesn’t work as a standard market story.
All of this doesn’t necessarily mean that socialized medicine, or even single-payer, is the only way to go. There are a number of successful health-care systems, at least as measured by pretty good care much cheaper than here, and they are quite different from each other. There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence.
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Under Wyden's plan, employers would no longer provide health coverage, as they have since World War II. Instead, they'd convert the current cost of coverage into additional salary for employees. Individuals would use this money to buy insurance, which they would be required to have. Private insurance plans would compete on features and price but would have to offer benefits at least equivalent to the Blue Cross "standard" option. Signing up for insurance would be as easy as ticking off a box on your tax return. In most cases, insurance premiums would be withheld from paychecks, as they are now.
Under questioning by members of the Senate Budget Committee, CBO director Douglas Elmendorf said bills crafted by House leaders and the Senate health committee do not propose "the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."What sort of 'fundamental changes' could he be talking about? The only thing I can think of is smashing the health care industry into oblivion and going to a single-payer system.
But to say out loud, as the House has just done, that those in our society who can most readily afford it should pay for the health insurance of those who cannot is, well, audacious.And to say that small business gets hurt by this
There's another word for it: fair.
But there's no reason to suppose that taking a tiny sliver of the incomes of the top 1 percent will reduce all that much of their ardor to invest, innovate, and hire in the future. Yet if this tiny sliver means affordable health care for a far larger number of Americans, who will be able to get regular checkups and thereby stay healthy and productive, the positive effect on the American economy is likely to be far greater.
Don't believe critics who say the surtax will harm small business. According to the Center for Tax Justice, it would hit only five percent of small business owners...The only problem I have with the legislation is that it keeps the current health care system intact, just adding more people to our current system. This doesn't do much to address the rising costs. Rising costs will require more tax, and then you've got a big problem. I am all for taxing the rich on this. They've had it really great the lat 10 years, and it's time for them to say 'Thanks'. But to not smash up the health care industry is going to be disasterous.
Besides, only the profits of a small business would be taxed.
A Congressional Budget Office analysis of the public plan provisions in the bill from the Senate committee on Health, Education, Labor and Pensions (HELP) projected that they would neither increase the total number of people insured nor substantially affect costs, “largely because the public plan would pay providers of health care at rates comparable to privately negotiated rates.”The problem is similar to the Medicare Plan D, if you don't allow the government to negotiate rates, then the only winner is the health care industry. This is why I am such a fan of Single Payer. The winner becomes the people footing the bill, the taxpayer.
