Wednesday, August 26, 2009

Health Choice

Great article in yesterday;s New York Times about how choice is off the table in various health care proposals. One of the major ideas in the piece is the idea of health vouchers, where individuals could act as consumers directly purchasing insurance in a regulated market. It's not exactly the free market, but it would be a huge step in the right direction. And amazingly enough, a vast majority of the commenters in the the heavily liberal New York Times comment section were rather receptive to the proposals outlined in the article.

Of course, there are still those whose desire for single-payer care and fear of the market outweighs any semblance of logic and reason. This one commenter expresses the only real opposition to the idea of health vouchers: that individuals will be too stupid to make their own decisions about their health care dollars.

Concentration on "choice" is the wrong way to go. It is virtually impossible for most people to predict what plan will best serve them in the future, since their health is usually not predictable. What we must do if costs are to be reined in and service improved is to have everyone in the same pool; i.e., a single payer system. If we as a nation are unable to devise a way to go to such a plan in a time scale of 3 to 5 years, that shows just how ineffective our democracy has become. We need a change we can believe in!

Maybe there's some hope yet for real reform with choice in mind. The only opposition is nonsensical slogans and the notion that we can't make choices for ourselves.


Anonymous rose said...

I don't think the Obama administration would have much trouble at all winning public support if they threw their weight behind these kinds of ideas.

But they've hammered into the American people that insurance companies, big pharma, profits and other special interests (in short, all the market players) are the problem.

You can't then turn around and propose a market solution that acknowledges that government controls were part of the problem. It's like the article says, choice is off the table and is has to be because it's so contradictory to what they've been saying is the problem.

The part that baffles me is the absence of tort reform. I understand that trial lawyers donated a lot of money, but what's stopping Obama from screwing them over? He'd get bi-partisan support and be doing something that could bring down costs in his first term (right?). Isn't that a tradeoff worth making?

4:47 PM  
Blogger lonely libertarian said...

One of the comments I didn't link to was from a doctor who was similarly opposed to the idea of vouchers. This doctor had plenty of ideas, including taking it too "big phrama," but not one of his ideas involved cutting doctor pay to reduce health care costs or perhaps capping doctor salaries.

The problem is, doctors are another special interest, just like the plaintiff's lawyers who oppose tort reform. People decry special interests, but special interests always mean someone other than yourself.

The other thing I sort of forgot to mention is what this deep deeded opposition to choice is all about. I think we're so far removed from a health care system where people have real choices that most people can't grasp what choice really means. Single-payer sounds good because a potentially benevolent government sounds so much better than a money grubbing insurance company. And it's hard to argue on such a basic level. And I think people just plain forget that monetary decisions need to be made at every step of the health care process.

Some folks scoff at "the magic of the market," but this is exactly what markets are for- for competition between individuals looking for the best goods and services for the best deal and between other organizations looking to provide those goods and services. A functioning market helps sets prices which helps us determine value.

10:14 AM  
Anonymous rose said...

Yep, but our president clearly is one of those with a deep distrust of the market.

Remember his red pill, blue pill crap? A generic is 50% less expensive than a brand name drug etc. A non-leftist would realize that if more costs were borne out of pocket, brand name drug sales and prices would plummet. What is the markup on Advil versus Stop n Shop Ibuprofren? 10%? What is the markup on brand name drugs primarily purchased through a third party payer? A lot higher.

The structural problem then is 3rd party payment.

Yet the red/blue pill example was used by the prez to argue for the exact opposite.

And then of course, followed up by the obligatory demonization of doctors who chop of kids tonsils for the fun of it. Followed up by the demonization of insurance companies. Followed by demonzation of pharma, until pharma got a sweet heart deal and rolled.

It's amazing to me that Obama is considered to be a deep thinker by the mass media. These ideas and tactics are certainly not original.

2:55 PM  

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